Why joint ex­er­cise is a great way to keep arthri­tis at bay

The Jewish Chronicle - - NEWS - BYDRHUWBEYNON

IT WAS the Amer­i­can comed i a n G e o r g e Burns who said: “You can’t help get­ting older, but you don’t have to get old.”

As a rheuma­tol­o­gist, I would agree: it is not nec­es­sar­ily your chrono­log­i­cal age, but your bi­o­log­i­cal age that mat­ters.

Arthri­tis, which is an in­flam­ma­tion of the joints, can be caused by around 100 disorders. Not all of them are as­so­ci­ated with ad­vanc­ing age, but some are, in­clud­ing the most com­mon prob­lem that af­fects the joints — os­teoarthri­tis.

Eight mil­lion peo­ple in the UK are af­fected by os­teoarthri­tis, which causes pain and de­creased mo­bil­ity.

I t is a wear-and-tear dis­or­der of the ma­jor joints, in­clud­ing the hips, knees, spine and fin­gers.

The most com­monly af­fected joint is the hip. If you per­form X-rays on peo­ple over 65, you will find around one in 20 has ev­i­dence of wear and tear in their hip joint and it is a sig­nif­i­cant cause of dis­abil­ity in older peo­ple.

The sec­ond most com­mon prob­lem area is the knee, and the fin­ger and thumb joints are of­ten af­fected too, making it painful and dif­fi­cult to carry out the sim­plest of house­hold tasks.

So how likely are you to de­velop os­teoarthri­tis? As it is a con­di­tion pri­mar­ily caused by wear and tear, with the car­ti­lage be­tween the joints grad­u­ally be­ing worn away, the risks do in­crease the older you get.

But we also know that there is a ge­netic pre­dis­po­si­tion for the con­di­tion, and that it of­ten runs in fam­i­lies, be­ing passed down from gen­er­a­tion to gen­er­a­tion.

Weight is a fac­tor in os­teoarthri­tis of the knees and, in­ter­est­ingly, the fin­gers, but not the hips.

The con­di­tion is more com­mon in peo­ple who have dam­aged the joints, while play­ing sports for in­stance. There is also a link with jobs in­volv­ing a great deal of heavy lifting or pro­longed stand­ing.

Once you have de­vel­oped os­teoarthri­tis it is not nec­es­sar­ily al­ways a down­hill path, with in­creas­ing pain as the joints de­gen­er­ate. Some pa­tients can see an im­prove­ment while oth­ers might re­main stable for many years.

But in a sub­stan­tial num­ber of cases, the joints will de­te­ri­o­rate to the point at which or­thopaedic surgery be­comes the best op­tion.

For the right pa­tient — with the right sur­geon — surgery can give fan­tas­tic re­sults. But for some suf­fer­ing with os­teoarthri­tis, pain re­lief is the im­me­di­ate pri­or­ity and thank­fully there are a num­ber of op­tions, in­clud­ing anal­gesics, such as paracete­mol and codeine, and non-steroidal an­ti­in­flam­ma­to­ries.

Some peo­ple find us­ing a cream con­tain­ing cap­saicin, the ac­tive com­po­nent that gives chilli pep­pers their heat, helps.

Oth­ers find re­lief in other sources of heat, but they need to be care­ful not to cause se­ri­ous dam­age to the skin or blood ves­sels by, for ex­am­ple, sit­ting too close to a fire for hours on end.

There is also a wide range of pre­ven­ta­tive reme­dies on the mar­ket such as glu­cosamine. For most suf­fer­ers, there is no par­tic­u­lar ev­i­dence that they work. How­ever, some peo­ple swear by them, and as they do no harm, I am happy for pa­tients to take them.

There is ev­i­dence, how­ever, that tak­ing reg­u­lar doses of vi­ta­min D is im­por­tant. This is es­pe­cially so in Bri­tain, where dur­ing the win­ter months, huge num­bers of peo­ple suf­fer vi­ta­min-D de­fi­ciency through lack of ex­po­sure to sun­light, po­ten­tially caus­ing mus­cle and joint pain. In Lon­don, 70 per cent of peo­ple do not gen­er­ate suf­fi­cient vi­ta­min D dur­ing the win­ter.

Sadly, there is no won­der drug on the mar­ket for os­teoarthri­tis. Great claims have been made for some which have of­fered short-term im­prove­ments in pain lev­els, only for them to turn out to cause con­sid­er­able dam­age to the joints.

Other causes of arthri­tis, though, can be succ e s s f u l l y c o n t r o l l e d with drugs. Rheuma­toid arthri­tis, an in­flam­ma­tory version of the con­di­tion, can af­fect any or­gan of the body, al­though it is the joints that take the main hit.

With early di­ag­no­sis and treat­ment, drugs can “turn the dis­ease off”, pre­vent­ing de­struc­tion of the joints.

There are also suc­cess­ful treat­ments which can be used in an­other big cause of arthri­tis among older peo­ple — gout. This is a con­di­tion of­ten as­so­ci­ated with over-in­dul­gence, and

Wit­hearly di­ag­no­sis and treat­ment, use­of­drugs ‘can­turn­the dis­ease off’

For older peo­ple, arthri­tis can of­ten de­velop as a re­sult of in­juries sus­tained

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