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Arthritis Support Against Pain West Fife (A S A P)
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Health Matters

HEALTH MATTERS

items relating to general health

Tips for Managing Arthritis

1. Stay active. Exercise may be the last thing you want to do when your arthritis hurts. But many studies show that physical activity is one of the best ways to improve your quality of life. Exercise boosts your energy. It can also strengthen your muscles and bones, and help keep your joints flexible. Try resistance training to build stronger muscles. Your muscles protect and support joints affected by arthritis. Go for aerobic workouts to burn calories, which will help you lose weight. Maintaining a healthy weight relieves stress on painful joints. Of course, if you're experiencing a bad flare-up, it may be better not to exercise until the pain subsides.

2. Eat a balanced diet. Studies show that a variety of nutrients may help ease arthritis symptoms. Foods rich in vitamin C, especially fruits and vegetables, may help. Omega-3 fatty acids, found in fish and fish oil, may also help relieve pain. Experts say it's best to focus on healthy foods rather than on single nutrients. You can get all the nutrients you need simply by following a balanced diet. Make sure your menu includes plenty of fruits and vegetables, whole grains, low-fat dairy, fish, and lean meats such as turkey and pork tenderloin. Also, choose healthy fats, such as nuts and avocados, and healthy oils, including olive and canola oil.

3. Lose weight. Being overweight puts undue strain on weight-bearing joints such as your knees, spine, hips, ankles, and feet. Losing weight can ease symptoms of arthritis. Shedding pounds and keeping them off isn't easy. Think baby steps. Make small changes each day that help you eat smaller portions and burn more calories.

4. Sleep well. A good night's sleep will help you cope with the pain and stress of arthritis. To sleep better, try going to bed at the same time every night. Take distractions like television and computers out of your bedroom. If you're uncomfortable in bed because of arthritis, try using pillows to take the pressure off painful joints. If you have frequent sleep problems, talk to your doctor.

From the Arthritis Foundation

http://www.arthritis.org/

Medications

Medications that can help  various conditions of arthritis: 

Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications (aspirin, ibuprofen, naproxen sodium) are another option for pain relief. However, the risk of GI side effects such as ulcers and bleeding is also higher with NSAIDs than with acetaminophen. NSAIDs are also associated with cardiovascular risk and kidney damage. The panel recommends “conservative dosing and treatment duration consistent with approved prescribing limits.” In people at moderate to high risk of GI side effects, the committee recommends adding a stomach-protective drug called a proton pump inhibitor (PPI) while taking NSAIDs. However, people at high risk for side effects like cardiovascular disease or GI bleeding are advised to avoid using NSAIDs entirely.

Topical NSAIDs. These rub-on products may be as effective as oral NSAIDs, but they pose less risk of GI problems. And though topical NSAIDs can cause skin irritation, they’re considered a safer option than oral drugs. Topical NSAIDs are recommended for people with knee-only OA. For those with OA in other joints, the recommendation is “uncertain.”

Diacerein. This slow acting drug may slow cartilage breakdown in people with OA. A 2010 analysis found a small benefit for pain relief compared to placebo, but the drug also increased the risk for diarrhea. Though diacerein may be safer than NSAIDs, more high-quality studies are needed to confirm its effectiveness. For now, the recommendation is “uncertain.”

Duloxetine (Cymbalta). This antidepressant, which was evaluated for OA for the first time in these guidelines, may help with chronic pain. However, side effects like nausea, dry mouth, fatigue, constipation, and increased sweating may keep some people from taking it. Duloxetine is appropriate for people with OA of the knee and other joints. Whether people with knee-only OA and coexisting health conditions should take it is uncertain.

Capsaicin. This analgesic, which is derived from chili peppers, is better than placebo at reducing pain, but it can cause side effects such as a burning sensation or skin redness. It’s appropriate for knee-only OA in people without existing health conditions, but uncertain in people with multi-joint OA and those with health conditions.

Opioid and narcotic analgesics. A review of 18 randomized controlled trials showed a significant reduction in pain, and some improvement in physical function with the use of these strong pain relievers. However, these benefits were countered by significant side effects, including nausea, constipation, dizziness, sleepiness, and vomiting. Overall, about a quarter of patients treated with opioids—and particularly with strong drugs like oxycodone and oxymorphone—dropped out of studies because of side effects. The recommendation on both oral and patch forms of opioid pain relievers is “uncertain.”

Corticosteroid injections. Injecting corticosteroid compounds directly into affected joints can be useful for decreasing pain in the short term, although the effect tends to wear off after a few weeks. To maintain relief, you may need to have corticosteroid injections in the same joint every few months, or use another treatment.

Hyaluronic acid injections. Hyaluronic acid is meant to supplement a natural substance that gives joint fluid its viscosity. Most of the studies conducted have been in patients with knee OA. Although the study outcomes differ, some do find the treatment relieves pain. Hyaluronic acid injections seem to reach their peak benefit 8 weeks after the shot is given, and the effect lasts for about 24 weeks. Side effects were minimal, including temporary pain and swelling at the injection site. Because of inconsistent study results, hyaluronic acid injections are “not appropriate” for people with OA of the hip and other joints, and “uncertain” for knee only oa

Self Care for Flare Ups

Along with following your doctor’s recommendations, there are many self-care steps you can incorporate into your plan.

Balance periods of activity with periods of rest. Although more rest can help during an arthritis flare, you probably don't need to abandon your regular activities or exercise program. But you may need to modify your usual program. Even though you may feel like spending long periods in bed, it may not be best. Instead, combine periods of rest with some light activity. Try to keep joints from becoming stiff by moving them through the fullest range of motion possible. You can do something as simple as slowly raising and lowering your legs while seated comfortably. Just make sure to pace yourself and don't overdo it. If this action is causing you more pain, stop immediately.

Have a plan to deal with your obligations. Have a contingency plan for work and family obligations. At work, try to arrange for days off, change your daily work schedule, work fewer hours per week or work from home. Make a plan with supervisors and co-workers ahead of time so you can transition smoothly when a flare occurs. At home, let family members know which responsibilities will be shifted to them in order to keep things running smoothly.

Communicate with your family and friends. It's important to let family and friends know how a flare may affect you and ways they can help before one occurs. Other sources of help can include your church or a local patient advocacy or volunteer organisation.

Apply a hot or cold pack to inflamed joints. Heat can soothe joint pain by increasing blood flow to the painful area and relaxing the muscles. Use heating pads, warm compresses, heat patches or warm baths; apply two or three times a day for 15 minutes at a time. Cold eases inflammation by constricting the blood vessels. It lessens pain because cold sensations travel along large nerve fibres and helps to disrupt pain sensations. Apply cold packs – bags of frozen vegetables work well – two to four times a day for 15 minutes at a time. Be careful not to overdo either treatment..

Practice relaxation or mind-diversion techniques. These techniques work best when you do them on a regular basis. Even though relaxation may not directly reduce your pain, it can minimise stress, which will indirectly relieve your pain.

The Foot and Rheumatoid Arthritis

Rheumatoid arthritis (RA) is the commonest type of inflammatory arthritis. Up to 90% of people with this condition will report associated foot problems. For some people, the foot is the first area of the body to present with signs and symptoms of RA. For others, it may be months, years or they may never experience any foot problems at all.

Musculoskeletal signs and symptoms in the feet:

Signs and symptoms of rheumatoid arthritis that you may experience in your feet can vary from soreness, warmth and swelling (a flare) of one or more foot joints that lasts a few days or longer, through to joint erosions, with joint instability, pain and associated changing foot shape.

It should be stressed that with the advent of improved and earlier drug therapy, the ‘classic’ changes to foot shape as a result of RA should become less common. However, if you experience any new foot pain, changes in joint shape, nodules, swelling or inflammation you should seek urgent attention from your rheumatology Health Care Practioner, (Rheumatology Specialist Nurse, Podiatrist, GP or Consultant).

The joints which are most commonly affected in RA are: the smaller joints of the toes, the ‘metatarsophalangeal (MP) joints’ in the forefoot, the ‘subtalar’ joint and less commonly, the ankle joint.

Symptoms of joint pain and swelling can impact on a person’s ability to undertake their usual daily activities and it is recommended that exercise should be reduced when you are experiencing the signs and symptoms of an acute ‘flare’. Treatment aimed at reducing painful symptoms, supporting the joints of the feet and improving foot function is usually via the use of appropriate insoles or orthoses and it has been found that the early use of orthoses, together with successful medical management, can slow the development of joint changes.

RA can cause bursae; (fluid filled sacs) that develop as a result of excess rubbing in a particular area that can become inflamed (bursitis) and painful. Bursa can often be found under the ball of the foot affected by RA. Treatment for this type of bursa usually involves reducing pressure over the ball of the foot with the use of insoles or orthoses.

In some people with RA, nodules may form in the soft tissues that may be susceptible to rubbing from hosiery and footwear.

Common sites for these nodules in the feet are: over the Achilles tendon in the heel pad and over any bony prominences.

