How exercise can ease arthritis

From navhindtimes.in

World Physiotherapy Day is observed on September 8 to raise awareness about the vital role that physiotherapy plays in enhancing public health and well-being.

This year, the focus of World Physiotherapy Day which is observed annually on September 8 is arthritis, with an in-depth look at some of the forms of inflammatory arthritis including rheumatoid arthritis (RA) and axial spondyloarthritis (AS). This follows the theme for 2022, which focused on osteoarthritis (OA).

Arthritis is a broad complex. It’s an acute or chronic inflammation that often co-exists with pain and structural damage. Arthritis is often associated with older age groups but it can also affect children. Being a joint disease, arthritis also has systemic repercussions. A few forms of degenerative arthritic conditions include osteoarthritis, spondyloarthritis, autoimmune or autoinflammatory process causing rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, arthritis due to septic infections, and juvenile idiopathic arthritis in children.

Arthritis affects people in different ways and each condition has specific symptoms. However, some common symptoms are pain, swelling, redness, warmth, morning stiffness or reduced movement of the joint, fatigue, rashes, fever, and weight loss. Rheumatoid arthritis (RA) is a systemic autoimmune disease where joint complaints are in the foreground. Joint involvement occurs insidiously over a period of months and in some cases, it may occur over weeks. It includes polyarthritis of small joints of hands and morning stiffness in the joints like wrist, elbows, shoulders, hips, knee, and cervical spine which may last up to several hours. Patients also complain of difficulty in walking or doing daily activities of living. Late in the course of the disease, patients may present with different deformities. Other symptoms include symmetrical joint swelling and tenderness, positive rheumatoid factor, and radiographic erosive bone loss.

Ankylosing spondylitis (AS) or axial spondyloarthritis is a type of arthritis that causes stiffness and pain in the spine. It causes some of the bones in the spine called vertebrae to fuse. This fusing makes the spine less flexible resulting in structural and functional impairment. In advanced stages, it can give the spine a similar appearance to bamboo. Hence, this condition is also called bamboo spine. Along with the spine, it also affects the hips, knees, shoulders, eyes, skin, and the cardiac as well as intestinal systems.

Many people are unaware that early intervention by the physical therapist will help preserve the integrity and function of the affected joints. Early intervention can also stave off the unnecessary suffering from debilitating pain and a possible recourse to surgery. Hence, physiotherapy is an important part of your overall treatment of all forms of arthritis. Being part of a multi-disciplinary team, physiotherapists will be able to assess your condition and abilities and guide you to keep active, and help manage your symptoms.

People with RA and AS have an increased risk of cardiovascular disease. Hence, a healthy lifestyle, including physical activity, is important. Physiotherapists will devise an exercise programme tailored to help you to maintain the whole body flexibility and reduce pain, manage swelling, and support you in developing skills for daily activities of living. Even when you are in pain, continuing exercises at the levels that suit you has significant benefits. Physiotherapy helps to slow down the degenerative process by improving the strength and stability in the muscles that surround a given joint, thereby decreasing the wear and tear to your joints from activities of daily living.

In brief, physical therapists help you strengthen your muscles around the affected joints, advice on stretches to maintain the range of the movement of joints, teach you proper postures and body mechanics to ease the activities, suggest modifications to your environment such as ergonomic advice like using proper chairs or cushioned mats, and help you choose assistive devices, braces, splints and shoe inserts to relieve stress on the joints, and to control deformities.

Hydrotherapy (aqua therapy), a form of exercise in water, is also an excellent treatment procedure to improve your mobility as well as strengthen muscles as water reduces 50% of body weight. Hydrotherapy enables people with RA to exercise with ease as water supports your body weight and there’s reduced pressure on the joints. In addition, physiotherapists will also take care of socio-psychological factors along with rehabilitative options to improve the patient’s quality of life. While it is impossible to turn back the hands of time to eliminate the effects of arthritis, physical therapy is proven to help individuals decrease their symptoms of pain and stiffness associated with arthritis.

https://www.navhindtimes.in/2023/08/30/magazines/buzz/how-exercise-can-ease-arthritis/

Are people with arthritis or other inflammatory neurological diseases more likely to be depressed?

