Strengthening Exercises

Exercises to strengthen your hip muscles can reduce pain and improve your physical function. Strong muscles help support and protect your hip joints and may delay the progression of your condition. Strength training is important for people with arthritis of the hip because it also helps to maintain healthy bones
These exercises will help you maintain strength in your hips


General guidelinesKeep your back in a comfortable position – not too flat and not too arched. This is called neutral spine
You should feel gentle movement in your hip. You should not feel more pain in your hip
Repeat these exercises 10 to 20 times, 2 to 4 times a day

Mini squat using a chair

.Hold onto the back of a chair with your feet shoulder width apart

Mini squat using a chair
Slowly bend your knees a few inches and squat
Keep knees over feet. Squat only a short distance, to avoid pain in your knees
Hold for 5 to 10 seconds, then return to starting position

Bridging
Lie on your back with your knees bent and your feet flat on the floor. You may want to place a pillow under your head. Gently tighten your stomach and buttock muscles. Lift your hips 3 to 5 inches from the floor without arching your back. Hold the bridge for 5 to 10 seconds, then slowly lower your hips to the floor

Basic Clam
Lie on your side with both knees bent and positioned in front of you. Gently tighten your abdominal muscles to protect your back. You may use a pillow to support your neck

Basic Clam
Slowly raise your top knee up and outward like a clam opening, using your buttock muscles. Hold for 5 seconds, then slowly lower your knee back to the starting position. Keep your buttock muscles tight and your feet together throughout the exercise. Do not roll your body or pelvis backward

Say No To Arthritis (Optimum Nutrition Handbook
?CHAPTER 3:  HOW YOUR BODY MaKes Pain                         
The first indication that you may be developing arthritis is joint pain. Pain and inflammation are the body’s way of saying, ‘Help!’ Although it is important to understand and deal with the underlying causes, taking painkillers and anti-inflammatory substances can help to calm down excessive and harmful inflammation, taking the body out of ‘emergency’ mode. Drugs can reduce pain by blocking chemicals that trigger inflammation, but they don’t come without side effects, which is why so many people are turning to natural alternatives.Inflammation – characterised by swelling, redness, pain and heat – underlies many diseases, probably a lot more than most of us realise. These include all the ‘itis’ conditions: arthritis, dermatitis, colitis, nephritis and hepatitis. Also included are asthma and others not usually associated with inflammation, such as Alzheimer’s and Parkinson’s (in which parts of the brain become inflamed), and atherosclerosis (in which the arteries become inflamed).
Pain and inflammation can be caused by an imbalance in a number of body processes, such as impaired liver detoxification, disturbed blood sugar control, allergies, excess oxidants, insufficient antioxidants and a lack of essential fats. Each of these can tip the body into a state of alarm. We’ll be looking into each of these key factors, because simple diet and lifestyle changes can strengthen your body’s resilience so that it won’t be tipped into a state of inflammation.
YOUR PAIN LEVEL
Before we look at what happens in your body when pain occurs, and the mechanism behind painkilling drugs and natural painkilling nutrients and herbs, let’s gauge your pain level.
Unlike a disease such as diabetes, which can be measured in the blood, there is no easy indicator in the blood for arthritis. The main indicator of pain and inflammation is simply how you feel. For this reason, health professionals use questionnaires to discover how effective a treatment is. There are several standard questionnaires, including the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) check for hip and knee pain, and the Oswestry test for back and leg pain. Check yourself out on the
questionnaire below
?Questionnaire: how’s your pain
?  Do you suffer from arthritis
? Do you have painful or aching muscles
   ?  Do you suffer from muscle stiffness that limits your movement
?  Do you wake up with physical pain
     ? Do you suffer from headaches  ?If so, how often
  On average once a week (score 1)
, twice a week (score 2) or more (score 3)
  ?  Does your level of pain make you feel tired
?     Does pain make you feel weak
?   Does it limit your ability to move around?Do you have aching or painful joints
    ? Does it limit your ability to sit for more than 30 minutes
?  How intense is your pain, without medication
Mild (score 1); discomforting (score 2); distressing
(score 3); horrible (score 4); excruciating (score 5)
Score 1 for each ‘yes’ answer, then add up your score
:Total score   