Skin and Nail problems:

Shape changes in the front of the foot and the toes can create pressure sites that develop corns and calluses (hard skin).

These may develop into areas of ulceration if not treated appropriately, and so it is advisable to request podiatry guidance if hard skin or corns are present on your feet.

Professional guidance should always be sought with regard to self-treatment of hard skin and corns - you are advised not to use pedicure blades, corn plasters and paints on these areas. The reason for not using these is that they can remove good skin and cause breaks in the skin which bacteria can then invade and cause a serious infection.

Circulation and nerve problems in the lower limb:

Some people with RA can experience decreased blood supply to feet and legs associated with atherosclerosis (hardening of the arteries) which can lead to cramp-like pains in your calf, thigh or buttock muscles when walking and other circulation related disorders such as Raynaud’s phenomena where the small blood vessels in the skin of the hands and feet ‘shut down’ in response to changes in temperature leading to the following colour changes: toes/fingers go white, then blue and then red. These colour changes may also accompanied by a tingling sensation in the affected areas.

In rare cases people with RA can develop a skin rash, that may ulcerate, known as ‘vasculitis’ -an inflammation of the blood vessels. This is usually associated with long term disease and the risks of it occurring are increased by smoking.

Some people may experience problems with the nerve supply to their feet known as Peripheral Neuropathy (this can be caused by vasculitis as the small blood vessels that feed the nerves can be damaged, thus leading to abnormal nerve function. This may mean that they cannot feel pain or other sensations such as temperature (hot or cold) and pressure, or they may experience ‘pins and needles’ in certain parts of their feet as a result of a trapped nerve.

The above are types of problems that are less common and hopefully you may never experience them, but you should be aware of the symptoms if they arise and inform your rheumatology Health Care Practitioner responsible for monitoring your rheumatoid arthritis.

*** All information is given in good faith. Common sense should be used when following this information.  The reader is advised that the articles published are intended to be helpful and supportive.  We advise that a doctor, nurse, or physiotherapist gives approval for anything a person would do or is concerned about in their personal circumstances of managing their condition. 

Arthritic Knees

What treatments are there for osteoarthritis of the knee?

There’s no cure for osteoarthritis as yet, but there are a number of treatments that can help ease symptoms and reduce the chances of your arthritis becoming worse.

Drugs for osteoarthritis of the knee

Painkillers (analgesics) help with pain and stiffness but they don’t affect the arthritis itself and won’t repair the damage to your joint.

Painkillers are best used occasionally when you’re in pain or when you’re likely to be exercising. Paracetamol is usually the best and most well-tolerated painkiller, but make sure you take the right dose because many people take too little – try 1 g (usually 2 tablets) 3 or 4 times a day. You can buy them from your chemist or supermarket. Combined painkillers (e.g. co-codamol, co-dydramol) contain paracetamol and a second codeine-like drug, so they may be helpful for more severe pain. Because they’re stronger than painkillers, they’re more likely to cause side-effects such as dizziness and constipation.

Non-steroidal anti-inflammatory drugs (NSAIDs), for example ibuprofen or naproxen, may be recommended if inflammation is contributing to your pain and stiffness.

NSAIDs can sometimes have side-effects, but your doctor will take precautions to reduce the risk of these. They may suggest the lowest effective dose for the shortest possible time and prescribe another drug called a proton pump inhibitor to help protect your stomach from digestive problems.

NSAIDs also carry a slightly increased risk of a heart attack or stroke, so your doctor will be cautious about prescribing them if there are other factors that increase your overall risk (e.g. you smoke or you have circulation problems, diabetes, high blood pressure or high cholesterol).

Non-steroidal anti-inflammatory creams and gels are a good option if you have trouble taking NSAID tablets.

Creams and gels can be applied directly onto painful joints three times a day and there’s no need to rub them in – they absorb through your skin on their own. They’re extremely well tolerated because very little is absorbed into your bloodstream. You can tell within a few days whether they’ll help with your pain. Capsaicin cream is made from the pepper plant (capsicum) and is an effective and well-tolerated painkiller.

Capsaicin cream is only available on prescription and needs to be applied three times a day.

Most people feel a warming or burning sensation when they first use it, but this generally wears off after several days.

The pain relief starts after a few days and you should try it for at least two weeks before deciding if it’s helped.

Stronger painkillers, for example opioids/anti-inflammatories, may be prescribed if you have severe pain and other medications don’t work well enough.

Stronger painkillers are more likely to have side-effects, especially nausea, dizziness and confusion, so you’ll need to see your doctor regularly and report any problems. Some opioids can be given as a plaster patch to wear on your skin, which can give pain relief for a number of days. Stronger painkillers are only available on prescription.

Because these treatments work in different ways, you can combine them for greater pain relief. Ask your chemist or doctor for advice on safe combinations.

If you have trouble opening childproof containers, ask the pharmacist to put your drugs in a more suitable container. You can also order a child-resistant closure card.

Steroid injections are sometimes given directly into a particularly painful knee joint.

The injections can start working within a day or so and may improve pain for several weeks or months. They’re mainly used for very painful osteoarthritis, for sudden attacks caused by shedding calcium crystals and to help you through important events (such as a family wedding).

Arthritis Research UK has awarded a grant for the PROMOTE trial, a study into whether methotrexate, a drug commonly used to treat rheumatoid arthritis, can be used to treat osteoarthritis of the knee. Another trial is looking into whether a drug called spironolactone is an effective treatment.

Other treatments for osteoarthritis of the knee

Applying warmth or cold to your knee can relieve pain and stiffness.

Heat lamps are popular, but a hot-water bottle or reheatable pad (available from most chemists) are just as effective.

An ice pack can also ease pain. Don’t apply a hot or cold pad directly onto the skin. Hyaluronic acid injections, which help to lubricate your knee joint, are sometimes given when steroid injections don’t work.

You may be given a single injection or a course of several injections.

This form of treatment isn’t approved by the National Institute for Health and Clinical Excellence (NICE) and isn’t widely used because the evidence that it works isn’t convincing. Transcutaneous electrical nerve stimulation (TENS) can be used for pain relief, although research evidence suggests that it doesn’t work for everyone.

A TENS machine is a small electronic device that sends pulses to the nerve endings via pads placed on the skin. The device produces a tingling sensation which is thought to modify the pain messages sent to the brain. TENS machines are available from pharmacies and other major stores, but a physiotherapist may be able to loan you one to try before you decide to buy one.

Knee braces are becoming more popular and more evidence to support their use for osteoarthritis is emerging.

There are several types that can help to stabilise the kneecap and make it move correctly. You can buy knee braces from sports shops and chemists, but you should speak to your doctor or physiotherapist first. They may also be able to provide braces or recommend the best ones for you. Surgery may be recommended if you have severe pain or mobility problems.

A knee replacement operation can give substantial pain relief in cases where other treatments haven’t helped enough. Replacements now last on average over 15 years.

If your knee locks, an operation to wash out loose fragments of bone and other tissue from the joint can be performed – this is called arthroscopic lavage

Neck Pain

What treatments are there for neck problems?

If your neck pain doesn’t improve with simple medications and other self-help measures there are a number of treatments and therapies that should help, and your doctor may be able to prescribe stronger painkillers if needed.

Physical treatments

Physiotherapists, chiropractors and osteopaths are all trained to treat neck problems. Treatment carried out by one of these therapists, along with home exercises, are often all that’s needed. It’s important to make sure that any physical treatments are given by qualified practitioners.

These professionals can suggest general stretching and strengthening exercises for the neck or they may suggest specific ones.

Manipulation

Manipulation is a type of manual therapy used to adjust parts of your body to treat stiffness. It can sometimes be uncomfortable at the time, so it's important to understand what’s involved. Talk to your therapist about the treatments before they start. Your therapist should ask you about osteoporosis, as some treatments aren’t suitable for people with this condition. Recent research suggests that manipulation usually works best within the first three months of developing a neck problem.

The Alexander Technique

The Alexander Technique is a method of teaching bodily awareness and reducing unwanted muscle tension. A qualified teacher will advise you on your sitting and standing posture and your patterns of movement. Some physiotherapists are trained in this technique but it's not always available on the NHS.

TENS (transcutaneous electrical nerve stimulation)

A TENS machine is a small battery-driven machine which may help to reduce pain in the short term. Small pads are placed over the painful area and low-voltage electrical stimulation produces a pleasant tingling sensation. It's suggested that this can interfere with pain signals from the nerves to the brain. You can buy TENS machines from pharmacies, but your physiotherapist may be able to let you borrow one to try first.

Collars

Some people find a special collar helpful if a pinched nerve is causing pain that can be felt down the arm. However, there's little research evidence that they help with either short-term or long-term neck pain. The use of collars for neck problems varies across the UK – some healthcare professionals suggest they promote stiffness whereas others believe they can be helpful as long as they're fitted well and not used for long periods of time.

