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What is rheumatoid arthritis?

<p>Arthritis is a broad term to describe inflammation of the joints which become swollen and painful. There are many <a href="https://arthritisaustralia.com.au/what-is-arthritis/types-of-arthritis/">different kinds</a>. <a href="https://arthritisaustralia.com.au/types-of-arthritis/osteoarthritis/">Osteoarthritis</a>, the most common, is caused by wear and tear.</p> <p>This is <a href="https://painhealth.csse.uwa.edu.au/pain-module/rheumatoid-arthritis/">followed by</a> rheumatoid arthritis, an autoimmune condition where the person’s immune system mistakenly attacks and damages its own joints and <a href="https://www.sciencedirect.com/science/article/abs/pii/S1568997211001923">other organs</a>.</p> <p>Rheumatoid arthritis is relatively common, affecting around <a href="https://www.sciencedirect.com/science/article/pii/S0140673616301738">one in 100 people</a>, including young people and even children.</p> <p>Twenty-nine-year-old Danish tennis player Caroline Wozniacki <a href="https://www.abc.net.au/news/2018-10-26/caroline-wozniacki-diagnosed-with-rheumatoid-arthritis/10432300">told fans last year she was diagnosed with this condition</a>. Earlier in 2018, she had won the Australian Open, then struggled with unexplained symptoms.</p> <p>Researchers do not fully know what causes rheumatoid arthritis, but suspect certain genes may trigger it when combined with environmental and lifestyle <a href="https://www.sciencedirect.com/science/article/pii/S0140673616301738">factors</a> such as smoking or infections.</p> <p><strong>How does it feel?</strong></p> <p>People commonly experience joint pain, but it is particularly bad in the mornings and when they rest. Joints in the hands, feet, wrists, elbows, knees and ankles may be stiff for hours at a time. But unlike osteoarthritis, the pain can actually get better with movement.</p> <p>If the inflammation in rheumatoid arthritis is not controlled, people experience joint pain, stiffness, fatigue and can almost feel like they have the flu.</p> <p>The inflammation can lead to damage to the bones and cartilage (cushion) in joints causing deformity and disability. This can affect work, and social and family life.</p> <p>In <a href="https://www.sciencedirect.com/science/article/abs/pii/S1568997211001923">18% to 41% of patients</a>, the condition can cause inflammation in other parts of the body, such as the lungs (this may cause a condition called interstitial lung disease) and the blood vessels (leading to a condition called vasculitis).</p> <p>People with severe rheumatoid arthritis also have an <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/hon.2525">increased risk of developing lymphoma</a>, a type of cancer of the lymphatic system, which helps rid the body of toxic waste.</p> <p><strong>How is it diagnosed?</strong></p> <p>When a GP suspects someone has rheumatoid arthritis, the patient is referred to a rheumatologist for a detailed physical examination focusing on joint pain, tenderness, swelling and stiffness.</p> <p>The patient will have some routine blood tests to look for signs of inflammation and “autoimmunity” – <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6287017/">antibodies directed against the patient’s own tissues</a>.</p> <p>The person may also have an x-ray of the affected joints (if the symptoms have been present for more than three months) to look for signs of cartilage thinning and bone erosion (small bites out of the bone).</p> <p>Ultrasound and MRI are less useful for <a href="https://advancesinrheumatology.biomedcentral.com/articles/10.1186/s42358-018-0023-y">diagnosis</a>, but can sometimes be used to monitor the condition.</p> <p><strong>How is it treated?</strong></p> <p>While there is no cure for rheumatoid arthritis, medicines can effectively control the condition and stop visible signs of damage.</p> <p>With good treatment, it’s now very rare to see deformed joints or people in wheel chairs.</p> <p>Treatments should start as early as possible and will vary according to how active and severe the condition is. Some people need only a small amount of medicine whereas others will try many different medicines, sometimes in combination.</p> <p>Because the immune system is overactive and mistaken in its target, the treatment approach is to dampen the immune response.</p> <p>Initial treatment may include a low dose of steroids called prednisolone, as well as an immune-suppressing drug such as <a href="https://www.arthritis.org/living-with-arthritis/treatments/medication/drug-types/disease-modifying-drugs/methotrexate-side-effects.php">methotrexate</a> or <a href="https://rheumatology.org.au/patients/documents/Leflunomide_2016_Oct2016_000.pdf">leflunomide</a>, to control the inflammation.