Score

Score
:If your total score is

Below 5
Your level of pain might be reduced by following the advice in this chapter. If not, I recommend you seek
advice from a nutritional therapist or nutritionally oriented doctor
Between 5 and 10 You have a moderate level of pain and should definitely explore each of the options in this chapter as well as seeking advice from a nutritional therapist or nutritionally oriented doctor

More than 10 You have a high level of pain and I advise you to consult a nutritional therapist or nutritionally oriented doctor. Although exploring the options in this chapter will give you a good background, you may well need additional help to put it all into practice.

WHAT CAUSES PAIN AND INFLAMMATION AND HOW ARE
 ?THEY TREATED 
The substances that cause inflammation and pain are called ‘inflammatory mediators’, which your body produces in response to some sort of ‘insult’. There are many of these body chemicals, such as prostaglandins, interleukins, cytokines, leukotrienes, oxidants, nitric oxide, insulin, and immunoglobulins. These in turn promote the accumulation of the substances that cause swelling, redness and pain.Pain-causing prostaglandins and leukotrienes are made from one of the omega-6 fats, arachidonic acid, which is very high in meat and dairy products. Too much of these foods in your diet can lead to over-production of these pain-causing body chemicals. So it’s a good reason to go easy on these foods if you’re in pain. Although some degree of inflammation can be an important protective mechanism, too many inflammatory mediators create pain. This is because inflammation is an ‘alarm signal’ to alert the body that something is wrong.
All over the body there are chemical accelerators and brakes. In the case of inflammation, there are three critical enzymes that turn harmless arachidonic acid into harmful inflammatory mediators. These enzymes are called COX-1, COX-2 and 5-LOX, as shown in Figure 4 overleaf. You could think of COX-1 as the ‘good’ COX, because it helps to protect the gut and the kidneys and promotes normal blood clotting; however, COX-2 is the ‘bad’ one because it increases pain and swelling, but also thins the blood. Blocking COX-1 alone reduces pain but damages the gut and thins the blood. Blocking COX-2 alone reduces pain but increases blood clotting (this is examined in detail on pages 32–34). Non-steroidal anti-inflammatory drugs (NSAIDs for short), such as aspirin or ibuprofen, target both of these enzymes, so they are good for stopping pain and inflammation. On the minus side, though, they are also likely to put you at risk of gastrointestinal bleeding when used regularly over the long term, and they also tax the liver.


Figure 4 – How your body’s chemistry makes pain
Because of the gastrointestinal problems mentioned above, the thinking was that the ideal NSAID would be one that blocked only COX-2 and left COX-1 alone. And the launch of drugs such as Vioxx in 1999 caused huge excitement because that’s exactly what they did. But problems with these drugs began emerging a few years after they appeared on the scene. Blocking an element – such as an enzyme – that is part of a network as complex as the body almost never has just one effect, which is why drugs nearly always have damaging side effects.
In 2004, Merck voluntarily withdrew Vioxx from the market because of concerns about increased risk of heart attack and stroke associated with long-term, high-dosage use. The precise details of the case have been chewed over in the courts for years, but whatever the legal niceties it’s clear that behind the scenes and in the medical literature, alarm bells had been ringing for years about the link with heart attacks. It’s just that they had been deliberately ignored.

