Living well with arthritis

Assistant Professor of Medicine at Boston University Dr David Hunter has recently published a book on how to best manage arthritis. We pick his brains on how instances of the disease are progressing, and what solutions exist not only for its treatment, but for improving our quality of life. 

Q: How do patients react when they’re diagnosed with arthritis? 
A: Dr Hunter: The majority of people tend to perceive it as the worst possible diagnosis, a common misconception is that they may end up in a wheelchair in a very short period of time, that they’ll be unable to walk or do anything with their hands, and that it’s a very destructive disease. But these days, this is not the case – most of these diseases are usually easily managed and can be well controlled. I spend the majority of my first consultations with people dispelling those misconceptions. 

Q: Are cases of arthritis on the up? 
A: For inflammatory-type arthritis - rheumatoid or lupus - the occurrence and prevalence in the community is pretty stable. However cases of osteoarthritis are increasing, and that’s largely a function of increasing obesity in the community; we’re also getting older, and the baby boomer generation are reaching an age where many are starting to become affected. 

Q: Does arthritis only affect the elderly? 
A:  No, not at all. There are particular forms of juvenile arthritis. Rheumatoid arthritis typically occurs in people between 30 and 50. Osteoarthritis, particularly in men, usually begins under the age of 50 and is sequelae to either a knee or hip injury, or another joint injury. So the common complaint you hear of soccer or football players after they’ve torn a ligament or meniscus is of other knee problems. That’s often a sign of osteoarthritis. 

Q: What do younger people need to be aware of? 
A: The important thing is to take the appropriate action when you think you may have a particular type of arthritis. Go along and get a proper diagnosis then make an effort to be as best informed as you can about your condition and what medical care can do for you. 

Q: How does joint inflammation lead to pain? 
A:  Inside the joint capsule lining there’s a tissue called synovium. In a person who has arthritis that synovium becomes quite thickened and develops in much greater excess than normal. The tissue itself is actually quite full of nerves, when it becomes thickened and inflamed, people can perceive that as pain. While that’s the most common form of joint pain, inflammatory or other type of arthritis can involve changes from within the bone which can also produce pain. 

Q: What are some other key strategies people can follow to live well with arthritis? A: With inflammatory arthritis, make sure you get appropriate rest. If you experience joint pain and have limited function as a result, there are modifications you can make to make your lifestyle easier. If someone has neck pain, there are modifications to a person’s car that can be made. The list is limitless and it depends on what type of arthritis you have. Be sure to see an appropriate health professional and read about other options for managing your arthritis. 

Q: Are there any other complementary medicines you’d recommend? 
A:  I frequently recommend glucosamine – it’s sometimes better than the standard antiinflammatories that a lot of doctors often prescribe for various types of arthritis. In most of the studies completed, glucosamine (and to a lesser extent chondroitin) have been shown to be equally effective as most antiinflammatories in relieving pain. Recently there was a big study carried out in the US sponsored by the NIH which studied the efficacy of glucosamine and chondroitin. Essentially the results of that study were pretty negative, but that was largely because they didn’t recruit the appropriate population. In other words, they didn’t recruit many people with joint pain – so if you don’t have much in the way of pain, there’s not too much you can relieve. 

Q: How do you go about prescribing the right mix of traditional medicine, exercise and natural therapies? 
A: It’s important to make any treatment you recommend very individual, taking into account the person and the type of arthritis experienced. I spend a lot of time talking about ‘conservative’ options: basic lifestyle changes that help them manage their arthritis in the long term, so mostly exercise and dietary-based options. A lot of the general community are very well informed about over-the-counter preparations and complementary therapies. Then I usually get around to talking about the medical therapies, which a lot of other rheumatologists would spend more time on – I’m an advocate for all types of therapy rather than just writing out a prescription. 

Q: How can diet and exercise make a difference? 
A: It depends on what type of arthritis you’re talking about, but a lot of these people are overweight and that’s what is contributing to the development of the disease. I work with a nutritional counsellor and we spend a lot of time on dietary advice to try and reduce caloric intake, and then maintain that reduction. As far a dietary supplementation is concerned, Omega-3 fatty acids are quite helpful: fish oil and flaxseed oil. Unfortunately when it comes to Omega-3, if you just rely on dietary sources you have to eat an inordinate amount of fatty fish and a lot of people don’t want to do that – so more often than not, we recommend buying an over-the-counter supplement. The other misconception is that things like alcohol and acidic foods will make their condition worse, but unless you’ve got gout, which is one of the less common forms of arthritis, it’s unlikely to be the case. As far as exercise is concerned, for overweight people I encourage gentle aerobic exercise to try and assist in weight loss. In treating knee or hip osteoarthritis, and I often work with physiotherapists to facilitate specific strengthening and aerobic exercises.