No single cure
In the second part of this article on arthritis,
Just as there is no simple answer about the cause of most forms of arthritis, there is - as yet - no single cure for most rheumatic diseases.
However, some rheumatic diseases can be easily and effectively controlled, and most can be alleviated by modern treatment. Research has led to great improvements in this area.
Because the severity as well as the type of arthritis varies greatly in different people, and at different stages of the disease, treatment has to be tailored to the needs of each individual. In the more severe cases this requires a lot of skill, experience and understanding on the part of health care professionals.
With treatment, many people with arthritis wll be able to live full lives with relatively little pain or disability. For some, the condition may cause major problems or difficulties, although the effects of these can often be minimised with treatment. Alternatively, the problem may resolve itself in the course of time. A few people still develop very serious problems due to arthritis, inspite of modern treatment.
Drug therapy can be helpful for most people with severe arthritis. Some drugs can relieve a great deal of the pain and stiffness, as well as helping to control the disease and prevent it getting worse.
Drug treatment is also getting safer, as well as more effective. However, there is no effective treatment that does not occasionally cause side-effects. Minor side-effects are not uncommon with the drugs used to treat arthritis; fortunately, serious side-effects are rare.
A number of different types of drugs are used. They include:
Analgesics (painkillers) such as paracetamol, which reduce pain.
Anti-inflammatory drugs which reduce stiffness and swelling of joints, as well as relieving the pain. Anti-inflammatory drugs often cause indigestion and can cause more serious problems such as bleeding from the stomach, asthma, liver, and kidney problems.
Anti-rheumatic drugs include a number of more powerful treatments which can be effective in suppressing arthritis and preventing or reducing damage to the joints. However, their use does need careful medical supervision.
Steroids are powerful, natural anti-inflammatory agents, which can be injected into painful areas, as well as being used in tablet form. They too can have side-effects as well as great benefits, and have to be used carefully.
Surgery may be necessary and advisable if the damage to a joint is severe enough to make life very difficult, and when other treatment is not reducing the pain. Joint replacements are now remarkably sophisticated and successful. Many different joints, including hips, knees and finger joints, are routinely replaced in people with advanced arthritis. There are also a number of other pain-relieving or reconstructive operations which are sometimes helpful.
There are many ways in which you can help yourself if you have arthritis. Do not let it get on top of you, or let it stop you doing things you want to. Be determined to enjoy life as much as possible. You can help yourself by appropriate exercise, rest, diet and stress control.
Rest and exercise
Joints do not wear out either as a result of being used, or with normal exercise. It is important to keep your joints moving and your muscles strong - whether you have arthritis or not. In general it is better to keep active.
If a joint is inflamed, a short period of rest may help the inflammation to settle down. You should also protect inflamed or damaged joints. It is better to use them 'little but often' rather than persisting with activities that afterwards cause lasting pain. However, it is also important not to rest the joints too much.
All joints should be put through a full range of motion at least once a day, to prevent them stiffening up. In every case, keeping active is good for your general health.
In addition, specific exercises may be helpful, but these will depend on the type of arthritis and the joints affected. A physiotherapist will be able to provide advice on this.
All of us need to be sensible about what we eat or drink. It is important to avoid being overweight (as this puts extra strain on the joints). A good diet with plenty of fruit and fibre, avoiding too much meat or animal fat, is good for geneal health.
Special diets rarely make a great deal or difference to arthritis. A diet that replaces animal fat with vegetable or fish oils may reduce joint inflammation a little, and be of benefit to some people.
Chronic arthritis can get you down and constant pain may lead to anxiety and depression. Counselling from your rheumatologist, or from someone he recommends, may help. Sharing the problem with friends and others who are affected can also be helpful. Relaxation techniques can also be beneficial.
Stress is not the cause of arthritis, but it can make it feel worse. It is sensible to be aware of this, and try to find ways of coming to terms with the condition, and dealing with the stress it causes.
(The writer is Consultant Rheumatologist at the Sri Jayewardenepura General Hospital)