NEW DISCOVERY
Scientists have focused on the COX-1 and COX-2 enzymes, but another pain-causing enzyme called 5-lipoxygenase (5-LOX) has been largely ignored. Scientists at the University of British Columbia found that combinations of COX and 5-LOX inhibitors were more effective than single inhibitors. Some nutrients – boswellic acid and curcumin, for example – have been found to inhibit this enzyme. Although 5-LOX is only just beginning to receive the attention it deserves among researchers, some pioneering work on the nature of this powerful enzyme suggests that levels tend to increase as we age.7 What is even more exciting is that the effect of various nutrients working together is only just starting to become known. When you combine some nutrients in a certain way the pain-relieving effect is multiplied.Using anti-inflammatory drugs in the short term can improve healing – as long as the problem that triggered the inflammation in the first place has gone. Eventually, if pain and inflammation persist over the long term, body tissues will begin to break down. In the case of arthritis, for example, the joint becomes increasingly hard and stiffened – calcified – until you can’t use it at all.
If you have joint problems, you may have had your erythrocyte sedimentation rate (ESR) measured. A high ESR means that your body is in a state of inflammation, as does a high level of c-reactive protein (CRP)?How is inflammation usually treated
The most common medical treatment for inflammation is anti-inflammatory drugs. These drugs are effective symptom suppressors, providing pain relief but doing nothing to address the causes of the inflammation. According to Dr Jeffrey Bland, a pioneer in new approaches to dealing with inflammation, instead of thinking pain means drug, inflammation is the body’s way of saying something is wrong. Inflammation is a systemic problem, not just a localised phenomenon, in which the body’s physiology is shifted into an ‘alarm state’. It’s as if there is a series of underlying imbalances in the body’s chemistry that build up and then burst forth, once the body can no longer cope. The actual symptoms, or pain, are the wave breaking, but the wave is a long time coming.   

Say No To Arthritis (Optimum Nutrition Handbook

INTRODUCTION

According to Dr Robert Bingham, a specialist in the treatment of arthritis, ‘No person who is in good nutritional health develops rheumatoid or osteoarthritis.’ Yet, by the age of 60, nine in every ten people in the UK have arthritis. According to the Arthritis Research Campaign, nearly 9 million adults in the UK (that’s 19 per cent of the adult population) have seen their GP in the last year for arthritis or a related condition, and 45 per cent experience symptoms. For all sufferers, arthritis means living with pain and stiffness. For some, it is a living hell and can be life-threatening. Yet arthritis is not an inevitable consequence of ageing. Arthritis can be prevented and the underlying causes can be eliminated. This book tells you how to:
    Reduce pain and inflammation without drugs.
    Identify and eliminate the causes of arthritis.
    Recover and gain mobility.
    Prevent arthritis and stop it progressing.
    Prevent osteoporosis and improve your bone density.
    Reduce muscle pain and prevent fibromyalgia.


CHAPTER 1
GETTING THE RIGHT DIAGNOSIS
There are two major kinds of arthritis, and many, less common, arthritis-like conditions. The most common kind is osteoarthritis (sometimes called OA). This ‘wear and tear’ disease affects joints that have been injured or simply worn out, often through poor posture and/or lack of mobility, which is necessary to keep joints flexible and healthy. This is much more common in people over the age of 50. Rheumatoid arthritis (sometimes called RA), however, is less common and more complex, but can strike at any age – even in childhood. It affects younger people and is ‘systemic’, meaning that the whole body’s immune system and inflammatory responses go into overdrive, perhaps nudged by hereditary factors and infections, as well as by diet and lifestyle