From breakinglatest.news

Mood disorders, including anxiety and depression, are often associated with inflammatory rheumatologic diseases, particularly rheumatoid arthritis and spondyloarthritis

I have suffered from arthritis for years and now also from depression. I have changed several therapies, but without definitively resolving the mood disorder which has a strong impact on my life and perhaps also on the pain. What can I do?

Answers Charles Selmi
Head of Rheumatology and Clinical Immunology, Humanitas Institute, Milan (VAI AL FORUM): 

Mood and anxiety disorders, especially depression, are the condition most frequently associated with inflammatory rheumatologic diseases, especially rheumatoid arthritis and spondyloarthritis including ankylosing spondylitis and psoriatic arthritis. From an immunological point of view, it is known that some mechanisms of inflammation are also at the basis of depression and anxiety and above all that the presence of these disorders worsens chronic pain, often increasing the need for symptomatic therapy. 

The severity of depression and anxiety does not depend on the severity of the arthritis, although better control of rheumatologic disease also leads to improved mood. A recent study presented at the annual congress of the European society of rheumatology EULAR, held in Milan at the beginning of June 2023, demonstrated that out of over 42,000 patients with arthritis, 34% of those with ankylosing spondylitis and 22% of those with rheumatoid arthritis, suffered from anxiety while 27% and 19%, respectively, suffered from depression. The same study demonstrated that the presence of anxiety or depression is associated with a worse control of the rheumatological disease also due to a lower adherence to the prescribed therapy and therefore to less regular use of prescribed medications. 

The management of anxiety and depression is often unsatisfactory and the results of this study demonstrate that it is necessary to recognize these conditions to improve the management of rheumatological diseases. It is also necessary to remember that some therapies, especially in the case of psoriatic arthritis, must be used with caution or avoided in those suffering from depression because they could cause it to worsen. 

Rheumatoid arthritis and spondylarthritis represent systemic diseases that are associated with a high risk of other conditions, both metabolic and psychiatric, and in the case of the presence of depression or anxiety in arthritis sufferers, a combined management between rheumatologist and psychiatrist is certainly desirable for better control of both diseases and to improve the quality of life.

https://www.breakinglatest.news/health/are-people-with-arthritis-or-other-inflammatory-neurological-diseases-more-likely-to-be-depressed/ 

The Connection Between Back Pain & Arthritis

From wth.org

Back pain is one of the most common medical complaints. It’s widely reported that about 80% of adults experience low back pain at some point in their lives. Most back pain goes away on its own within a few days to a few weeks and is not due to chronic disease. Most acute back pain is due to a musculoskeletal injury like a muscle strain or sprain and usually lasts one to seven days. Otherwise, it’s considered chronic and may be caused by arthritis. 

Adam Reinhard, NP

Many people do not suspect arthritis as a cause of their back pain. Arthritis in the back can occur in conjunction with other causes of back pain which can make it harder to get the right diagnosis and treatment. Many forms of arthritis and related conditions can cause back pain, stiffness and swelling. The lower back is the most common site of arthritis back pain.

“Although back pain is a common symptom, not all people with arthritis in the back have symptoms like pain, even those with advanced back arthritis,” said Adam Reinhard, Nurse Practitioner with West Tennessee Medical Group Neuroscience & Spine. “On the other hand, some people may experience back pain even before evidence of arthritis can be seen on an X-ray.”

Arthritis in the back, known as spinal arthritis, is inflammation of the joints in the spinal column, ranging from the pelvis up to the neck. Back arthritis is not one disease, rather, many different types of arthritis may cause back pain and stiffness. Symptoms may be related to issues like wear and tear of the joints in the spine, autoimmune disease and widespread inflammation, or infection. Though many different types of arthritis can affect the back, they generally fall into two basic categories—mechanical causes and inflammatory causes, which include rheumatoid arthritis as well as arthritis in the spinal arthritis family. Mechanical back pain, which includes osteoarthritis, is far more common than inflammatory back pain. 

The differences between mechanical and inflammatory back pain can sometimes be subtle, but there are often clear differences in the nature of the pain. Generally, inflammatory back pain strikes at a younger age, feels stiff first thing in the morning, feels better with exercise and movement but worsens with rest and inactivity. It can last for three months or more but can come and go. The inflammatory back can also wake you in the middle of the night with severe pain. 

