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diagnosed with arthritis: managing treatments, support and resources
10 minute read
occupational therapists and physiotherapists, who can also ease pain and increase the range of motion in limbs, are important components of a multidisciplinary team when managing arthritis.
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arthritis is more than just an annoying ache in your hips or hands. it’s actually a term that describes a collection of more than 100 diseases characterized by chronic inflammation in the joints, causing pain and stiffness, according to arthritis society canada.
it affects roughly six million canadians and, if left untreated, it can lead to serious damage, culminating in disability.
of the 100 types, there are two broad categories that encompass these many diseases — osteoarthritis (oa) and inflammatory arthritis (ia).
osteoarthritis is the most common, and is caused by the joint deterioration – usually in the knees, hips, hands and spine – that comes with aging, but it can also be caused by injury, obesity, surgery or genetics.
when the cartilage that protects the ends of bones breaks down, bone-on-bone contact creates pain, stiffness, swelling and reduced range of movement.
in the case of inflammatory arthritis, which encompasses rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, juvenile idiopathic arthritis, and gout, joint damage is the result of inflammation.
most forms of inflammatory arthritis are autoimmune diseases, where the immune system attacks its own healthy tissues. it can progress faster and more aggressively than osteoarthritis and, in addition to the joints, it can affect the eyes, skin, lungs and other organs.
most types are also more prevalent in women, at nearly 60 per cent, although ankylosing spondylitis and gout are more common in men. your genes can also predispose you to certain types, including rheumatoid arthritis, systemic lupus erythematosus and ankylosing spondylitis.
regardless of type, there are resources and supports available to help those with arthritis live a better quality of life.
here’s how you can manage an arthritis diagnosis.
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understanding an arthritis diagnosis
most people are diagnosed with arthritis when pain and stiffness in their joints persists and sometimes interferes with daily life. their family doctor will do a physical exam and ask about medical history and usually make a diagnosis then and there, especially for hip and knee arthritis.
sometimes an x-ray is ordered to rule out another medical issue or if the doctor recommends surgery.
often the first step for people with hip or knee arthritis is to be referred for a surgical consultation, although only about 10 to 15 per cent of those will go on to actually have the surgery, so self-management strategies are vital, says erin miller, registered occupational therapist and clinical practice lead at ontario’s arthritis rehabilitation and education program, which is part of arthritis society canada.
with inflammatory arthritis, specifically rheumatoid arthritis, however, a rheumatologist will make the diagnosis and likely treat and manage the patient for life, says miller, with visits usually every three months at first, then as the disease stabilizes, every six to 12 months.
what does – and doesn’t – cause arthritis
although arthritis is not necessarily an older person’s disease – about three in 1,000 children have childhood arthritis and people between the ages of 40 and 60 are more commonly afflicted with rheumatoid arthritis – the risk of developing osteoarthritis increases with age, according to arthritis society canada.
lifestyle can play a big role in helping to avoid developing most types of arthritis. maintaining a healthy weight eases pressure on hips and knees, and the healthy diet that goes along with that maintenance can help prevent or reduce the likelihood of developing gout.
good oral hygiene is also important, according to dr. diane lacaille, rheumatologist, scientific director and researcher at arthritis research canada. “it’s been recognized that gum disease causes an autoimmune reaction in the mouth and some of those antibodies cross-react and can cause rheumatoid arthritis. we also know that microbiome, the flora in your gut, may play a role.”
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you can also ward off arthritis by protecting your joints during sports or other activity that requires repetitive knee bending. on the other hand, inactivity can increase severity and progression of many types of arthritis. and, of course, not smoking reduces your risk.
“exposure to smoke [triggers] the production of antibodies called ccp [cyclic citrullinated peptide] that can [initiate] the autoimmune reaction that causes the inflammation in the joints,” says lacaille. “not smoking is particularly important in first-degree relatives of people with ra who have that antibody.”
what doesn’t cause arthritis, despite popular belief, is cracking your knuckles. it can, however, harm ligaments or tendons which can eventually reduce grip strength. you also won’t get it from sleeping on one side or sitting cross-legged. but if you already have arthritis, good posture can curb soreness, stiffness and fatigue.
and nightshade foods (potatoes, tomatoes, bell peppers, eggplant, and spices like cayenne and paprika) won’t bring it on, either. there are some foods, however, that can increase inflammation if you already have arthritis, such as processed meats, red meat, refined carbohydrates, high-fructose corn syrup, and the added sugars in many processed foods.
on the flip side, there are certain foods that can help fight inflammation, such as fruits and vegetables, extra virgin olive oil, omega-3 fatty acids, dairy, green tea, nuts and garlic.
“there’s a lot of misinformation about [foods],” says miller. “what we [recommend] is eating for overall health and well-being, so picking a diet that’s based on canada’s food guide, which includes lean protein, lots of fruits and vegetables, whole grains. it also helps with our energy level, which might encourage us to exercise which can indirectly help with arthritis.”
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know your arthritis treatment and therapy options
each arthritis type is treated differently, says lacaille, with inflammatory arthritis having more promising therapies. “we now recognize that inflammation is not only bad for the joints, it’s bad when it’s in the whole body, which can lead to other chronic diseases like heart attack and stroke.