Acupuncture

During a session of acupuncture, very fine needles are inserted, virtually painlessly, at a number of sites on the skin (meridians) but not necessarily at the painful area. It's suggested that acupuncture may reduce pain in the short term by interfering with pain signals to the brain and by causing natural painkillers (endorphins) to be released.

Injections

In a very small number of cases, especially if you have continuing pain in the back of your head or arm, a long-acting local anaesthetic and/or a steroid injection may help. The injection may be given into the small facet joints of your neck or sometimes into the narrow spaces where the nerves branch out from the spine.

These injections are usually given in an x-ray department so that the specialist can position the needle precisely.

Surgery

Surgery is only rarely needed. It may be helpful if a nerve or your spinal cord is being squeezed and is causing weakness or severe pain that won't go away. The surgeon will take a scan of your nerves and bones before discussing the pros and cons of surgery with you. You can then decide whether to go ahead with the operation.

Drug treatments

Amitriptyline

If over-the-counter painkillers alone aren't effective, you may be prescribed an additional medication called amitriptyline. This acts to relax muscles and improve sleep. You'll usually be prescribed the lowest possible dose to control your symptoms. If the medication isn't effective at first, your dose can be gradually increased. This approach helps to lower the risk of side-effects. Common side-effects include dry mouth, drowsiness and blurred vision.

Gabapentin and pregabalin

Gabapentin and pregabalin aren't usually given as an initial treatment for ordinary neck pain. However, if a pinched nerve in your neck is causing discomfort in your arm(s), then these drugs can help by reducing nerve irritation. They may need to be taken for six weeks to begin with, and sometimes longer. As with all drugs there can be side-effects, so they won't be suitable for everyone. You should discuss this with your doctor.

Hip Pain

Pain in the hip is very common. Hip pain affects children and adults and can have a variety of different causes. If you have hip pain that persists, you should see a doctor or physiotherapist.

Hip pain symptoms

You might have soreness inside the hip joint but you may also feel pain in your:

• buttock

• lower back

• thigh

• groin

• knee.

Sometimes pain from other areas can be felt in your hip - this is called ‘referred pain’. Pain in the hip can affect you when you:

• walk up or down stairs

• sit or stand for some time

• exercise or play sport.

You should talk to your doctor or physiotherapist about your hip pain immediately if:

• the pain is sudden or intense

• the result of an injury or a fall

• you notice swelling or bleeding.

If your child has pain in the hip, talk to your doctor.

What causes hip pain?

The cause of your hip pain will affect when and where you feel the soreness.

Conditions that cause hip pain include:

• arthritis of the hip from a variety of causes - osteoarthritis is the most common, especially in people older than 50

• lower back problems

• a fracture of the neck (top) of the femur (thigh bone)

• a strained muscle

• an inflamed tendon or other inflammatory conditions

• polymyalgia rheumatica

• an infection

• pinched nerves.

Hip pain diagnosis

A doctor or physiotherapist can work out what is causing the pain in your hip. They might talk to you and examine you, checking how you stand, how you walk and what movements cause pain. They may suggest blood tests or X-rays.

Hip pain treatment

The treatment might include:

• physiotherapy or occupational therapy

• anti-inflammatory, pain-killing medicines or creams

• antibiotics

• steroid injections

• acupuncture

• advice about weight loss and exercise

• stretching, strengthening exercises or resistance training

• water exercise including swimming.

Your doctor may suggest you consult an orthopaedic surgeon if surgery or other specialist treatment is needed. You might find pain relief with home treatments such as rest, heat or ice, massage or gentle exercises can help.

How to Help Your Hip Pain

There are several things you can try if you have hip pain. These include using painkillers, exercising and reducing the strain on your hip.

Painkillers

Simple painkillers such as paracetamol (an analgesic) may help to ease pain. It’s best to take them before the pain becomes very bad, but you shouldn’t take them more often than every four hours or more than eight in 24 hours.

Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, which you can buy at chemists and supermarkets, can also help.

You can use painkillers and NSAIDs ( take with a meal) for a short course of treatment of about a week to 10 days. If they’ve not helped after this time then they’re unlikely to and you should see your doctor. However, if they do help but the pain returns when you stop taking them, you could try another short course. You can also try rubbing anti-inflammatory creams or gels onto affected areas.

If you’re pregnant, if you smoke, or if you have asthma, indigestion or an ulcer you should speak with your doctor or pharmacist before taking ibuprofen or aspirin.

If you have circulation problems, high blood pressure, high cholesterol or diabetes, you should check with your doctor or pharmacist whether over-the-counter NSAIDs are suitable for you, in case they could interact with any medication you’re taking.

If you have stomach problems after using over-the-counter medication, you should stop taking the tablets and see your doctor.

Exercise

It's recommended that you don’t rest for more than a few days – start some gentle exercise as soon as the pain begins to ease. Simple exercises can help to restore your range of movement, promote strength, ease stiffness and get your hip back to normal.

Start by exercising very gently and build up gradually.

When the pain is gone and you’re feeling better, it’s important you continue to exercise on a regular basis otherwise the improvements you’ve made will disappear within a few weeks.

Simple exercises are designed to stretch, strengthen and stabilise the structures that support your hip. They may not be suitable for all types of hip pain, so it’s a good idea to get advice from a doctor or physiotherapist about specific exercises before you begin. You should stop if you get any joint pain that doesn’t go away quickly.

Reducing the strain

It’s generally best to carry on doing your normal activities, but try not to overdo things. You might need to pace yourself to allow you to do a little bit more each day. Try the following tips:

• Avoid sitting in low chairs as this bends the hip a lot and might give you more pain.

• Don’t carry heavy weights. Use a trolley when you go shopping if carrying a basket is uncomfortable.

• Find a comfortable sitting position at work to lessen the strain on your hip.

• Use a walking stick to make walking easier. Use the stick on the opposite side to your painful hip. A therapist or doctor can advise on the correct length and the best way to use the stick.

• Lose weight if you’re overweight.

• Alter activities where you have to stand on one leg; for example, when you get into a car, sit on the side of the seat and swing both legs in rather than stepping in one leg at a time.

Complementary therapies

Many different complementary therapies and herbal remedies are believed to help with pain relief. Some people do feel better when they use complementary therapies, but on the whole these treatments aren’t recommended for use on the NHS because there’s no proof that they definitely work.

Generally speaking, complementary and alternative therapies are relatively safe, although you should always discuss their use with your doctor before starting treatment. There are some risks associated with specific therapies.

In many cases the risks associated with complementary and alternative therapies are more to do with the therapist than the therapy. This is why it’s important to go to a legally registered therapist or one who has a set ethical code and is fully insured.

If you decide to try therapies or supplements, you should be critical of what they’re doing for you, and base your decision to continue on whether you notice any improvement.

Hand Arthritis

Types of arthritis in the hands and fingers.

• Juvenile arthritis (JA). Juvenile arthritis is the term used to describe arthritis when it begins before age 16. There are several different types of juvenile arthritis that can cause pain and swelling in the wrist and joints of the hands.

• Gout. Gout is a form of arthritis that occurs when excess uric acid, a bodily waste product circulating in the bloodstream, is deposited as needle-shaped monosodium urate crystals in tissues of the body, including the joints. For many people, the first symptom of gout is excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Subsequent attacks may occur off and on in other joints, including the wrist and joints of the fingers. After years with the disease, lumps of uric acid, called tophi, may form beneath the skin of the hands.

• Reactive arthritis. Reactive arthritis is a chronic form of arthritis that often occurs following an infection of the genital, urinary or gastrointestinal system. Features of reactive arthritis include inflammation and swelling of the joints, eyes and structures within the gastrointestinal or genitourinary tracts, such as intestines, kidneys or bladder. A small percentage of people with the disease develop a rash or hard nodules on the soles of their feet or palms of their hands.

• Lupus. Lupus is a chronic autoimmune disease, meaning the body's immune system creates antibodies that attack healthy tissues, including the joints. The wrist and small joints of the hands are among those most commonly affected by lupus. Lupus can also cause inflammation in many organs, including the skin, heart, lungs and kidneys.

• Psoriatic arthritis. Psoriatic arthritis is a form of arthritis accompanied by the skin disease psoriasis. The skin disease often precedes the arthritis; in a small percentage the joint disease develops before the skin disease. The joint involvement of psoriatic arthritis often causes inflammation of the entire finger, giving it a sausage-like appearance. Approximately 80 percent of people with psoriatic arthritis experience changes to the nails including pitting, thickening and/or separation from the nail bed. The skin rash of psoriatic arthritis can also affect the hands.

• Infectious arthritis. Also called septic arthritis, infectious arthritis refers to arthritis that is caused by an infection within the joint. Infectious arthritis is often caused by bacteria that spread through the bloodstream to the joint. Sometimes it is caused by viruses or fungi and can affect the joints of the hands.