OSTEOARTHRITIS
About 80 per cent of people over the age of 50 show osteoarthritis-like joint damage, and a quarter of them experience pain. By the age of 60, over 90 per cent of people show evidence on X-ray of arthritis-like joint damage. Whereas osteoarthritis occurs later in life, painful and stiff knee problems – often diagnosed as chondromalacia (an abnormal softening or degeneration of joint cartilage, especially of the knee) – occur frequently in people under 40.Under the age of 45, osteoarthritis is more common in men; over the age of 45, it’s more common in women, probably due to reduced calcium absorption after the menopause. It starts as stiffness, usually of the weight-bearing joints such as the knees, hips and back, and progresses to pain on movement. The joints then become increasingly swollen and inflexible.
Figure 2 – How arthritis develops
The cause of this form of arthritis is more mysterious, but it may be due to immune system problems, perhaps triggered by a viral or bacterial infection, or a genetic weakness (it is thought that rheumatoid arthritis is, in part, hereditary). Rheumatoid arthritis often starts and flares up when nutrition is under par, probably because good nutrition is vital for immune strength. Most rheumatoid arthritis sufferers develop antibodies that attack normal components of the body, as if the immune system has malfunctioned. This is why rheumatoid arthritis is called an autoimmune condition – there is evidence that the body’s own immune system attacks the joints. Rheumatoid arthritis can be mild, or severe and active most of the time, last for many years, and lead to serious joint damage and disability. It is so disabling that half of all patients have to stop working within ten years of diagnosis.
ANKYLOSING SPONDYLITIS
The condition ankylosing spondylitis differs from other arthritic conditions in that it starts with inflammation of the ends of the ligaments, where they attach to the bones. This most commonly starts in the sacroiliac joint, where the pelvis and spine meet. As the disease progresses, the vertebrae at the base of the spine start to fuse together. The symptoms are lower back pain and stiffness. As the area becomes more and more inflamed, joint pain and stiffness may also occur in other parts of the body.When there is evidence of spinal fusion, but no pain or inflammation, the condition is called spondylosis.

GOUT
One in every 200 people will suffer from gout. It is caused by a build-up of uric acid, a substance in the blood that should be excreted from the body via the kidneys. Excess uric acid can form crystals that lodge in joints and tissue, most commonly the big toe, causing localised pain. When gout is present there is usually increased inflammation, which may affect other joints.

OSTEOPOROSIS
The condition osteoporosis is the gradual loss of bone density. As such it is not specifically a disease of the joints, but of the bones themselves. However, the health of bones does affect joints, and many underlying mechanisms that are now thought to contribute to osteoporosis are shared with osteoarthritis.
Osteoporosis is thought to affect over two million people in the UK. It occurs twice as commonly in women, and is most prevalent in women after the menopause. One in three women and one in 12 men have a fracture as a result of osteoporosis by the age of 70. It is usually identified only when a fracture occurs – often of the hip – and it is therefore considered a hidden epidemic. Forty people die every day as a result of fractures caused by osteoporosis.
Loss of bone density occurs because calcium is not being properly deposited in bone, or is actively being removed. Many factors are known to upset the calcium balance in bone. These include excess protein consumption, excess tea, coffee or alcohol, blood sugar problems, thyroid or parathyroid hormone imbalances, stress, loss of oestrogen and progesterone in the menopausal years, lack of weight-bearing exercise, lack of magnesium, and lack of vitamin D or sunlight. These factors are covered in more detail in Part 3, and Chapter 17 gives you a strategy for preventing and reversing osteoporosis.
POLYMYALGIA AND FIBROMYALGIA
An increasingly common problem, polymyalgia mainly affects older women, in which muscles (rather than joints) become stiff and painful. The onset is usually rapid and suggests that the problem may be triggered by a virus or by accumulated stress – ‘the straw that breaks the camel’s back’ – thus initiating a rheumatoid-like condition, marked by inflammation. The recommendations given in this book for reducing inflammation without drugs are often helpful (see Part 2).
Another debilitating condition causing muscle aches, pain and stiffness is fibromyalgia. This is different from polymyalgia in that it is not characterised by inflammation. The pain is thought to be caused by problems with energy production within cells, leading to muscle tension. These conditions are discussed fully in Chapter 18
OSTEOMALACIA OR RICKETS
The disease osteomalacia (in adults), or rickets (in children), is caused by a deficiency in vitamin D. We need this vitamin in order to use calcium properly. A lack of it leads to weak and pliable bones, resulting in bone deformities such as bow legs or bent fingers and toes. Vitamin D is made in the skin in the presence of sunlight, so both diet and exposure of the skin to the sun play a part. People with dark skin, who get little direct exposure to sunlight, and who also eat a vegan diet (without eggs, dairy products, meat or fish), are most at risk..
DISPLACED INTERVERTEBRAL DISC
Often wrongly referred to as a ‘slipped disc’, displaced inter-vertebral disc occurs when two vertebrae in the spine are out of alignment. This can put pressure on the spinal nerve that runs through the spinal column. Poor spinal alignment can also lead to rupture of the synovial sac between vertebrae, causing tremendous pain both from inflammation and through nerve compression. Eventually the vertebrae can fuse together.
BURSITIS, TENDONITIS AND TENOSYNOVITIS
These three inflammatory conditions do not affect joints as such. Bursitis refers to inflammation of the fluid-filled cushions that separate muscle from bone. The most common sites are in the shoulders, elbows and knees. Tendonitis is inflammation where the tendons attach to bone, and tenosynovitis is inflammation of the sheath surrounding the tendon.Terms such as lumbago (back ache) and rheumatism (systemic joint and muscle ache) usually refer to symptoms that can be described more accurately by one of the above types of arthritic condition.degeneration
.


