September: Arthritis
Over 6 million Canadians have some form of arthritis. In fact, it’s one of the leading causes of long-term disability in Canada today. Appropriate treatment, as well as learning how to manage this chronic condition, can go a long way to help. Find out about the differences between the most common forms of arthritis and what you can do to help manage the symptoms.
Arthritis: a term for many disorders
Arthritis is a general term for several chronic and painful joint disorders. It affects people in different ways, depending on the type. The two most common forms are rheumatoid arthritis and osteoarthritis.
Rheumatoid arthritis (RA) affects about 1% of the population. People of any age can get it, but the condition most often strikes around the age of 40 to 50, affecting women 3 times as often as men. Rheumatoid arthritis is considered to be an autoimmune disorder because the body attacks its own joints, starting with the tissues that line and cushion them. This causes inflammation and, eventually, tissue damage and scarring as the cartilage, bone, and ligaments slowly erode.
This type of arthritis usually starts in the small joints of the hands and feet, then moves into other joints like the elbow, knees, shoulders, or hips. As the joints become inflamed, scar-like tissue forms, resulting in joint stiffness. As arthritis progresses, joints, especially those of the fingers and toes, may become bent and distorted.
Some of the symptoms of rheumatoid arthritis include:
- fatigue
- joint pain
- joint swelling, usually affecting the same areas on both sides of the body
- low-grade fever
- morning joint stiffness lasting at least one hour
- round, painless nodules (bumps) under the skin
- weight loss
Osteoarthritis is what usually comes to mind when we hear “arthritis,” as it’s the most common form. It has been called degenerative arthritis because it was thought to be the result of years of wear and tear, excess weight, or prior injuries to the joint. However, there is also an imbalance of cartilage breakdown and repair, resulting in joint pain. Unlike rheumatoid arthritis, in which swelling occurs and scar tissue forms, osteoarthritis affects the cartilage (the cushioning that acts as shock absorbers in the joint), resulting in pain as the bones rub against each other.
In the past, it was believed that an average amount of exercise could cause osteoarthritis. New research has shown that normal amounts of exercise are good for your joints. Talk to your doctor about how much exercise you should be getting and which types are best for you.
Osteoarthritis generally appears in both men and women. Before the age of 45 it is more common in men but after age 45, more women than men develop it. The risk of developing osteoarthritis increases as you age.
Osteoarthritis generally affects the hands, knees, hips, and feet. It may show up in the spine as well.
Some of the symptoms of osteoarthritis include:
- bumps or swelling of the fingers
- deep joint pain
- grating or cracking sounds from joint movement
- joint stiffness lasting less than 30 minutes, especially after resting or in the morning
Other, less common types of arthritis include:
- psoriatic arthritis, which affects people who have psoriasis
- gout, which generally occurs in men, resulting from a build-up of uric acid around certain joints, particularly the big toe
Don’t let arthritis keep you down
Living with arthritis means learning how to manage the symptoms and maximize mobility, and, for some types of arthritis, slowing down the progression of the disease with medications.
First, see your doctor if you haven’t already. Pain relievers and anti-inflammatory medications can make it easier for you to move around and can relieve joint stiffness. It’s important not to get discouraged if the medications don’t seem to be working right away, since some medications may take several weeks to reach their full effect. What helps one person may not help another; you may need to try different medications at various dosages before you find adequate relief.
It’s understandable to feel frustrated or down when you can’t do things you once could – whether it’s taking long hikes in the woods or doing fine needlework. But to stay healthy in body, mind and spirit, we need to adapt. Take shorter routes if you used to enjoy long walks, or take part in a “mall walk” sponsored by your local shopping centre. If it’s getting too difficult to do your favourite hobby, maybe you can learn a similar one that puts less stress on your joints, or use adaptive aids to help you continue doing the one you love. Occupational therapists are a great resource for handy devices that might make it easier for you to continue enjoying your activities.
It’s important to exercise! Exercise helps arthritis by improving joint movement and strengthening the muscles that surround the joints. Swimming and walking are great exercises with low impact on the joints when done in moderation. This will keep your muscles active without increasing inflammation or joint pain. Swimming is particularly good since the water helps support the weight of your body, taking the strain off of the joints. Call your local community centre to see what special exercise activities they have to offer. Check with your doctor or physiotherapist before starting a new exercise program.
Staying active, physically and mentally, is important to maintain good health. For example, participating regularly in swimming and exercise programs can help you get out of the house and maintain social contacts. Ask your doctor or physiotherapist for ideas.
Easing the discomfort
Arthritis is usually a chronic condition that needs long-term treatment. Some people do go into remission – meaning they’ll be pain-free for a while. However, if you are experiencing pain, it needs to be addressed. Fortunately, there are medications that can help.