“with newer treatments, we’re able to turn off that autoimmune and inflammatory response. and if we do it early enough, before it’s caused damage to the joints, it makes a huge difference in the long-term outcome of these patients and they don’t develop the deformities we used to see 20 years ago.”
she says researchers have gained a much better understanding of what drives inflammation, what’s abnormal in the immune system, and in the inflammatory pathways that causes that inflammation that then becomes a self-perpetuating cycle.
as a result, there are now drugs — and more in the pipeline — that target those parts of the immune pathways that are causing the inflammation and joint damage.
“arthritis is a lifelong disease, and often one medication will work for a certain amount of time then lose its effect, or people develop side effects and need to change medication,” says lacaille. “the good news is that there are a lot of different options that target different parts of the immune system, different classes of biologic agents that are extremely effective at stopping the inflammation and preventing joint damage.”
as for a cure, she says we’re not there yet. “we like to call it a remission, when you’ve been so effective at blocking the inflammation that there is essentially little to no symptoms.”
the news isn’t so good for osteoarthritis, which is generally due to the cartilage in the joint losing the ability to repair itself causing premature degeneration of the cartilage inside the joints, says lacaille. “so the initiating event is not an autoimmune phenomenon causing inflammation. it can be a prior sports injury, for example, or a metabolic disease that affects the composition of the cartilage that makes it not able to repair itself. or it may be an alignment problem in a person’s joints that causes excessive loads in, say, their knees or hips.
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“there is also inflammation in oa but it’s a secondary process. once you have some breakdown, it then turns on an inflammatory reaction inside the joints which leads to some damage and you get a perpetuating cycle where you get more and more damage to the joint.”
she says acetaminophen helps with pain management and has the least risk of side effects. if that’s not sufficient, anti-inflammatory creams can be effective. “anti-inflammatory pills are also an option, as long as you don’t have contra-indications like high blood pressure, heart disease or kidney disease. we tend to use them sparingly, especially as people get older. but some people need them to have a good quality of life, we [just need to monitor] the kidneys and blood pressure and the potential for inflammation in the stomach.”
miller says some provincial medical plans cover medications, particularly for people over 65. your family doctor or a social worker can advise on who to contact for more information on coverage options.
find your arthritis care team
occupational therapists and physiotherapists, who can also ease pain and increase the range of motion in limbs, are important components of a multidisciplinary team.
“often people try to grin and bear it and push through on their own,” says miller. “we would love it if more people came to see us when they first start having symptoms because the earlier we can intervene the better. most people are referred by their family doctors, rheumatologist or surgeon and it’s usually at a point when they’re having a lot of trouble with mobility or pain.”
funding for these types of therapies varies from province to province. the arthritis rehabilitation program is fully funded by ontario health, as is the mary pack arthritis program in b.c., which offers the services of occupational therapists, physiotherapists, social workers, and group or one-on-one education and supports.
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miller says the therapists in her program assess people either virtually or in one of their clinics.
“we get to know how they’re doing with their functional activities, then we teach them self-management strategies they can do at home on their own. we might look at their foot wear to make sure they’re wearing proper supportive shoes; maybe they need an assistive device to help with their function; often there’s an exercise component as well.”
she says that, while they don’t endorse no-pain-no-gain exercise, they do believe you’ll lose it if you don’t use it. so they encourage participants to keep moving since symptoms tend to get worse the more sedentary they are.
“we might prescribe range of motion exercises where you’re bending and straightening a joint through whatever range you have available to loosen that joint, which helps with circulation and blood flow and often with stiffness. we also encourage some form of low-impact cardiovascular and weight-bearing exercise, such as swimming, stationary bike, or walking, where you’re putting some weight and pressure through the hips and knees, which can help keep the cartilage healthy. we call it the sponge theory: if you think of cartilage like a sponge and you squeeze it when you’re walking and running and biking, you’re helping the fluid go in and out of the cartilage.”
day-to-day arthritis management and support
as for heat versus cold packs to ease the pain, miller says you should choose whatever works for you. “most people prefer the heat. i would suggest using a heating pad for 10 to 20 minutes and see how that feels. moist heat is usually a bit more effective than dry heat. for the hands, you can try rubbing a little mineral oil on your hands, put on a pair of yellow cleaning rubber gloves, and soak them in hot water.”
she says there is also a wide variety of splints, such as a functional splint that supports the hand joint during the day, and then a resting splint for nighttime to keep the joint in a comfortable position while you sleep. compression gloves are also good for sore joints.
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miller says that while there is some evidence that supplements, such as turmeric or glucosamine, might help with inflammation, it’s mostly inconclusive. so she sticks to the recommendation of maintaining a healthy diet and lifestyle overall.
and while some people may need the help of an in-home personal support worker to help with mobility, or physiotherapists or occupational therapy so they can remain at home longer, those services are in such demand that there’s often a long wait list to see one in many provinces.
she says the ontario arthritis rehabilitation program also offers social workers for mental health support. “it really is part of a well-rounded treatment plan to involve a social worker or counsellor, someone who can help with managing the emotional challenges that come with living with a chronic illness.”
other support groups, either in person or virtual, are available through arthritis society canada, through webinars such as arthritis talks on youtube, and arthritis research canada’s “wellness conversations” on everything from exercise to managing fatigue, anxiety, depression and stigma, to preparing for medical appointments and even parenting with arthritis. miller also recommends the gla:d program, an education and exercise plan for people with hip and/or knee osteoarthritis.
“whether it’s a walking buddy, a group exercise class in your community, or having a regular phone call with a friend or family member, ensuring we have adequate social support can be an important aspect of maintaining a good quality of life with arthritis,” says miller.
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