Figure 4 – How your body’s chemistry makes pain
Because of the gastrointestinal problems mentioned above, the thinking was that the ideal NSAID would be one that blocked only COX-2 and left COX-1 alone. And the launch of drugs such as Vioxx in 1999 caused huge excitement because that’s exactly what they did. But problems with these drugs began emerging a few years after they appeared on the scene. Blocking an element – such as an enzyme – that is part of a network as complex as the body almost never has just one effect, which is why drugs nearly always have damaging side effects.
In 2004, Merck voluntarily withdrew Vioxx from the market because of concerns about increased risk of heart attack and stroke associated with long-term, high-dosage use. The precise details of the case have been chewed over in the courts for years, but whatever the legal niceties it’s clear that behind the scenes and in the medical literature, alarm bells had been ringing for years about the link with heart attacks. It’s just that they had been deliberately ignored. You can read more about this shocking scandal in my book Food is Better Medicine than Drugs, with Jerome Burne

NEW DISCOVERY

Scientists have focused on the COX-1 and COX-2 enzymes, but another pain-causing enzyme called 5-lipoxygenase (5-LOX) has been largely ignored. Scientists at the University of British Columbia found that combinations of COX and 5-LOX inhibitors were more effective than single inhibitors. Some nutrients – boswellic acid and curcumin, for example – have been found to inhibit this enzyme. Although 5-LOX is only just beginning to receive the attention it deserves among researchers, some pioneering work on the nature of this powerful enzyme suggests that levels tend to increase as we age.7 What is even more exciting is that the effect of various nutrients working together is only just starting to become known. When you combine some nutrients in a certain way the pain-relieving effect is multiplied.
Using anti-inflammatory drugs in the short term can improve healing – as long as the problem that triggered the inflammation in the first place has gone. Eventually, if pain and inflammation persist over the long term, body tissues will begin to break down. In the case of arthritis, for example, the joint becomes increasingly hard and stiffened – calcified – until you can’t use it at all.
If you have joint problems, you may have had your erythrocyte sedimentation rate (ESR) measured. A high ESR means that your body is in a state of inflammation, as does a high level of c-reactive protein (CRP).

How is inflammation usually treated?

The most common medical treatment for inflammation is anti-inflammatory drugs. These drugs are effective symptom suppressors, providing pain relief but doing nothing to address the causes of the inflammation. According to Dr Jeffrey Bland, a pioneer in new approaches to dealing with inflammation, instead of thinking pain means drug, inflammation is the body’s way of saying something is wrong. Inflammation is a systemic problem, not just a localised phenomenon, in which the body’s physiology is shifted into an ‘alarm state’. It’s as if there is a series of underlying imbalances in the body’s chemistry that build up and then burst forth, once the body can no longer cope. The actual symptoms, or pain, are the wave breaking, but the wave is a long time coming.