• Raynaud's phenomenon. Raynaud’s phenomenon is a condition characterized by a narrowing of the blood vessels to the extremities, usually the hands, in response to cold temperatures or stress. When blood vessels close down, fingers become cold and white, then blue, and numb or painful. When the vessels open up again, the hands become red or purple. Raynaud’s is often associated with connective tissue diseases, notably scleroderma.

• Osteoporosis. Osteoporosis is a condition in which the bones lose enough mass that they become brittle and prone to breaking with slight trauma. The bones of the wrist are among those most commonly fractured in people with osteoporosis. The condition can occur with aging, inflammatory disease (such as rheumatoid arthritis) inactivity, a low-calcium diet or use of corticosteroid medications.

• Carpal tunnel syndrome. This condition occurs when the median nerve, a nerve that runs from the forearm into the hand and supplies sensation to the palm and thumb side of the hand, becomes compressed within the carpal tunnel in the wrist. The carpal tunnel is a narrow passageway formed by bones and a ligament, through which the median nerve and several tendons run. If there is swelling within the tunnel, the nerve can become compressed, resulting in pain, weakness, and/or numbness in the hand and wrist, radiating up the arm.

• Scleroderma. Literally translated "hard skin," scleroderma is an umbrella term for disorders that involve the abnormal growth of the connective tissue supporting the skin and internal organs. Although there are several different forms of scleroderma, all can cause thickening and tightening of the skin on the fingers called sclerodactyly. This can make it harder to bend or straighten the fingers.

• Dermatomyositis. Dermatomyositis is an inflammatory muscle disease that often has a severe onset. Symptoms can include muscle pain and weakness, joint pain, skin rash, changes around the beds of the fingernails and roughening and cracking of the skin on the palms and fingertips, often referred to as Mechanic's hands.

• Dupuytren’s contracture. Dupuytren's contracture, sometimes called Dupuytren's disease, is an abnormal thickening of the fascia, a flat band of tissue beneath the skin, in the palm of the hand. This can lead to the development of firm cords and lumps that cause the fingers to bend toward the palm. The ring and little finger are most commonly affected. The disease, which occurs primarily in men older than age 40 of European descent, less commonly affects the fascia on the soles of the feet.

• Ganglion cysts. Ganglion cysts are lumps that form next to the joints or tendons in the hand and wrist. The most common locations are the joints at the base of the fingers (metacarpophalangeal joint or MCP), joints closest to the nail (distal phalangeal joint or DP), the top of the wrist and the palm side of the wrist. These cysts can occur in people of any age, they may come and go for no apparent reason, and they may or may not be painful.

• Stenosing tenosynovitis (trigger finger). This condition, also known as trigger finger, occurs when the pulley (one of the rings connective tissue that hold tendons of the fingers close to the bone) at the base of a finger or thumb thickens, constricting the tendon that enables the finger to move. This can cause popping, pain or a catching feeling in the finger or thumb. In some cases, repeated use can worsen inflammation and make it difficult to straighten or bend the finger.

fatique

http://www.misstreated.org/…/five-reasons-fatigue-isnt-like

Arthritis and the Back

Arthritis and Diseases That Affect the Back

From cartilage breakdown to muscle inflammation – problems that may be to blame for back pain.

Several forms of arthritis – collectively referred to as the spondylarthropathies (meaning spinal arthritis)– primarily affect the spine. These include:

• Ankylosing spondylitis. Ankylosing spondylitis is a chronic inflammatory disease that primarily affects the spine, particularly the sacroiliac joints near the pelvis, and the hip joints. Ankylosing is a term meaning stiff or rigid and spondylitis means inflammation of the spine.

Enthesitis (inflammation of the place where ligaments and muscles attach to bones) accounts for much of the pain and stiffness of ankylosing spondylitis. This inflammation eventually can lead to bony fusion of the joints (where the fibrous ligaments transform to bone, and the joint permanently grows together).

Other joints can also develop synovitis (inflammation of the lining of the joint), with lower limb joints more commonly involved than upper-limb joints.

• Reactive arthritis. Reactive arthritis is a chronic form of arthritis that often occurs following an infection of the genital, urinary or gastrointestinal system. Features of reactive arthritis include inflammation of the joints, eyes and structures within the gastrointestinal or genitourinary tracts, such as intestines, kidneys or bladder.

• Psoriatic arthritis. Psoriatic arthritis is a form of arthritis accompanied by the skin disease psoriasis. The skin disease often precedes the arthritis; in a small percentage the joint disease develops before the skin disease. For about 20 percent of people with psoriatic arthritis, the disease involves the spine. In some cases, bony overgrowth can cause two or more vertebrae to grow together, or fuse, causing stiffness.

• Juvenile Spondylarthropathy. Also called juvenile-onset spondyloarthritis (spinal arthritis), this term is used to describe spondylarthropathies that begin before age 16. In addition to affecting the spine, they may cause pain and inflammation in the joints of the pelvis, hips, ankles and knees. They may also affect other body organs such as the eyes, skin and bowels.

• Enteropathic arthritis. This is a form of arthritis that occurs in about 5 percent of people with inflammatory bowel disease, which includes ulcerative colitis and Crohn's disease. It commonly affects the sacroiliac joints, causing lower back pain.

Other forms of arthritis and related conditions that can affect the back include:

• Osteoarthritis. The most common form of arthritis of the back, osteoarthritis is a chronic condition characterized by the breakdown of the cartilage that cushions the ends of the bones where they meet to form joints. In the spine, this breakdown occurs in the cartilage of the facet joints, where the vertebrae join. As a result, movement of the bones can cause irritation, further damage and the formation of bony outgrowths called spurs. These spurs can press on nerves, causing pain. New bone formation can also lead to narrowing of the spinal canal, known as spinal stenosis.

• Rheumatoid arthritis. Rheumatoid arthritis is a chronic inflammatory disease of the joints that occurs when the body’s immune system – which normally protects us from infection – mistakenly attacks the synovium, the thin membrane that lines the joints. Although rheumatoid arthritis most commonly affects the hips, knees, hands, wrists, feet, elbows and ankles, it can also affect the facet joints in the spine, causing pain and, in severe cases, destruction of the joints. This may allow the upper vertebra to slide forward on top of the lower vertebra, a condition called spondylolisthesis. The slipped vertebra may put pressure on the spinal cord and/or the nerve roots where they exit the spine.

• Gout. Gout is a form of arthritis that occurs when excess uric acid, a bodily waste product circulating in the bloodstream, is deposited as needle-shaped monosodium urate crystals in tissues of the body, including the joints. For many people, the first symptom of gout is excruciating pain and swelling in the big toe – often following a trauma, such as an illness or injury. Subsequent attacks may occur off and on in other joints, primarily those of the foot and knee. Less commonly gout can affect the spine, causing extreme pain, numbness and tingling. It can be confused with a spinal infection.

• Infectious arthritis. Also called septic arthritis, infectious arthritis refers to arthritis that is caused by an infection within a joint. It can occur in the facet joints of spine. Infectious arthritis is often caused by bacteria that spread through the bloodstream to the joint. Sometimes it is caused by viruses or fungi.

• Polymyalgia rheumatica. An inflammatory disorder that causes widespread muscle pain and stiffness, polymyalgia rheumatica mainly affects the neck, shoulders, upper arms, lower back, thighs and hips. The disease often comes on suddenly and resolves on its own in a year or two.

• Fibromyalgia. An arthritis-related condition, fibromyalgia is a syndrome of chronic, widespread muscle pain and fatigue, which can be debilitating. The lower back is a common site of fibromyalgia pain.

• Osteoporosis. Osteoporosis is a condition in which the bones loose so much mass that they become brittle and prone to break with slight trauma. The condition, which can occur with aging, inactivity, a low-calcium diet or use of corticosteroid medications, commonly affects the spine. When this occurs in the spine, the inner spongy bone and more solid outer portion of the vertebrae become porous. The weakened vertebrae can break – an injury called a compression fracture – and lose about one-half of their height. In most cases, compression fractures, are painful. In some cases, the resulting back pain is severe. Usually, the pain resolves within a few weeks, but for some people, it is long-lasting.

• Spinal stenosis. Literally meaning "spinal narrowing," spinal stenosis can occur when changes in arthritis lead to bony overgrowth of the vertebrae and thickening of the ligaments. This can occur with osteoarthritis or ankylosing spondylitis. If a significant overgrowth occurs, it can cause the spinal column to narrow and press on the nerves housed within. Because the affected nerves have many functions, the condition may cause diverse problems in the lower body, including back pain, pain or numbness in the legs, constipation or urinary incontinence.

• Paget's disease of bone. Paget’s disease is a chronic disorder in which excessive breakdown and formation of bone causes the bones to become enlarged, misshapen and weakened. The disease usually does not affect the entire skeleton, but just one or a few bones. The vertebrae are among the bones most commonly affected by Paget's disease.