</p> <p>If the condition is not controlled by these drugs, then other medicines, mostly injections, called “<a href="https://arthritisaustralia.com.au/things-to-consider-when-taking-a-biologic/">biological</a>” drugs, can be added. These mimic substances naturally produced by the body and block specific substances in the immune system. Very recently, some newer tablets have been approved for rheumatoid arthritis.</p> <p>Pain management may also be needed with medicines like non-steroidal anti-inflammatory drugs such as ibuprofen.</p> <p>Inflamed, swollen joints can also periodically be treated by local joint injection of steroids.</p> <p>People with rheumatoid arthritis will also greatly benefit from physiotherapy and occupational therapy. They will learn exercises to maintain joint flexibility, as well as alternative ways to perform daily tasks that may be difficult or painful.</p> <p>But the fatigue is very difficult to treat. Gentle graduated exercise programs, a good healthy diet, understanding of the condition and its treatment, as well as psychological support, can help with fatigue.</p> <p>Most people with rheumatoid arthritis can no longer be distinguished from people without the condition and live full and active lives. However, for a small percentage of unlucky patients who have aggressive disease or cannot tolerate any of the medicines, the course can be more difficult.</p> <p><em>Written by <span>Fabien B. Vincent, Research Fellow; Rheumatology Research Group, Centre for Inflammatory Diseases, Monash University and Michelle Leech, Rheumatologist, Professor/Director Monash Medical Course/ Deputy Dean Health Faculty, Monash University</span>. Republished with permission of </em><a rel="noopener" href="https://theconversation.com/what-is-rheumatoid-arthritis-the-condition-tennis-champion-caroline-wozniacki-lives-with-119537" target="_blank"><em>The Conversation</em></a><em>. </em></p>

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Diet tricks to combat arthritis

<p>I sat down in an armchair in our new house – we'd moved in a few days earlier – and realised that my thumb was aching, painfully.</p> <p>That was seven years ago. Over the next few days and weeks, the aches spread. I couldn't use my hands as normal. Getting lids off jars was impossible. I put it down to the stress of moving home and work – my husband and I run a yacht design business and had just relocated from London to Lymington in Hampshire. I was exhausted.</p> <p>Two weeks later, I suffered what I now know was a full-blown rheumatoid attack. Every joint in my body ached, I couldn't get up from my chair or drive, as raising my arms to steer was impossible. I climbed stairs like someone much senior to my age. I was only 43.</p> <p>My husband, Richard, and daughter Charlotte, then aged eight, were worried, too. I went to a chiropractor, who sent me straight to a GP. After three months of to-ing and fro-ing, I was diagnosed with rheumatoid arthritis, an autoimmune disease in which the immune system attacks the cells that line the joints, making them swollen, stiff and painful.</p> <p>The rheumatologist gave me a steroid injection followed by ongoing steroids (prednisolone), then put me on methotrexate, a disease-modifying anti-rheumatic drug that is also used in higher doses in chemotherapy. It blocks the immune system from attacking the joints, slowing the progress of the disease and preventing pain. Within a few weeks, the pain had subsided, I could function again. It was a huge relief.</p> <p>But I was worried about the long-term effects of the medication. Methotrexate can affect the liver and compromise the immune system, and can cause side effects such as nausea, diarrhoea, headache and irritability.</p> <p>I had to have my liver function tested every two months. My white blood cell count dropped and I was getting coughs and colds, a sign that my immune system was weak. So, after a year, I asked my rheumatologist how long I'd have to remain on the medication. "For life," was his reply.</p> <p>That horrified me. So what caused my illness? He thought stress could be partly to blame, but didn't suggest any lifestyle changes that might help, nor that diet could be linked with inflammation. I therefore did some research of my own.</p> <p>I'm half-Italian and was brought up on a healthy Mediterranean diet with plenty of olive oil and vegetables. In my twenties and thirties, though I still ate my five-a-day, I ate out a lot. I wasn't fat but I ate too many processed foods, too many refined carbohydrates, such as bread, pasta and biscuits.</p> <p>The more I looked into the latest research challenging the status quo, the more convinced I became of the link between certain foods and inflammatory conditions.