(Say No To Arthritis (Optimum Nutrition HandbooK
CHAPTER 2
WHY ARTHRITIS؟
When you get ill, two questions usually come to mind. The first is: ‘How do I get better?’ And the second is: ‘Why did I get ill in the first place?’ Knowing why you have developed a disease doesn’t cure it, but it is usually the first step towards finding a solution. In the search for the cause of arthritis, many factors have been considered, including diet, physical exercise, posture, climate, hormones, infections, allergies, genetics, old age and stress. Most of these have proven relevant to at least some arthritis sufferers. But what is the cause? I believe the answer – as for most diseases – is that arthritis does not have a single cause. The symptoms of arthritis, or of any arthritis-like disease, are the result of an accumulation of factors: accumulated stresses eventually reach a tipping point and trigger inflammation, causing joint, bone and muscle

Figure 3 – Factors that affect the bones

The likely factors that contribute to the development of this painful condition are:

Poor lubrication of the joints Good nutrition is needed to make sure the synovial fluid between joints stays fluid and lubricating. Cartilage and synovial fluid contain proteoglycans, which can be provided by certain foods. That’s where nutrients such as glucosamine are beneficial .

Hormonal imbalance Hormones control calcium balance in the body. If the body’s hormones are out of control, bones and joints can become porous and subject to wear and tear. Calcium can then be deposited in the wrong place, resulting in arthritic ‘spurs’. The problem is not usually insufficient calcium intake, but rather the loss of calcium balance in the body. Vitamin D, which is actually a hormone, is vital in this regard.

A lack of exercise, too much tea, coffee, alcohol or chocolate, exposure to toxic metals like lead, excessive stress or underlying blood sugar or thyroid imbalances all upset calcium control. This can be worse after the menopause, probably due to the loss of oestrogen and progesterone. However, oestrogen dominance – in other words, too much oestrogen relative to progesterone – also makes arthritis worse. It’s all a question of balance. Another hormone, insulin, stimulates the synthesis of proteoglycans, from which cartilage is made.

Allergies and sensitivities Almost everyone who suffers from rheumatoid arthritis, and many who suffer from osteoarthritis, have food and/or chemical allergies or sensitivities that make their symptoms flare up. Some allergies cause arthritis in the first place. Others develop as a consequence of medication, inducing gut damage that makes matters worse. The most common food allergies are to wheat and dairy produce. It’s well worth avoiding these foods strictly for one month to see whether this reduces the problem.

Free radicals In all inflamed joints, a battle is taking place in which the body is trying to deal with the damage. Some of the key weapons of war faced by the body are free oxidising radicals (or free radicals, for short). These are like the body’s own nuclear waste, made from oxygen reacting with glucose, the end result of breathing and eating. The reaction releases energy that allows our cells to work, but it also creates dangerous oxygen by-products, which can destroy cells and damage body tissue. Some free radicals are made through normal body processes. Eating a lot of fried food, for example, or smoking cigarettes, will increase them.

The body protects itself from free radicals with an army of antioxidant nutrients, such as vitamins A, C and E, and antioxidant enzymes, which contain minerals such as zinc and selenium. Specific foods, ranging from oregano to cherries, are especially high in antioxidants. I’ll show you which foods to eat more of so that you can increase your antioxidant potential in Chapter 10.
The body even generates free radicals to destroy misbehaving cells such as cancer cells or invaders such as viruses. If the immune system isn’t working properly, as in rheumatoid arthritis, it produces too many free radicals, which can damage the tissue around the joint. A low intake of antioxidant nutrients can therefore make arthritis worse.

Infections Any infection, be it viral or bacterial, weakens the immune system, which controls inflammation. But some viruses and bacteria particularly affect the joints by lodging in them and recurring when your immune defences are low. Often the immune system can harm surrounding tissue in its efforts to fight an infection, like an army which lays its own country waste when trying to get rid of an invader. Building up your immune defences through optimum nutrition is the natural solution.

Bone strain and deformities Any damage or strain, often caused by faulty posture, increases the risk of developing arthritis. A yearly check-up with an osteopath or chiropractor, plus regular exercise to increase joint suppleness and strength is the best prevention. Once arthritis has set in, special exercises can help to reduce pain and stiffness.

State of mind There is little question that arthritis, particularly rheumatoid arthritis, can create major stress both for the sufferer and their family.2 But to what extent does psychology encourage the physical changes that lead to arthritis?