• Sciatica. This is inflammation of the sciatic nerve. The largest nerve in the human body, the sciatic nerve runs from the lower part of the spinal cord, through the buttock and down the back of the leg to the foot. The most common causes of sciatica include compression of the nerve where it exists the spine by a herniated disc, or a rupture of one of the structures that cushions the vertebrae in the spine. Sciatica may be felt as a sharp or burning pain that radiates from the hip. It may also be accompanied by low back pain.

• Scoliosis. Instead of running straight up the center of the back, a spine with scoliosis twists to one side. Scoliosis can be classified as true (meaning it has to do with abnormal development of the spine) or functional (meaning its cause is not directly related to the spine). Functional scoliosis may occur when a discrepancy in leg length causes the pelvis to tilt to one side to compensate. The cause of true scoliosis is largely unknown.

Hand Arthritis Exercises

Treating hand arthritis

There are some medicinal options for treating hand arthritis. You can take oral pain relieving medicines. You can also get steroid injections in your joints, and splint your hands to give them support. If these options don’t work, you may need to have surgery to fix the damaged joint.

There are many home treatments you can use to reduce the pain and disability of arthritis. One easy and noninvasive way to keep the joints flexible, improve range of motion, and relieve arthritis pain is by doing hand exercises. Hand exercises can help strengthen the muscles that support the hand joints. This can help you perform hand movements with less discomfort.

Movement can also help to keep ligaments and tendons flexible, which can help improve range of motion and hand function. Finally, exercise can increase the production of synovial fluid, which can also improve joint function.

Treating hand arthritis

There are some medicinal options for treating hand arthritis. You can take oral pain relieving medicines. You can also get steroid injections in your joints, and splint your hands to give them support. If these options don’t work, you may need to have surgery to fix the damaged joint.

MAKE A FIST

You can do this easy exercise anywhere and any time your hand feels stiff. Start by holding your left hand up straight. Then, slowly bend your hand into a fist, placing your thumb on the outside of your hand. Be gentle, don’t squeeze your hand. Open your hand back up until your fingers are straight once again. Do the exercise 10 times with the left hand. Then repeat the whole sequence with the right hand.

FINGER BENDS

Start in the same position as in the last exercise, with your left hand held up straight. Bend your thumb down toward your palm. Hold it for a couple of seconds. Straighten your thumb back up. Then bend your index finger down toward your palm. Hold it for a couple of seconds. Then straighten it. Repeat with each finger on the left hand. Then repeat the entire sequence on the right hand.

MAKE A O

Start with your left hand pointing straight up. Then, curve all of your fingers inward until they touch. Your fingers should form the shape of an “O.” Hold this position for a few seconds. Then straighten your fingers again. Repeat this exercise a few times a day on each hand. You can do this stretch whenever your hands feel achy or stiff.

FINGER LIFT

Place your left hand flat on a table, palm down. Starting with your thumb, lift each finger slowly off the table one at a time. Hold each finger for a second or two, and then lower it. Do the same exercise with every finger of the left hand. After you’re done with the left hand, repeat the entire sequence on the right hand.

WRIST STRETCH

Don’t forget about your wrists, which can also get sore and stiff from arthritis. To exercise your wrist, hold your right arm out with the palm facing down. With your left hand, gently press down on the right hand until you feel a stretch in your wrist and arm. Hold the position for a few seconds. Repeat 10 times. Then, do the entire sequence with the left hand.

Outlook for arthritis in hands

Make these exercises part of your daily routine for best results. Talk to your doctor if these exercises become difficult for you to do. Your doctor can recommend more specific exercises for you, or other treatments to help your pain.

What is Fibromyalgia?

What is fibromyalgia?

Fibromyalgia is a long-term (chronic) condition that can cause widespread pain and tenderness over much of the body. It's quite common – up to 1 person in every 25 may be affected.

In the past, other terms were used to describe the condition, including muscular rheumatism and fibrositis. The condition may even have been misdiagnosed as degenerative joint disease.

We now know that fibromyalgia isn't linked to inflammatory or degenerative arthritis, even though the symptoms may sometimes be very similar.

Fibromyalgia in itself doesn't cause any lasting damage to the body's tissues. However, it's important to keep as active as you can in order to avoid weakening of the muscles (deconditioning) which could lead to secondary problems.

We don’t yet know exactly what causes fibromyalgia, but research suggests that there’s an interaction between physical, neurological and psychological factors. The pain we feel is often affected by our emotions and moods – depression or anxiety can make the pain seem worse. At the same time, being in pain can lead to stress, worry or low mood.

Usually, people feel pain when part of the body is damaged (as in arthritis) or suffers a physical injury. The pain people with fibromyalgia feel is different because it's not directly caused by damage or injury to the area that's hurting. Instead there's a problem with the way the brain and nervous system process pain from that area. This doesn’t mean the pain is any less real, but because there’s no physical damage that can be healed there's no easy way to stop the pain. This is why fibromyalgia pain can be long-lasting (chronic).

Research has shown that people with fibromyalgia are more sensitive to physical pressure. This means that what would be a relatively minor knock for most people could be extremely painful for someone with fibromyalgia. This increased sensitivity isn't fully understood but it’s thought that it could be related to changes in the way the nervous system processes pain. Some researchers have shown using special brain scans that these processes are altered in people with fibromyalgia.

Sleep disturbance may also contribute to this increased sensitivity. Brainwave studies show that people with fibromyalgia often lose deep sleep. A number of things may lead to sleep disturbance, such as:

• pain from an injury or another condition such as arthritis

• stress at work or strain in personal relationships

• depression brought on by illness or unhappy events.

People with fibromyalgia quite often report that their symptoms started after an illness or accident, or following a period of emotional stress and anxiety. However, others can't recall any particular event leading up to the onset of symptoms.

In an experiment where healthy volunteers were woken during each period of deep sleep, a number of them developed the typical signs and symptoms of fibromyalgia.

Not surprisingly, a combination of pain, sleep disturbance and anxiety or depression can turn into a vicious cycle. Poor sleep will contribute to the severe tiredness that often goes with fibromyalgia.

Some people who have fibromyalgia also report being affected by some of the following problems:

• chronic tiredness (fatigue)

• depression and anxiety

• headaches

• joint pain in various parts of their body

• spasms in either or both legs (restless leg syndrome)

• dry eyes – sometimes your doctor may recommend tests to check whether this is caused by Sjögren’s syndrome

• irritable bowel syndrome (IBS)

• problems with the joint connecting the jawbone to their skull, causing pain in the jaw and areas nearby (temporomandibular joint disorder or TMJD)

• underactive thyroid (hypothyroidism).

The symptoms of fibromyalgia are often very similar to the symptoms of chronic fatigue syndrome (previously known as myalgic encephalomyelitis or ME). It's not yet clear whether the two conditions are related. People with chronic fatigue syndrome can often recall a viral infection before their fibromyalgia symptoms started. However, they may have less pain than people with fibromyalgia.

There’s no cure as yet for fibromyalgia, but there are ways of managing your symptoms. Your doctor will be able to suggest treatments and therapies to tackle specific aspects of the condition. These may include drug treatments but physical and other therapies are just as important or even more so.

Good Food Matters

Fish

Fatty fish varieties such as salmon, mackerel, sardines and trout are high in omega-3 fatty acids, which have been shown to have potent anti-inflammatory effects.

In one small study, 33 participants were fed either fatty fish, lean fish or lean meat four times each week. After eight weeks, the fatty fish group had decreased levels of specific compounds related to inflammation

An analysis of 17 studies found that taking omega-3 fatty acid supplements decreased joint pain intensity, morning stiffness, the number of painful joints and use of pain relievers in patients with rheumatoid arthritis

Similarly, a test-tube study showed that omega-3 fatty acids reduced several inflammatory markers that are involved in osteoarthritis

Fish is also a good source of vitamin D, which can help prevent deficiency. Multiple studies have found that rheumatoid arthritis may be associated with low levels of vitamin D, which could contribute to symptoms

The American Heart Association recommends including at least two servings of fatty fish in your diet each week to take advantage of the beneficial anti-inflammatory properties

SUMMARY:

Fatty fish is high in omega-3 fatty acids and vitamin D, both of which may be beneficial for reducing inflammation and the severity of arthritis symptoms.

Garlic

Garlic is jam-packed with health benefits.

In some test-tube studies, garlic and its components have been shown to have cancer-fighting properties. They also contain compounds that may lower the risk of heart disease and dementia

Additionally, garlic has been shown to have an anti-inflammatory effect that may help decrease symptoms of arthritis.

In fact, some research has shown that garlic may enhance the function of certain immune cells to help strengthen the immune system

In one study, researchers analyzed the diets of 1,082 twins. They found that those who ate more garlic had a reduced risk of hip osteoarthritis, likely thanks to garlic’s strong anti-inflammatory properties

Another test-tube study showed that a specific component in garlic could decrease some of the inflammatory markers associated with arthritis

Adding garlic to your diet could benefit both arthritis symptoms and overall health.

SUMMARY:

Ginger

Besides adding a burst of flavor to teas, soups and sweets, ginger may also help ease the symptoms of arthritis.

