Arthritis

Arthritis is pain and inflammation in a joint where bones connect. Arthritis is a common condition that covers a group of over 100 diseases. In the UK more than 10 million people of all ages (including children) have arthritis, or similar conditions, that affect the joints. 

If a blood vessel becomes inflamed, and narrows, the blood supply to the area of the body it serves may be partially or completely blocked. If alternate blood vessels (called collateral blood vessels) are not available in sufficient quantity to carry the blood, to such sites, the tissue supplied by the affected vessels will die. Inflammation can occur in any part of the body: any tissue or organ can be affected. 

The 2 most common types of arthritis are:

· Osteoarthritis- mainly affects your hands, hips, spine and knees. Osteoarthritis is the most common type of arthritis in the UK; affecting nearly 9 million people. It is more common in women and people with a family history of the condition. It most often develops in adults who are in their mid-40s but it can occur at any age as a result of an injury or be associated with other joint-related conditions: such as gout or rheumatoid arthritis. Osteoarthritis initially affects the smooth cartilage lining of the joint. This makes movement more difficult than usual, leading to pain and stiffness. Once the cartilage lining starts to roughen and thin out, the tendons and ligaments have to work harder. This can cause swelling and the formation of bony spurs, called osteophytes. Severe loss of cartilage can lead to bone rubbing on bone, altering the shape of the joint and forcing the bones out of their normal position. The most commonly affected joints are those in the: hands; spine; knees; hips.

· Rheumatoid arthritis is a disease where the body’s immune system attacks its own tissues. The outer covering (synovium) of the joint is the first place affected. This can then spread across the joint, leading to further swelling and a change in the joint's shape. This may cause the bone and cartilage to break down. This can damage the joint surface and underlying bone. In the UK, rheumatoid arthritis affects more than 400,000 people. It often starts when a person is between 40 and 50 years old. Women are 3 times more likely to be affected than men. RA mostly targets your fingers, thumbs, wrists, elbows, shoulders, knees, feet, and ankles. It can give you pain, swelling, stiffness and trouble with moving. You may also have: fatigue; fever; weight loss; eye inflammation; bumps under the skin (called nodules); lung inflammation. 

Other less common types of arthritis and related conditions can affect other connective tissues and organs: 

· Ankylosing spondylitis – a long-term inflammatory condition that mainly affects the bones, muscles and ligaments of the spine: leading to stiffness and to joints fusing together (also with inflammation where a tendon joins a bone)

• Cervical spondylosis – (also known as      degenerative osteoarthritis) affects the joints and bones in the neck,      which can lead to pain and stiffness
• Fibromyalgia – causes pain in      the body's muscles, ligaments and tendons
• Lupus is a      long lasting, autoimmune      disease that can damage almost any part of the      body, including joints and skin.
• Gout is      another form of arthritis that can be very painful. Uric acid build-up in      the body causes needle-like crystal deposits to form in your joints. You      might notice lumps under your skin (called tophi). A lot of people see the first symptoms      of gout in their big toe, which can get swollen,      sore, red, and warm. Other areas that gout can      attack include: the      instep of the foot; ankles; heels; knees; wrists; fingers; elbows. Bouts      of gout can      come and go. The pain might become constant if you don't get the condition      treated. You can treat it with medication but      you’ll also need to control your weight, limit alcohol consumption, and      cut down on meats and fish that have chemicals called purines.

· Psoriatic arthritis – an inflammatory joint condition that is related to the skin condition, psoriasis. It’s often mild but can sometimes be serious.

· Enteropathic arthritis – a form of chronic, inflammatory arthritis associated with inflammatory bowel disease (IBD):  the 2 main types being ulcerative colitis and Crohn's disease. About 1 in 5 people with Crohn's disease or ulcerative colitis will develop enteropathic arthritis. The most common areas affected by inflammation are the peripheral (limb) joints and the spine.

· Reactive arthritis – this can cause inflammation of the joints, eyes and urethra (the tube that urine passes through). It develops shortly after an infection of the bowel or genital tract or, less frequently, after a throat infection.

· Secondary arthritis – a type of arthritis that can develop after a joint injury and sometimes occurs many years afterwards.

· Polymyalgia rheumatica – a condition that almost always affects people over 50 years of age, where the immune system causes muscle pain and stiffness; usually across the shoulders and tops of the legs. It can also cause joint inflammation.

The cause of arthritis is not known but the following things contribute:

• Age - your joints wear with      age
• Gender - (except for ghout) arthritis is more common among      women
• Genetics - rheumatoid arthritis, lupus and ankylosing      spondylitis can be linked to certain genes
• Excess weight - carrying      extra pounds puts more weight on the knees which in turn can cause arthritis      to start sooner and get worse faster
• Injuries - can result in joint      damage that can bring on some types of the condition
• Infection - bacteria, viruses or fungi can infect joints      and trigger inflammation
• Work - builders, carpenters and      gardeners are at greater risk of getting osteoarthritis as their roles put      more stress on their knees

There's no cure for arthritis but there are many treatments that can help slow it down.