The more common types of arthritis that affect the back include: 

Osteoarthritis is the most common form of arthritis. Also known as “wear and tear” arthritis. It is a chronic condition caused by the breakdown of the cartilage, which cushions the ends of the bones where they meet to form joints. This breakdown causes the bones to rub together, causing stiffness, pain and loss of joint movement. As you get older, you’re more likely to develop osteoarthritis of the spine. 

Rheumatoid arthritis is an autoimmune disorder, meaning that the immune system turns on itself. It attacks the lining of the joints. Although rheumatoid arthritis is more common in other joints, it can also affect the spine, specifically the neck. Rheumatoid arthritis of the spine is not caused by wear and tear, so it’s considered an inflammatory arthritis. It may cause back pain and pain in other joints even when these joints are not in use. It tends to affect women more than men. This inflammatory arthritis often affects the cervical region of the spine (neck). It is more commonly diagnosed in women. 

Spondyloarthritis is an umbrella term for several types of arthritis that cause inflammation in the spine. These include ankylosing spondylitis, psoriatic arthritis, reactive arthritis, undifferentiated spondyloarthritis, and inflammatory bowel disease-associated spondyloarthritis. While each of these conditions can bring on different symptoms, they all can cause inflammation and pain in the spine. 

The causes of arthritis in the back or neck vary depending on the type of arthritis you have. Besides normal wear and tear and autoimmune triggers, in many cases, the exact cause remains unknown. Genetic components have been identified in connection with some forms of spinal arthritis, meaning that it may be hereditary.

The treatment for spinal arthritis varies depending on several factors, including type and severity of arthritis, level of pain, age, and overall health status. Because arthritis is a chronic disease, meaning there is no cure, the treatments typically focus on pain management and preventing further damage to the joints.

“When back pain persists for weeks or months, it’s time to investigate whether a medical condition could be responsible for the symptoms,” said Reinhard. “Arthritis is difficult to self-diagnose. Talk with a doctor about your symptoms. Left undiagnosed and untreated, your condition may worsen and cause disability.” 

https://www.wth.org/blog/the-connection-between-back-pain-arthritis/ 

Early sign of arthritis that's a pain in the backside

From irishnews.com

Too often lower backache is put down to sciatica - and the long delay in diagnosis can lead to permanent damage

AS a hotel chef often on his feet for 10 hours a day, and a keen rugby player, Gareth Dwyer put the constant ache in his buttocks down to his work and lifestyle.

"I played rugby as a prop - pushing against the full weight of the opposing team's scrum - so I thought the pain was just wear and tear from being very active," says 42-year-old Gareth.

"When I was walking, though, I was hunching over like a turtle and the pain could radiate into my hips - the only way I'd get any relief was to put my hands behind my back and press my palms together like Prince Charles does, which my wife took the mickey out of me for."

The backside aches had affected him since his late 20s, and at times were severe enough to wake him in the early hours, but he ploughed on.

It wasn't until the age of 35, when he fell down some steps and fractured his spine, that Gareth learned his aching buttocks were a sign of a form of inflammatory arthritis.

His X-ray and MRI scans showed that the bones in the joints, which join the lower spine to the pelvis, were fused and inflamed.

Gareth also had a positive blood test for the HLA-B27 gene, which predisposes people to developing inflammatory arthritis. This confirmed that Gareth had axial spondyloarthritis (or axial SpA), a form of arthritis that affects the spine and sacroiliac joints.

Back pain that radiates into the hips is usually caused by sciatica but can also be a form of inflammatory arthritis

An estimated 220,000 people in the UK are thought to have axial SpA. It can run in families, and possible triggers for those with a genetic predisposition include infections, stress and trauma.

The conditions that fall under the umbrella include non-radiographic axial SpA (where these joints become inflamed, but this is not visible on an X-ray).

In some cases this can progress to radiographic axial SpA (also known as ankylosing spondylitis), where inflammation causes extra bone to grow, leading to the fusion of vertebrae in the spine.

As well as affecting the ability to do everyday things, including bending, it can impact breathing if the ribcage is affected and the lungs can't expand enough. The inflammation also causes pain and fatigue, and walking can be hard.