A 2001 study assessed the effects of ginger extract in 261 patients with osteoarthritis of the knee. After six weeks, 63% of participants experienced improvements in knee pain

One test-tube study also found that ginger and its components blocked the production of substances that promote inflammation in the body

Another study found that treating rats with ginger extract decreased levels of a specific inflammatory marker involved in arthritis

Consuming ginger in fresh, powdered or dried form may reduce inflammation and aid in reducing symptoms of arthritis.

SUMMARY:

Ginger has been shown to reduce symptoms of arthritis. Test-tube and animal studies have also found it may decrease inflammation, but more research in humans is needed.

Broccoli

It's no secret that broccoli is one of the healthiest foods out there. In fact, it may even be associated with reduced inflammation.

One study that looked at the diets of 1,005 women found that the intake of cruciferous vegetables like broccoli was associated with decreased levels of inflammatory markers

Broccoli also contains important components that could help reduce symptoms of arthritis.

For example, sulforaphane is a compound found in broccoli. Test-tube studies have shown that it blocks the formation of a type of cell involved in rheumatoid arthritis development

An animal study also found that sulforaphane could reduce the production of certain inflammatory markers that contribute to rheumatoid arthritis

While more studies in humans are needed, these test-tube and animal study results show that the compounds in broccoli may help decrease symptoms of arthritis.

SUMMARY:

Broccoli has been associated with reduced inflammation. It also contains sulforaphane, which may have anti-inflammatory properties, according to test-tube studies. More research is needed to look at the effects of broccoli in humans.an and test-tube studies have found garlic may possess anti-inflammatory properties, and that eating it may be associated with a decreased risk of osteoarthritis.

Walnuts

Walnuts are nutrient-dense and loaded with compounds that may help reduce the inflammation associated with joint disease.

One analysis of 13 studies showed that eating walnuts was associated with reduced markers of inflammation

Walnuts are especially high in omega-3 fatty acids, which have been shown to decrease the symptoms of arthritis (5).

In one study, 90 patients with rheumatoid arthritis took supplements of either omega-3 fatty acids or olive oil.

Compared to the olive oil group, those who received omega-3 fatty acids experienced lower levels of pain and were able to reduce their use of arthritis medications

However, most existing research focuses on the effects of omega-3 fatty acids in general on arthritis. Further studies are required to learn more about the effects of walnuts, specifically.

SUMMARY:

Walnuts are high in omega-3 fatty acids, which could alleviate arthritis symptoms as well as inflammation.

Berries

Tons of antioxidants, vitamins and minerals are crammed into each serving of berries, which may partially account for their unique ability to decrease inflammation.

In one study of 38,176 women, those who ate at least two servings of strawberries per week were 14% less likely to have an elevated level of inflammatory markers in the blood

Additionally, berries are rich in quercetin and rutin, two plant compounds that boast a huge number of benefits for your health.

In one test-tube study, quercetin was found to block some of the inflammatory processes associated with arthritis.

Another study gave rats quercetin and rutin supplements, both of which decreased arthritis-related inflammation .

Fortunately, if you want to take advantage of these impressive health benefits, there's a wide variety of berries to choose from. Strawberries, blackberries and blueberries are just a few options that can satisfy your sweet tooth and provide plenty of arthritis-fighting nutrients.

SUMMARY:

Berries contain antioxidants that have been shown to decrease arthritis-related inflammatory markers in test-tube and animal studies.

Spinach

Leafy greens like spinach are full of nutrients, and some of their components may actually be able to help decrease inflammation caused by arthritis.

Several studies have found that a higher intake of fruits and vegetables is linked to lower levels of inflammation .

Spinach, in particular, contains plenty of antioxidants as well as plant compounds that can relieve inflammation and help fight disease (

Spinach is especially high in the antioxidant kaempferol, which has been shown to decrease the effects of the inflammatory agents associated with rheumatoid arthritis

A 2017 test-tube study treated arthritic cartilage cells with kaempferol, and found it reduced inflammation and prevented the progression of osteoarthritis

However, more research is needed to study the effects of spinach and its components on humans with arthritis.

SUMMARY:

Spinach is rich in antioxidants, including kaempferol. Test-tube studies have found that kaempferol can reduce inflammation and slow the progression of osteoarthritis.

Grapes

Grapes are nutrient-dense, high in antioxidants and possess anti-inflammatory properties.

In one study, 24 men were given either a concentrated grape powder that was equivalent to about 1.5 cups (252 grams) of fresh grapes, or a placebo daily for three weeks. The grape powder effectively decreased levels of inflammatory markers in the blood

Additionally, grapes contain several compounds that have been shown to be beneficial in the treatment of arthritis. For example, resveratrol is an antioxidant present in the skin of grapes.

In one test-tube study, resveratrol showed potential for helping prevent the thickening of the joints associated with arthritis by blocking the formation of rheumatoid arthritis cells

Grapes also contain a plant compound called proanthocyanidin, which may have promising effects on arthritis. For example, one test-tube study showed that grape seed proanthocyanidin extract reduced inflammation related to the disease

Keep in mind that these are test-tube studies using concentrated doses of antioxidants far greater than the amount you would consume in a typical serving.

Further research is needed to determine how these results may translate to humans.

SUMMARY:

Grapes have anti-inflammatory properties and contain compounds that may help reduce inflammation. However, additional studies in humans are needed.

Olive Oil

Well-known for its anti-inflammatory properties, olive oil may have a favorable effect on arthritis symptoms.

In one study, mice were fed extra-virgin olive oil for six weeks. This helped stop the development of arthritis, reduce joint swelling, slow cartilage destruction and decrease inflammation .

In another study, 49 participants with rheumatoid arthritis consumed either fish oil or an olive oil capsule each day for 24 weeks.

At the end of the study, levels of a specific inflammatory marker had decreased in both groups — by 38.5% in the olive oil group and between 40–55% in the fish oil group .

Another study analyzed the diets of 333 participants with and without rheumatoid arthritis, finding that olive oil consumption was associated with a lower risk of the disease.

Although more research is needed on the effects of olive oil on arthritis, including olive oil and other healthy fats in your diet can definitely benefit your health, and may also reduce arthritis symptoms.

SUMMARY:

Olive oil has been shown to reduce inflammation and may be associated with a lower risk of arthritis. One animal study found that it may slow arthritis progression and ease symptoms.

Tart Cherry Juice

Tart cherry juice is an increasingly popular beverage derived from the fruit of the Prunus cerasus tree.

This potent juice offers a wide array of nutrients and health benefits, and may even help reduce the symptoms of arthritis.

In one study, 58 participants received either two 8-ounce (237-ml) bottles of tart cherry juice or a placebo every day for six weeks.

Compared to the placebo, tart cherry juice significantly decreased symptoms of osteoarthritis and reduced inflammation .

In another study, drinking tart cherry juice for three weeks reduced the levels of inflammatory markers in 20 women with osteoarthritis.

Be sure to look for an unsweetened variety of tart cherry juice to make sure you don’t consume excess added sugar.

In combination with a healthy diet and other arthritis-fighting foods, a serving of unsweetened tart cherry juice per day may help decrease some of the symptoms of arthritis.

SUMMARY:

Studies show that tart cherry juice could lower inflammation and alleviate some symptoms of arthritis.

The Bottom Line

It's clear that diet can play a major role in arthritis severity and symptoms.

Luckily, a variety of foods with powerful components may offer relief from inflammation and arthritis — while also promoting overall health.

Along with conventional treatments, eating a nutritious diet containing healthy fats, a few servings of fatty fish and plenty of produce may help reduce some symptoms of arthritis.

Osteoarthritis

There's no cure for osteoarthritis, but the condition does not necessarily get any worse over time. There are a number of treatments to help relieve the symptoms.

The main treatments for the symptoms of osteoarthritis include:

lifestyle measures – such as maintaining a healthy weight and exercising regularly

medication – to relieve your pain

supportive therapies – to help make everyday activities easier

In a few cases, where other treatments have not been helpful, surgery to repair, strengthen or replace damaged joints may also be considered.

Lifestyle changes

Exercise

Exercise is one of the most important treatments for people with osteoarthritis, whatever your age or level of fitness. Your physical activity should include a combination of exercises to strengthen your muscles and exercises to improve your general fitness.

If osteoarthritis causes you pain and stiffness, you may think exercise will make your symptoms worse.

However, regular exercise that keeps you active, builds up muscle and strengthens the joints usually helps to improve symptoms.

Exercise is also good for losing weight, improving your posture and relieving stress, all of which will ease symptoms.

Your GP, or possibly a physiotherapist, will discuss the benefits you can expect from a exercise programme and can give you an exercise plan to follow at home.

It's important to follow this plan because there's a risk that doing too much exercise too quickly, or doing the wrong sort of exercise, may damage your joints.

Find out more more about health and fitness including simple ways to exercise at home.

Losing weight

Being overweight or obese often makes osteoarthritis worse, as it places extra strain on some of your joints.