For osteoarthritis: treatments include lifestyle changes, medications and surgery.

Lifestyle measures

· Avoid being overweight (or obese) as this often makes osteoarthritis worse as it can place some of your joints under increased strain.

· If osteoarthritis causes you pain and stiffness, you may think exercise will make your symptoms worse but regular exercise, that keeps you active, builds up muscle and strengthens the joints usually helps to improve symptoms. Whatever your age, or level of fitness, exercise is one of the most important treatments for people with osteoarthritis. Your physical activity should include a combination of exercises to strengthen your muscles and exercises to improve your general fitness.

Medication – to relieve your pain

· Paracetamol - best taken regularly rather than waiting until your pain becomes unbearable.

· Ibuprofen, Naproxen or Diclofenac - non-steroidal anti-inflammatory drugs (NSAIDs) can be used to reduce inflammation. It is important to highlight that NSAIDs can break down the lining in your stomach that protects it against acid and also these may not be suitable for people with certain conditions, such as: asthma, a peptic ulcer, angina, after stroke or after a heart attack. 

· Codeine - opioids can help relieve severe pain but can have side effects such as: drowsiness, nausea and constipation ( the latter will lead to straining and could increases the likelihood of mini-strokes).

· Tramadol – not suitable if you have uncontrolled epileptic seizures.

· Dihydrocodeine - not recommended for patients with chronic obstructive pulmonary disease (COPD).

· Capsaicin cream - blocks the nerves that send pain messages from the treated area.

· Steroids injections - to treat particularly painful musculo-skeletal problems. These are only likely to provide short-term relief. If steroid injections are helping, you may be offered up to 3 injections in the same area with, at least, a 3 to 6 months gap between them.

· Transcutaneous electrical nerve stimulation (TENS) - a machine that sends electrical impulses through sticky electrode patches attached to the skin. This may help ease the pain caused by your osteoarthritis by numbing the nerve endings in your spinal cord which control pain. Treatment with TENS is usually arranged by a physiotherapist who can advise on the strength of the pulses and how long your treatment should last.

· Hot or cold packs (thermotherapy or cryotherapy) - can be very effective in reducing pain.

· Manual therapy – immobility can cause your muscles to waste and may increase the stiffness caused by osteoarthritis. Manual therapy is a treatment, provided by a physiotherapist, that uses stretching techniques to keep your joints supple and flexible. 

· Occupational therapy – good advice on footwear, walking aids, splints and handheld mechanical aids to help reduce the stresses on your joints is something that an occupational therapist can provide. Footwear with shock absorbing soles can help relieve some of the pressure on the joints of your legs as you walk. A walking aid or a splint (a piece of rigid material used to provide support to a joint or bone) can also be useful if you need to rest a painful joint. Special devices, such as tap turners, can make performing turning a tap far more manageable.

Surgery for osteoarthritis

· Arthroplasty - surgeon will remove your affected joint and replace it with an artificial joint (prosthesis) 

· Arthrodesis – if joint replacement isn't suitable your joint can be fused. You will no longer be able to move the joint but it will be stronger and less painful.

Treatment for rheumatoid arthritis

Disease-modifying anti-rheumatic drugs (DMARDs)

· Methotrexate

· Leflunomide

· Hydroxychloroquine

· Sulfasalazine

These drugs help slow the progression of the disease by blocking the effects of the chemicals released when the immune system attacks the joints which could otherwise cause further damage to nearby bones, tendons, ligaments and cartilage. Taking these medications can affect your blood count and your liver as well as the lungs. Close monitoring is required. Side effects can be: shortness of breath, persistent cough, feeling sick, loss of appetite, a sore mouth, diarrhoea, headaches and hair loss. 

The symptoms of arthritis you experience will vary depending on the type you have which is why it's important to have an accurate diagnosis if you have:

· joint pain, tenderness and stiffness

· inflammation in and around the joints

· restricted movement of the joints

· warm, red skin over the affected joint

· weakness and muscle wasting

The symptoms can be constant, or they may come and go. They can range from mild to severe. More-severe cases may lead to permanent joint damage.

Carbon dioxide is colour and odourless gas that is heavier than air. When bathing (to chest height) in a “dry carbon dioxide” the gas is absorbed through the hair follicles and skin into the capillaries and connective tissues. This (vasodilation) expands the blood vessel’s diameter which improves blood flow and the removal of waste products as well as increasing the transport of oxygen, nutrients and glucose to the tissues.

Effects:

Within the first couple of minutes a client experiences pleasant heat and perspiration.

Blood pressure is decreased typically by 15-20mmHg Systolic and 10-15mmHg Diastolic.

Benefits last up to six months:

Helps to alleviate Arthritis related pain

Better blood flow increases energy levels alleviates fatigue and improves mood

Cognition may improve

Eyesight may improve

Alleviates wheezing

Helps to improve independence and improves quality of life

Helps improve lymphatic fluid drainage (gravitational oedema) - meaning shoes fit properly

Gradually walking distance will improve