For rheumatoid arthritis, doctors often recommend medications such as:
- nonsteroidal anti-inflammatories (NSAIDs – e.g., ASA, ibuprofen, naproxen)
- disease-modifying anti-rheumatic drugs (DMARDs – e.g., hydroxychloroquine, oral and injectable gold, sulfasalazine, d-penicillamine, methotrexate)
- biologics (e.g., adalimumab, anarinka, etanercept, infliximab)
- corticosteroids (e.g., prednisone)
These medications can help with the symptoms of rheumatoid arthritis, including pain and inflammation. The NSAIDs and corticosteroids work to manage the symptoms and relieve inflammation, while the DMARDs and biologics reduce the signs and symptoms and help slow the progression of the disease.
As with all medications, there are side effects associated with the treatments for rheumatoid arthritis. Depending on your medical history, some of the medications may not be suitable for you. It is important to check with your doctor or pharmacist about what side effects to watch for and what you can do to manage them. As for any medication, ask your doctor or pharmacist about possible side effects and what you can do to prevent or minimize them.
Besides medications, physical therapy might be recommended to keep your joints as flexible and strong as possible.
To treat osteoarthritis, doctors take a slightly different approach because the pain doesn’t have the same cause as in rheumatoid arthritis. Medications with anti-inflammatory effects (such as NSAIDs and corticosteroids) are used, but in many cases the pain can be managed with acetaminophen, which isn’t an anti-inflammatory. As well, steroid injections directly into the painful joints might be helpful.
Other therapies include the natural health products glucosamine and chondroitin. These take a while to work, often up to 6 weeks, and may not be appropriate for certain people (for example, those with diabetes).
Other non-pharmaceutical approaches include physical therapy, wearing braces that stabilize the joint, and preventing movement. Also, losing weight can help relieve stress on weight-bearing joints such as the hips and knees. In more severe cases, surgery might be necessary.
Kids get arthritis too
Juvenile arthritis affects more than 3 in 1,000 Canadian children under 16 years old. A child is generally diagnosed with juvenile arthritis if the signs and symptoms of arthritis (swelling, redness, stiffness, and warmth in the joints) last more than 6 weeks. Some children don’t feel any pain, but instead experience a very limited range of motion in their joints as they become stiffer – it may vary quite a bit for each child. Although this type of arthritis can affect any joint, it mainly appears in knees, feet, and hands.
There are 3 main types of juvenile arthritis: oligoarticular, polyarticular, and systemic.
The most common type is oligoarticular arthritis, formerly known as pauciarticular arthritis, which affects 4 or fewer joints. About 40% to 50% of children with juvenile arthritis have this type, affecting the larger joints (like knees), as well as ankles, wrists, and elbows. It’s more common in girls than boys. Inflammatory eye problems can also develop.
Polyarticular arthritis is the next most common type, affecting about 30% of children with juvenile arthritis. It’s a more severe type than pauciarticular, involving 5 or more joints, usually both the smaller ones (such as hands and feet) and larger ones (such as knees and hips).
About 10% to 20% of children have the last type, systemic arthritis. It affects boys and girls equally. In addition to the typical arthritis symptoms, it also causes fever and rash, and may affect internal organs like the liver and heart.
Other types of juvenile arthritis include adult-type rheumatoid arthritis, psoriatic arthritis, and spondyloarthropathy. In children with psoriatic arthritis, it is common for the arthritis to develop before any sign of the psoriasis skin disease. Spondyloarthropathy is seen in children over the age of 10. This type of arthritis is more common in boys and usually affects the hips.
When doctors treat children with juvenile arthritis, their main concern is to keep them active and moving, so that they’re able to get the most out of life. Some of the same medications used for rheumatoid arthritis in adults may be recommended. Physiotherapy also plays an important role in keeping the joints as limber as possible.
With proper education, social support, and medication management, children and adults alike can manage arthritis to get the best out of life.
Ask Your Pharmacist
Question: What can I do to manage my arthritis?
Answer: You play an important role in helping to manage arthritis or any chronic condition. For arthritis, proper treatment and self-management can help decrease its impact on your daily life and reduce joint damage.
To help improve your joint health, Pharmacists can provide advice about lifestyle changes you can make to maintain a healthy weight and increase your physical activity. For instance, limit the amount of stress you put on your joints. Losing as little as 10 pounds can help reduce symptoms. Adding regular physical activity to your daily routine can help keep your muscles strong, which in turn helps protect your joints. To reduce your chances of getting injured, be sure to stretch and warm up properly before starting any activity. If you are considering starting a program more intensive than walking or if you have any medical conditions, talk with your healthcare provider to find out if this program is right for you. Your pharmacist can also review your prescription and non-prescription medications, recommend pain relief products and discuss other therapy options to help you manage your arthritis.
Do you have more questions? Speak with your Pharmasave pharmacist.
Health Tip
Track your progress and set goals for your arthritis treatment. This will help you know if the medications you are taking or the lifestyle changes you have made are working. Following the progress of how well your arthritis medication controls your pain will help to improve your level of comfort. However, if you are experiencing any side effects, your Pharmasave pharmacist can help you track and manage these. By managing your pain, you will be able to achieve goals like staying physically active and maintaining a healthy weight.
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