Living with arthritis – managing pain and removing barriers

Posted: 19/05/2017

Arthritis Care Awareness Week takes place this year between 14 and 21 May. The event has been established to raise awareness about arthritis and gather support for people with the condition.

There are a variety of types of arthritis and they can affect sufferers in different ways, but the common theme is painful inflammation and stiffness of joints. Arthritis is the common biggest cause of disability in the UK, and around 20% of the population are thought to suffer from arthritis or related conditions. Amongst the over 50s that increases to over a third. However, any damage to a joint can lead to arthritis and in younger people, frequently sports related injuries and autoimmune diseases can cause arthritis.

There are in fact over 100 different forms in total, but the most common types are osteoarthritis, rheumatoid arthritis, and psoriatic arthritis, fibromyalgia and gout. The mechanism of pain is different in each case.

• Osteoarthritis is an erosion of the protective cartilage within the joint. As the cartilage disappears, ultimately bone can start to rub on bone causing inflammation.
• Rheumatoid arthritis, psoriatic arthritis and lupus are where the body’s immune system starts to attack the joints, often along with other organs.
• Fibromyalgia is a chronic pain condition and often manifests as an increased sensitivity to pain, along with fatigue and muscle stiffness.
• Gout is where crystals of uric acid develop within the joint when this normal waste product builds up in the blood. This acute pain can be excruciating. 

While there is no cure for most types of arthritis, there are a number of different management and medical options that can include pain relief and anti-inflammatories, along with weight loss, moderated exercise and counselling.

Arthritis should therefore not be considered untreatable, and nor should it be considered a disease affecting only one section of the population. There are NICE guidelines in place for the management of many types of arthritis and clinicians should in general adhere to these guidelines when proposing treatment plans.

Given the number of patients who are affected, there are large numbers of evidence based studies on the effectiveness of medication (and given the potential source of sales for pharmaceutical companies, new drugs are frequently in development.)

For some patients, but not all, surgery can help some arthritic joints, and this can come in various forms.

• Arthroscopy, using specialised instruments to look inside the joint, can often repair or remove tears to cartilage, or flush out free-floating pieces causing pain and irritation.
• Joint resurfacing can replace part of a knee or hip with an implant.
• An osteotomy involves cutting through a long bone in order to shift the pressure from a damaged area of cartilage or correct a misaligned bone.
• Arthrodesis is the fusion of a joint, and may provide pain relief, but at the cost of reduced mobility.
• Hip and knee joints that are badly damaged from arthritis may benefit from replacement, but this is only suitable in some cases. Other joints including shoulders, elbows and finger joints can sometimes benefit from replacement of one or more components.

As with all medical treatments, there are risks and benefits to any therapy or any surgery, and patients should be counselled in detail before undergoing an operation. Replacement joints can wear out and there have been well publicised problems with previous metal on metal hip replacements. The replacement may not function as well as the initial joint and some patients are still left with chronic pain despite the replacement. It is therefore important that patients not only understand what surgery can achieve, but also have a full understanding of the potential problems.

There are a number of charities that are available to assist people who have been diagnosed with arthritis of any sort. Among them are:

• Arthritis Care 
• Arthritis Action 
• Arthritis Research UK
• National Rheumatoid Arthritis Society

Andrew Clayton, a senior associate in Penningtons Manches' clinical negligence team, said: “As there are such a wide range of types of arthritis and potential treatments, the key to management is a regime tailored for the individual. Patients should ensure that their GP and other treating clinicians take the time to explain all their options, and the risks and benefits of each. By raising awareness of the condition and the number of people affected, hopefully more people will be able to receive an effective management programme and reduce the impact that arthritis has on their lives.”

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