Rheumatoid arthritis
Is there a lifestyle connection?
For Yolande Wall, it was the day that she had to ask her teenage son, Jai, to act as a crutch when she walked when she finally realised that the pain in her knees needed investigating. “We were at a summer festival in 2015,” explains 50-year-old Yolande, an emergency nurse practitioner who lives in south London with her husband, David, an economist, 48, and their children, Jai, 17, and daughter Kady, 12. “And I just couldn’t cope with the undulations of the field. It was making my knees and feet very sore.”
When it came the diagnosis was rheumatoid arthritis, a chronic auto-immune disease. Affecting about 400,000 people in the
UK, it most commonly starts between the ages of 40 and
50, with three times as many women as men suffering. Last week, actress Sadie Frost, 52, revealed she, too, was a sufferer. She posted on Instagram: “Being healthy is at the top of my list. I have recently been diagnosed with early rheumatoid arthritis, which can be quite painful.”
For Yolande, the symptoms had begun earlier the year before – she recalls hot, inflammatory pain in her left foot. It seemed to travel to her wrists, and then her shoulder or elbow. “Getting up in the morning,” she says, “I couldn’t put weight on my feet – it was too painful and sensitive. I would hobble into the bathroom.”
Her index finger on her right hand became too weak to dispense her favourite Clinique face cream from a pump-action bottle. “It was lots of little things that escalated.”
As a nurse, Yolande says, “I should have known, but perhaps I was in denial, even though my mother has rheumatoid arthritis. On hearing about my symptoms, she suggested I get checked out. I just felt I was too young for all that. I didn’t want to admit to having a chronic illness”.
Eventually in September 2015, Yolande went to the GP, who ordered blood tests and then referred her to a rheumatologist. No single test identifies rheumatoid arthritis, says the charity Arthritis Research UK, with diagnosis made based on symptoms, blood tests, scans and physical examination. The most useful blood tests measure inflammation – either levels of erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP).
Tests can pick up anaemia and may be used to detect rheumatoid factor, which is an antibody produced by a reaction in the immune system. Another antibody test known as anti-ccp (anti-cyclic citrullinated peptide) is also available. People who test positive for anti-ccp are very likely to develop rheumatoid arthritis. And people who test positive for both rheumatoid factor and anti-ccp may be more likely to have severe rheumatoid arthritis.
Yolande’s blood tests came back positive for all the factors – the confirmation she needed to accept the result. But still no one knows for sure what causes rheumatoid arthritis, although there is evidence that lifestyle factors such as smoking, drinking coffee and eating a lot of red meat may contribute. Equally, it is less common in those with a high vitamin C intake and those who drink alcohol in moderation.
Frost, who was renowned for her hell-raising ways, as part of the infamous Nineties “Primrose Hill” set, which included Kate Moss, said of her diagnosis last week: “It’s silly, because I blame myself, but it’s mainly a genetic disorder and just happens when things degenerate then inflame.”
However, the charity says that while our genes may make rheumatoid arthritis more likely to develop, they do not cause it alone. Moreover, even where several family members have the condition, severity may differ from person to person.
Yolande, too, was concerned she was in some way to blame – “I liked my coffee,” she admits. And although she kept fit, she says she sometimes wondered if an enthusiasm for using vibration plate fitness machines at the gym perhaps exacerbated the inflammation. “I did feel almost disappointed in myself when I was finally diagnosed. I had a healthy lifestyle – non-smoker, drinking in moderation, mostly vegetarian diet.”
Yolande was told she would need to start on a regime of medication – daily doses of hydroxychloroquine (which regulates the immune system) and methotrexate (a form of chemotherapy that treats the underlying disease and prevents further damage to joints).
The drugs had side-effects and Yolande suffered hair loss. She changed to sulfasalazine, which acts to suppress the immune system, and took methotrexate by weekly injection, which reduced the side effects. “It was the start of a long road to adjust. I was unwell, tired and rundown, and got an abscess in my armpit, which had to be drained in a breast clinic.”
Yolande went online for advice including to the Arthritis Research UK website, and decided to overhaul her lifestyle – going on a two-week juice fast in Portugal, switching to an alkaline diet and swapping highintensity exercise for long dog walks. Frost has taken similar moves, claiming to have adopted an Ayurvedic diet and recommending natural remedies. She says: “Up your omega-3, calcium, vitamin C and D. Drink warm water, turmeric, black pepper, cider vinegar. Rub sesame oil into the painful areas. Don’t stress. Moderate exercise.”
Yolande gave up eating red meat altogether, and says even now that she can feel it in her joints if she consumes meat. “I still have a coffee now and again because I enjoy it,” she says. “But I am more likely to have a turmeric latte with homemade almond milk.”
Despite her positive approach, she admits the diagnosis and associated lifestyle changes are hard.
‘I felt I was too young for this… I didn’t want to admit to it’
“Sometimes I feel like I have to do it all by myself. David hasn’t given up coffee, red meat or wine like me, and the children eat differently too. So I can end up making three meals. “But I have to accept this change or risk deterioration. You need to be disciplined with rheumatoid arthritis. It would be easier to have a takeaway and wine but I would feel it.”
There are still some safe pleasures: “In my experience,” she laughs, “my symptoms aren’t aggravated by gin and tonic, and I can tolerate a glass of prosecco or bubbly.” As for the future, Yolande, who was born in Australia, has invested in a second home near Perth as the dry heat seems particularly helpful.
“I spent eight months there last year and had no problems with my joints. I was able to stay active with walks on the beach.” She will soon go back for three months, but family life in the UK prevents a permanent move.
“I am positive about the future,” she says. “I have this bolt-hole and, although it takes a lot of logistics to make it work, the weather really does help my RA. I feel very fortunate.”