</p> <p><strong>Eating too many refined foods can starve the body of important minerals. </strong></p> <p>Sugars-in particular, fructose, which is found in all sugar, both processed or natural, and in many foods as well as fruit juices - triggers the release of inflammatory messengers called cytokines, which drive inflammatory diseases. I learnt that modern eating habits - too many processed foods, carbohydrates, sugars and a severe lack of fibre - were leaving us overfed but at the same time starved of vital vitamins and minerals, which could be driving diseases such as cancer, Type 2 diabetes and, indeed, arthritis.</p> <p>So I cut out sugar, bread, anything containing refined flour and substituted it with chickpea flour. I avoided mayonnaise and food cooked in cheap vegetable oils, all too high in pro-inflammatory omega-6 polyunsaturated fat; instead, I opted for quality grass-fed butter or coconut oil (in moderation), along with plenty of steamed vegetables served with cold olive oil, as my Italian grandparents used to do.</p> <p>I began preparing homemade bone broths and chicken stocks, and making my own sauerkraut, which is full of probiotics - live bacteria and yeasts that enhance the immune system. I ate only fresh wholefoods. Diversity and moderation were my watchwords.</p> <p>Within weeks, I felt better. I slept soundly, my skin cleared and my energy levels soared. I swam five days a week and walked as much as I could.</p> <p>But I didn't know for sure whether my efforts were helping my arthritis, as the methotrexate was still masking the symptoms. So, after three years, I stopped taking it. To my relief, the symptoms had entirely gone. I was pain-free and remain so, four years later. These days, I don't take any medication - not even paracetamol.</p> <p>I still savour the joy of being able to take the stairs two at a time, drive, walk, swim, cook and work. I'll never take good health for granted again.</p> <p>Today, at 50, I feel happier, calmer, more energetic and focused than I have done in years. When you take a holistic approach, rather than trying to fix specific symptoms with medication, you fix your whole body.</p> <p>I decided to only eat fresh wholefoods in order to beat her rheumatoid arthritis</p> <p>I'm not anti-medication. It really helped initially, stopping further joint damage, stabilising my condition and giving me time to help myself.</p> <p>Frustrated by the confusion all around us on health and nutrition, I wrote a book condensing the expert advice and information I gathered in my six year-journey of research.</p> <p>I hope it will help others to learn how to protect them from inflammation, which, I believe, is the driving force of many modern western diseases. If we eat the right things, we can all be less fearful about our health. I'm living proof.</p> <p><strong>Dietary changes that can ease the pain of inflammation</strong></p> <p><strong>Omega-3s</strong></p> <p>A study funded by Arthritis UK suggested that a diet rich in long-chain omega-3 fatty acids – found in fish oils – could help. Try two portions of oily fish – such has salmon, trout, mackerel, sardines and fresh tuna (but not tinned) – per week.</p> <p><strong>A Mediterranean diet</strong></p> <p>A 2012 publication analysing findings from several studies found that foods high in olive oil, omega-3-rich fish, and fruit and vegetables could have a protective effect.</p> <p><strong>Avoiding sugar</strong></p> <p>Processed sugars can trigger the release of inflammatory messengers called cytokines, according to a study published in <em>The American Journal of Clinical Nutrition.</em></p> <p><strong>Cutting out trans fats</strong></p> <p>A study by Harvard School of Public Health found that trans fats – which are found in fast, processed and fried foods – can trigger systemic inflammation.</p> <p><strong>Healthy gut bacteria</strong></p> <p>A British study is investigating how the amount and quality of bacteria in the gut and mouth can affect the immune system, causing inflammatory conditions such as rheumatoid arthritis.</p> <p><em>Written by Marina Young, first appeared on <a href="/Stuff.co.nz" target="_blank"><strong><span style="text-decoration: underline;">Stuff.co.nz</span><span style="text-decoration: underline;">.</span></strong></a></em></p> <p><strong>Related links:</strong></p> <p><a href="/lifestyle/family-pets/2016/05/my-mother-battled-polio-here-is-what-it-taught-me/"><strong><em><span style="text-decoration: underline;">My mother battled Polio. Here’s what it taught me</span></em></strong></a></p> <p><a href="/health/body/2016/02/nutrients-that-ease-arthritis-symptoms/"><em><strong><span style="text-decoration: underline;">Ease symptoms of arthritis with these 3 nutrients</span></strong></em></a></p> <p><a href="/health/body/2016/02/natural-pain-relief-at-home/"><em><strong><span style="text-decoration: underline;">Natural pain relievers in your kitchen cupboard</span></strong></em></a></p>

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