As long ago as 1936, the onset of rheumatoid arthritis was associated with factors such as marital problems, work-related stress and worry.3 More recently, research at the University of Maryland School of Medicine has shown that an eight-week meditation training programme, followed by a four-month maintenance programme, significantly reduced psychological distress and improved general wellbeing in rheumatoid arthritis patients.4

While Dr Ronald Lamont-Havers was national medical director of the Arthritis and Rheumatism Foundation he examined hundreds of prison inmates and found only a negligible incidence of rheumatoid arthritis. In his opinion, ‘These individuals who let out their angers and aggressive feelings so violently that they wound up behind bars had practically no RA. Emotional stress, brought on by hidden anger, fear or worry, oftenaccompanies the beginning of arthritis.

The mind–body connection

Many ancient philosophies, and most modern theories of psychology, consider the mind and body to be intimately connected. Imbalances in a particular system in the body are thought to correspond with mental and emotional imbalances that may seek expression through the physical body. The musculoskeletal system is considered to be the physical manifestation of a person’s need for space, authority and ownership. So, according to this theory, a person who has been denied their own space and authority in the world may be more prone to musculoskeletal problems. We use the phrase ‘spineless’ to mean someone who doesn’t stand up for themselves.
Chronic arthritis is itself a great stress.6 It is sadly no surprise that a large proportion of people with rheumatoid arthritis have been found to also suffer from depression, marital difficulties and low self-esteem. One key factor is the thought of having a disease of unknown outcome, with no knowledge of a treatment that really works. This leads to the belief that effective solutions are not available to control or eliminate either the disease or other life stresses.
Yet, as you will discover from this book, unless you have already exhausted all the nutritional approaches to arthritis, there is much you can do to improve the outcome of any form of the disease, without the risk of side effects. And there are always ways of dealing with pressures and difficult situations.

Poor diet Most people with arthritis have a history of poor diet, which paves the way for many of the above risk factors. Too much refined carbohydrate and sugar, too much of the wrong kind of fat and not enough essential fats, too much protein and too many stimulants (coffee, tea, alcohol, cigarettes) can all exacerbate arthritic problems. A lack of any of a number of vital vitamins, minerals and essential fats could, in itself, precipitate joint problems. As I mentioned in the Introduction, according to Dr Robert Bingham, a specialist in the treatment of arthritis, ‘No person who is in good nutritional health develops rheumatoid or osteoarthritis.’

Great results can be achieved with arthritis by taking all these factors into account: eliminating possible risks, improving lifestyle, and following an optimal diet and supplement programme based on your individual needs. Pain and inflammation can be reduced, mobility can be increased, and, although it doesn’t happen overnight, there is clear evidence that damaged joints can heal. All these factors are discussed in more detail later in this book.

Fast Facts: Rheumatoid Arthritis
Introduction                                                            

    Rheumatoid arthritis (RA) is the commonest inflammatory joint disease, affecting approximately 1% of adults in the developed world. Here, we provide an easy-to-read and up-to-date overview of how RA is thought to develop, how it is diagnosed and monitored, and how it is treated, incorporating the major advances in these areas that have taken place since the first edition.
    The pathogenesis of RA is starting to become unraveled and, more than in any other disease, this has led to powerful targeted treatments. Specifically, nine targeted biological therapies have, at the time of press, received approval by regulatory agencies. These target inflammatory mediators and the cells that coordinate the dysregulated immune and inflammatory responses that characterize RA. They are discussed in the closing chapters of the book, along with our thoughts on future directions of investigation and management. We also cover the new classification criteria for RA, and a new autoantibody class, anti-citrullinated peptide antibody (ACPA), is discussed in the context of its use for diagnosing RA

                                1.i Synovium The normal joint                                            
    The synovial membrane lines the non-weight-bearing aspects of the synovial cavity and is divided into the lining layer or intima and sublining layer or subintima. It is the target tissue of the dysregulated inflammation and immunity that characterizes rheumatoid arthritis (RA) (Figure 1.1). The synovial membrane intima is just one or two cell layers thick and contains two major cell types: type A synoviocytes, which bear macrophage markers, and type B synoviocytes, which have fibroblastic characteristics. The intima lacks the typical features of an epithelium and does not possess a basement membrane or tight intercellular contacts between synoviocytes. The matrix of the intima is rich in proteoglycans and glycosaminoglycans, in particular hyaluronic acid






    Figure 1.1 Normal joint anatomy (left side of figure) and RA pathology (right).