To find out if you are overweight or obese, use the healthy weight calculator.

If you're overweight or obese, try to lose weight by doing more physical activity and eating a healthier diet.

Discuss any new exercise plan with your GP or physiotherapist before you start. They can help you plan a suitable exercise programme for you. Your GP and practice nurse can also advise about how to lose weight slowly and safely.

Find out more about losing weight.

Pain relief medicines

Your doctor will talk to you about medicines to relieve pain from osteoarthritis.

Sometimes a combination of therapies, such as painkillers, exercise and assistive devices or surgery, may be needed to help control your pain.

The type of painkiller a GP may recommend for you will depend on the severity of your pain and other conditions or health problems you have. The main medications used are below.

Paracetamol

If you have pain caused by osteoarthritis, a GP may suggest taking paracetamol to begin with. You can buy this at supermarkets or pharmacies. It's best to take it regularly rather than waiting until your pain becomes unbearable.

When taking paracetamol, always use the dose a GP recommends and do not exceed the maximum dose stated on the pack.

Find out more about paracetamol.

Non-steroidal anti-inflammatory drugs (NSAIDs)

If paracetamol does not effectively control the pain of osteoarthritis, a GP may prescribe a non-steroidal anti-inflammatory drug (NSAID).

NSAIDs are painkillers that work by reducing inflammation.

Some NSAIDs are available as creams (topical NSAIDs) that you apply directly to the affected joints. Some topical NSAIDs are available without a prescription. They can be particularly effective if you have osteoarthritis in your knees or hands. As well as helping to ease pain, they can also help reduce any swelling in your joints.

Your doctor will discuss with you the type of NSAID you should take and the benefits and risks associated with it.

NSAID tablets may be needed if paracetamol and topical NSAIDs are not easing the pain. They may not be suitable for people with certain conditions, such as asthma, a stomach ulcer or angina, or if you have had a heart attack or stroke. If you're taking low-dose aspirin, ask your GP whether you should use a NSAID.

If your GP recommends or prescribes an NSAID to be taken by mouth, they'll usually also prescribe a medicine called a proton pump inhibitor (PPI) to take at the same time. NSAIDs can break down the lining in your stomach that protects it against stomach acid. PPIs reduce the amount of acid produced by the stomach, reducing the risk of damage to your stomach lining.

Opioids

Opioids, such as codeine, are another type of painkiller that may ease your pain if paracetamol does not work. Opioids can help relieve severe pain, but can also cause side effects such as drowsiness, nausea and constipation.

Codeine is combined with paracetamol in common medicines such as co-codamol.

If you need to take an opioid regularly, your GP may prescribe a laxative to take alongside it to prevent constipation.

Capsaicin cream

A GP may prescribe capsaicin cream if you have osteoarthritis in your hands or knees and topical NSAIDs have not been effective in easing your pain.

Capsaicin cream works by blocking the nerves that send pain messages in the treated area. You may have to use it for a while before it has an effect. You should experience some pain relief within the first 2 weeks of using the cream, but it may take up to a month for the treatment to be fully effective.

Apply a pea-size amount of capsaicin cream to your affected joints up to 4 times a day, but not more often than every 4 hours. Do not use capsaicin cream on broken or inflamed skin and always wash your hands after applying it.

Be careful not to get any capsaicin cream on delicate areas, such as your eyes, mouth, nose and genitals. Capsaicin is made from chillies, so if you get it on sensitive areas of your body, it's likely to be very painful for a few hours. However, it will not cause any damage.

You may notice a burning sensation on your skin after applying capsaicin cream. This is nothing to worry about, and the more you use it, the less it should happen. But avoid using too much cream or having a hot bath or shower before or after applying it, because it can make the burning sensation worse.

Steroid injections

Steroids are a type of medication that contain manmade versions of the hormone cortisol, and are sometimes used to treat particularly painful musculoskeletal problems.

Some people with osteoarthritis may be offered steroid injections when other treatments haven't worked.

The injection will be made directly into the affected area. You may be given a local anaesthetic first to numb the area and reduce the pain.

Steroid injections work quickly and can ease pain for several weeks or months.

Supportive treatments

In addition to lifestyle changes and medicines, you may benefit from a number of supportive treatments that can help reduce your pain and make everyday tasks easier.

Transcutaneous electrical nerve stimulation (TENS)

Transcutaneous electrical nerve stimulation (TENS) uses a machine that sends electrical impulses through sticky patches, called electrodes, 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 or doctor, who can advise you on the strength of the pulses and how long your treatment should last.

Hot or cold packs

Applying hot or cold packs to the joints can relieve the pain and symptoms of osteoarthritis in some people. A hot-water bottle filled with either hot or cold water and applied to the affected area can be very effective in reducing pain.

Special hot and cold packs that can either be cooled in the freezer or heated in a microwave are also available, and work in a similar way.

Assistive devices

If osteoarthritis is causing mobility problems or making it difficult to do everyday tasks, several devices could help. Your GP may refer you to a physiotherapist or an occupational therapist for specialist help and advice.

If you have osteoarthritis in your lower limbs, such as your hips, knees or feet, your physiotherapist or occupational therapist may suggest special footwear or insoles for your shoes.

Footwear with shock-absorbing soles can help relieve some of the pressure on the joints in your legs as you walk. Special insoles may help spread your weight more evenly. Leg braces and supports also work in the same way.

If you have osteoarthritis in your hip or knee that affects your mobility, you may need to use a walking aid, such as a stick or cane. Hold it on the opposite side of your body to your affected leg so that it takes some of your weight.

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. Your physiotherapist can provide you with a splint and give you advice on how to use it correctly.

If your hands are affected by osteoarthritis, you may also need assistance with hand-operated tasks, such as turning on a tap. Special devices, such as tap turners, can make performing these tasks more manageable. Your occupational therapist can give you help and advice about using assistive devices in your home or workplace.

Manual therapy

Not using your joints can cause your muscles to waste and may increase stiffness caused by osteoarthritis. Manual therapy is a technique where a physiotherapist uses their hands to stretch, mobilise and massage the body tissues to keep your joints supple and flexible.

Find out more about physiotherapy.

Surgery

Surgery for osteoarthritis is only needed in a small number of cases where other treatments haven't been effective or where one of your joints is severely damaged.

If you need surgery for osteoarthritis, your GP will refer you to an orthopaedic surgeon. Having surgery for osteoarthritis may greatly improve your symptoms, mobility and quality of life.

However, surgery cannot be guaranteed to get rid of your symptoms altogether, and you may still experience pain and stiffness from your condition.

There are several different types of surgery for osteoarthritis.

Joint replacement

Joint replacement, also known as an arthroplasty, is most commonly done to replace hip and knee joints.

During an arthroplasty, your surgeon will remove your affected joint and replace it with an artificial joint (prosthesis) made of special plastics and metal. An artificial joint can last for up to 20 years, although it may eventually need to be replaced.

There's also a newer type of joint replacement surgery called resurfacing. This uses only metal components and may be more suitable for younger patients. Your surgeon will discuss with you the type of surgery that would be best.

Find out more about hip replacement and knee replacement.

Joint fusing

If joint replacement is not suitable for you, your surgeon may suggest an operation to fuse your joint in a permanent position, known as an arthrodesis.

This means your joint will be stronger and much less painful, although you will no longer be able to move it.

Adding or removing some bone around a joint

If you have osteoarthritis in your knees but you're not suitable for knee replacement surgery, you may be able to have an operation called an osteotomy. This involves your surgeon adding or removing a small section of bone either above or below your knee joint.

This helps realign your knee so your weight is no longer focused on the damaged part of your knee. An osteotomy can relieve symptoms of osteoarthritis, although you may still need knee replacement surgery eventually.

Complementary and alternative therapies

Some people with osteoarthritis try complementary or alternative therapies – such as acupuncture and aromatherapy – and find them helpful.

However, there's a lack of medical evidence to suggest they're effective and they generally are not recommended by the National Institute for Health and Care Excellence (NICE).

Nutritional supplements

A number of nutritional supplements have been used to treat osteoarthritis in the past, including chondroitin and glucosamine.

GPs no longer prescribe chondroitin and glucosamine on the NHS because there’s no strong evidence that they are effective as a treatment.

Generally, supplements can be expensive and NICE recommends that they should not routinely be offered on the NHS.

Rubefacients

Rubefacients are available as gels and creams that produce a warm, reddening effect on your skin when you rub them in. Several rubefacients have been used to treat joint pain caused by osteoarthritis.

However, research has shown that rubefacients have little effect in improving the symptoms of osteoarthritis and NICE therefore does not recommend their use.

Our Feelings and Emotions

Our Feelings

Our Emotions

The emotional effects of arthritis can have just as much of an impact as the physical symptoms. It’s important to take what steps you can to promote your emotional health, as this helps to find purpose in all that you do and engage with the world around you. This, in turn, can increase your confidence.