Not everyone with axial SpA develops spinal fusion - risk factors include smoking and testing positive for the HLA-B27 gene - but treating symptoms early may help prevent the progression.

Gareth's delayed diagnosis meant that his symptoms had already advanced to those of radiographic axial SpA.

"My posture was affected because of the weakness in my sacroiliac joints, as they couldn't support my spine," he says.

Buttock pain that lasts longer than three months is one of the common symptoms of axial SpA, says Dr Raj Sengupta, a consultant rheumatologist at the Royal National Hospital for Rheumatic Diseases in Bath.

"With axial SpA the main joints involved are the sacroiliac joints, which are over the top of the buttocks, and it's inflammation in these joints that is one of the key features," says Dr Sengupta, who is also a medical adviser for the National Axial Spondyloarthritis Society (NASS) charity.

"The buttock pain radiates from the joints and can alternate from one side to the other - this is a classic sign of axial SpA - or just stay on one or both sides.

"The problem with buttock pain is that it's often confused with sciatica, a common condition caused by irritation of one of the two sciatic nerves that come out of the spinal cord," he explains.

"Sciatica causes pain and tingling in the buttock and radiates down the leg to the feet, but with axial SpA, if you get the buttock pain, it won't radiate right the way down the leg and past the knee.

"Some people are told they have sciatica when they actually have inflammation of the sacroiliac joints caused by axial SpA."

Some people are told they have sciatica when they actually have inflammation of the sacroiliac joints caused by axial spondyloarthritis

Dr Sengupta says this is one of the reasons why it takes eight-and-a-half years to get a diagnosis on average.

"It's heartbreaking as a rheumatologist to see patients in a clinic who have experienced back pain for years and the cause has been put down to sports injuries or work," he says.

"I'll see up to five of these patients a week. The pain often first occurs when someone is in their 20s, when they are building relationships and a career, and they are left struggling with symptoms.

"This may lead to mental health problems, as well as more damage to their spine."

Another warning sign is back pain lasting more than three months that starts before the age of 40 - back pain that starts after 40 is more likely to be caused by wear and tear - including pain in the lower back that wakes you in the early hours.

One theory for this is that levels of cytokines, compounds that cause inflammation, peak at night. A further warning sign is morning joint stiffness that doesn't wear off after half an hour, but improves with movement and not rest.

Now the charity NASS has launched a campaign to encourage anyone under the age of 40 living with this kind of persistent back pain to see their GP to check if it's axial SpA.

"It's a race against time with axial SpA," says Dr Dale Webb, chief executive at NASS, explaining that the risk of serious and irreversible damage rises the longer someone goes without treatment.

"The good news is that, with the right treatment and care, people can live very well with axial SpA."

Axial SpA is typically treated with biologic drugs that switch off inflammation, says Dr Sengupta.

"These have been around for more than 20 years and were approved to treat axial SpA [in the UK] in 2008. There is a definite halting of progression of the disease with these drugs. This is why it's so important that we diagnose patients as early as possible, identify those who are most likely to progress and treat them appropriately," he says.

Following his diagnosis, Gareth was put on diazepam and the opioid tramadol to help with pain, but within two years he was needing higher and higher doses to keep the pain in check.

He was switched to biologic drugs three-and-a-half years ago and says their effects have been "transformative".

"I now inject myself with a pre-loaded jab once a week and it's been life-changing," says Gareth.

"I've been able to come off diazepam completely and greatly reduce my tramadol dose. It's also let me carry on working as a chef - at one point I thought I'd have to give up as the pain was so bad.

"I use walking poles to keep me upright and improve my breathing. But I can now walk with my hands by my side instead of held behind my back, and I can also be an active dad to my son, and lift him up and play ball games with him - things I had feared I'd never be able to do.

"What scares me, though, is that but for the accident, I could have gone on like that for years, while all the time my spine could have been degenerating.

"I just wish I'd known that pain in your backside can be a sign of a progressive illness and shouldn't be ignored, and then I might not have suffered permanent damage to my joints."

nass.co.uk   © Daily Mail

https://www.irishnews.com/lifestyle/health/2021/11/01/news/early-sign-of-arthritis-that-s-a-pain-in-the-backside-2461832/