This is especially important if you have a long-term condition such as arthritis, because maintaining a positive mental attitude can help you cope with change, uncertainty and potentially stressful situations.

• How can I look after my emotional wellbeing?

• Common emotions

• Emotions and your symptoms

• Your relationships

• Building a good frame of mind

• Accepting help when you need it

How can I look after my emotional wellbeing?

• Keep up with activities you enjoy, or take up a new one. This could be anything: gardening, reading, walking, cooking. The list is endless!

• Stay connected – to family, friends, the local community. If you’re feeling isolated, follow your interests (join a gardening club, book club or singing group, for example). Arthritis Care has local branches and groups all over the UK – many have coffee mornings, activity groups and other social events. There’s something to suit everyone.

• Keep active – many people say their arthritis symptoms lessen if they exercise.

• Give back – this could be a small gesture, such as giving someone a compliment, or a larger one, such as volunteering at a charity shop or soup kitchen.

Common emotions

Emotions send us quick, powerful messages about our environment. These then trigger reactions, which often allow us to function effectively in a given situation. Some emotions are automatically signalled – such as happiness, sadness and anger – while others, like guilt or jealousy, are more complex and often have no obvious signals.

One size rarely fits all in any aspect of life. It depends on you and at what stage your arthritis is: whether you’re experiencing the first symptoms, have just been diagnosed, are going through your first flare-up, or have been living with a chronic and relapsing condition for some time.

However, people with arthritis do talk about some common experiences. Hearing the diagnosis can be a shock. Some people deny anything is wrong, and try to ignore it. You might feel scared, or relieved to finally know what’s wrong.

However, there may be a sense that your body cannot be relied upon or trusted anymore, and the feelings of uncertainty can be hard to adjust to.

At any stage, many people feel angry and frustrated. It’s natural to ask “why me?” Anxiety is also common. You may be scared, especially if you have known someone with severe arthritis in the past.

Mind and body

Because your mind and body are so closely linked, the symptoms of arthritis, and the feelings you get, can influence each other. This can be good or bad, depending on how you look at it.

For example, if you are in pain or can’t do something, it might make you short-tempered or put you in a low mood. On the other hand, feeling positive about finding a solution or focusing on things you can do makes the physical symptoms of arthritis easier to deal with.

Two principles are important in appreciating how we experience pain:

• Each of us reacts to and manages pain differently.

• How we deal with our pain can affect the way we feel it.

A variety of other factors can determine how your body will react chemically to pain and whether your nerves will transmit or block a potentially painful message to your brain. These factors can include anxiety, fatigue and how you responded to pain while growing up. The pain caused by arthritis can be persistent and sometimes severe, but you can work at not letting it dominate your life.

Arthritis drugs

A side effect of some drugs can be mood changes. This can be directly or indirectly – as a knock-on effect – of another side effect, such as insomnia, headaches or dizziness. This, in turn, can cause you to become tired and withdrawn, and could, in the long term, lead to anxiety and depression.

Talk to your doctor or another healthcare professional you trust about the possible drawbacks and benefits of your arthritis medication. It is also important to talk to your GP if you feel your medication is affecting your emotions.

Best arthritis care

Work with your healthcare team to optimise your treatment to the best it can possibly be. Together, you can find the right combination of exercise, therapy and medication. This can be difficult, however, if you lack the confidence or the knowledge to have a meaningful, two-way discussion.

Rest and relaxation

When you feel threatened, your body goes into ‘fight or flight’ mode. This stress response releases chemicals that affect your heart, breathing, muscles, nerves, gut and brain.

There are lots of different ways to relax. Some people find that mindfulness helps them. Others find meditation, yoga, or listening to relaxing music beneficial. Another technique you could try is Autogenic Training – this is a relaxation process that addresses the imbalance in mind and body.

Pace yourself. Fatigue can be a big problem for many people with arthritis. Build extra time into your schedule so you can rest between periods of activity, without having to rush.

Sleep is vital

Some people with arthritis struggle to get a good night’s sleep – this can be due to pain, or worrying about the knock-on effects of your condition. Lack of sleep can make your pain worse, leave you grumpy or low, and can affect your concentration.

Stick to a calm routine, with a regular bedtime. Switch off your mobile phone, computer and TV. A comfortable temperature will help you drift off. If it’s not working, ask your GP for advice.

Staying active

You don’t have to go to the gym – staying active is about keeping moving, in a way that feels comfortable for you. Being physically active helps to alleviate arthritis symptoms, and is the key to staying mobile and staying independent with arthritis.

Your relationships

Good relationships are central to our emotional wellbeing. All relationships go through happy times and difficult times, and having a long-term condition such as arthritis can present challenges. However, being honest and upfront with the people you are close to, and spending time listening to each other, helps both you and them.

Changing roles

Arthritis means asking for extra help, and it’s not always easy. You may have to rely more on your spouse, partner or family, and you may not be comfortable with this.

You might worry about doing your fair share at work, or keeping the respect and friendship of colleagues. Some people stop going out as much, or give up their hobbies, and see their social life drifting away.

Relationships and emotions

Many of the emotions that come with arthritis are linked to our relationships. Worrying about being a burden and feeling misunderstood are two examples. Anger, frustration and sadness are also hard on the people we care about.

For family and friends

If someone you care about has arthritis, you want to be there for them. But it’s not always easy.

Perhaps you are helping with appointments, transport, or tasks at home. Maybe you provide personal care, like washing and dressing. You might have money worries too, which compound these problems.

If you’re caring for someone with a long-term condition, you can become depressed, isolated, anxious and/or stressed. It’s important to look after your own wellbeing. Let your GP know you are a carer, and ask your local council* for a carer’s assessment, which can open the door to benefits and services.

* In Northern Ireland, ask the local social services department.

Communication

The key to good relationships is trust, which depends on open communication. If something is bothering you, try to talk about it. To keep the conversation calm:

• Introduce the subject gently – use ‘I’ statements to ‘own’ your feelings

• Be aware of body language

• Focus on the problem, not on blame – talk about how things make you feel and what would help you

• Calmly explain your feelings

• Ask how they feel

• Listen without judging.

Staying connected

Many people with arthritis feel isolated. This can be due to stopping paid employment, not carrying on with the activities you enjoy, and generally being less active.

Research tells us that feeling connected to other people is essential for our emotional health and wellbeing, so it’s a priority. Here are some ideas:

• Look for new ways to stay in touch with family and friends. Can you talk on the phone, or online?

• Plan ahead and manage your arthritis, so you can carry on doing the things that matter to you. An occupational therapist can suggest adjustments, so ask your GP or social worker for a referral.

• Consider volunteering. Everyone has something to offer, and helping others is rewarding.

Building a good frame of mind

Self-confidence

Living with a long-term condition can knock your self-confidence in many ways. You may not able to socialise as much as you used to, or need help with certain tasks, and you may not be comfortable asking for help. You may also have experienced changes to your appearance, which can affect how you see yourself and what you feel capable of doing.

This can be especially difficult to deal with if you don’t have a support network. Connecting with others is a crucial part of looking after your emotional wellbeing. It can make you feel happier and more positive about yourself and the world around you.

If you would like to talk to someone about your arthritis, you can call Arthritis Care’s free Helpline Monday-Friday, 09:30-17:00. Our friendly team can talk to you about any aspect of the condition, and your call is confidential.

The methods you use to build your self-confidence are unique. What works for someone else, might not help you. If you would like to try building your self-confidence up slowly, why not try one or more of the following?

• Learning how to manage your arthritis.

• Setting small goals. These should be manageable and enjoyable. Why not try a new recipe, learn a few words of a foreign language, or say hello to a new person today?

• Being assertive – question the health professionals treating you, about medication and other treatment options you are offered (or not offered). Don’t be scared to question any aspect of your care and treatment.

• Check how you are talking to yourself about yourself throughout the day. Would you speak to a friend like that? We can be very hard on ourselves sometimes.

Warning signs

Depression is different from feeling low for a while: it goes on for weeks, and interferes with your daily life. You can lose your motivation and sense of enjoyment. It can leave you feeling hopeless, helpless, tearful or irritable. Having no energy and not sleeping well are other signs.

Anxiety can happen on its own or alongside other conditions like depression. It’s a feeling of being worried or frightened all the time, and can get in the way of everyday life.

What to do in a crisis

If the feelings are so bad that you feel on the verge of harming yourself, or someone else, this is an emergency that needs medical help. Talk to your GP immediately, call 999 or go to your local hospital’s A&E department. They will understand and are trained to help.

From www.arthritiscare.org.uk

Arthritis linked to Psoriases

Arthritis that causes psoriases.

A unusual type of arthritis can be linked to psoriasis, the skin problem that causes itchy red patches on the body, usually worse on the arm and leg areas. The Dermatology Department in Hospitals can provide support and help to ease the skin problem. A mousse type lotion is usually prescribed to take the itch and redness out of the skin lesions and this may be combined with the use of ultra violet light treatment.

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