    The subintima is a loose vascular connective tissue stroma containing blood vessels, lymphatics and nerve endings within a matrix comprising varying proportions of lipid, collagen fibrils and more organized fibrous tissue
1.ii Synovial fluid                                          

                                           
    The synovial membrane secretes lubricating and nourishing synovial fluid, a viscous fluid containing a high concentration of hyaluronic acid. Other constituents include nutrients and solutes that diffuse from the blood vessels in the subintima. The precise physiology of synovial fluid production is unknown, but exchange of fluid between the circulation and the joint space is governed by a balance of hydrostatic, osmotic and convective forces. As well as providing an osmotic force within the synovial cavity, hyaluronic acid contributes to the lubricating properties of synovial fluid although other constituents are also important. .



iiiArticular cartilage.1                                                 

    Articular cartilage comprises chondrocytes embedded in a hydrated matrix composed of collagen, proteoglycans and other matrix proteins. It is an avascular structure lacking lymphatics, and the synovial fluid is critical for providing nutrients to this tissue. Water makes up approximately 70% of normal cartilage by weight, whereas chondrocytes occupy only 5–10% by volume. Because of their low density, chondrocytes do not come into contact with one another directly but possess cellular processes which abut the matrix. These cells are critical to the integrity of articular cartilage because they synthesize collagen, proteoglycans and also other components such as fibronectin. Each cell is surrounded by a zone of secreted proteoglycans and a basket-like mantle of fibrillar collagen, but the highest collagen content occurs in the more distal intercellular matrix.

    Collagens are fibrillar proteins that, together with proteoglycans, account for the biomechanical properties of articular cartilage. There are 14 different types of collagen, divided into three major groups. The predominant collagen in articular cartilage is type II, constituting approximately 90% in the adult, with types IX and XI contributing most of the remainder. All collagens are based on a triple helical structure (Figure 1.2), and the differences between collagens relate to the length of the triple helix, the presence of non-collagenous units within the molecule that impart extra flexibility, or the addition of non-collagenous side-chains such as carbohydrates. The triple helical structure of collagens accounts for their tensile strength. Collagen biosynthetic and degradative pathways are quite well characterized.

Rheumatoid Arthritis: A Life-Changing Disease

    Rheumatoid Arthritis

Imagine being a seventeen-year-old girl. Suddenly you begin experiencing pain in your hands every morning. Your fingers are stiff and swollen; they look like little, fat sausages. When you walk across the room, it feels like sharp rocks under your feet. The constant pain puts a damper on your appetite and you begin to lose weight. Now imagine being told you have a crippling disease that will change your life. Thirty-nine years ago, I was that young girl; the disease was rheumatoid arthritis.(RA).
Constant pain and the loss of twenty pounds in three months told us I was experiencing more then “growing pains.” Even after an examination and several blood tests, my doctor wasn't sure what was wrong. She suspected rheumatoid arthritis, but at that time, a diagnosis of RA was rare for someone my age.

Rheumatoid Arthritis Diet And CookbooK

 

Forward

This book, Rheumatoid Arthritis Diet and Cookbook, is written for the many people who are suffering with arthritis or rheumatism, as the old folks called it, today as well as a condition called degenerative arthritis, and who would like to know why they have this crippling disease. As you walk through this book, you are going to discover the causes, symptoms and possible cures for rheumatoid arthritis and degenerative arthritis. You are going to learn how to manage arthritis if you have it and also how to keep from acquiring any kinds of arthritis if you don't have it. In other words, this book is going to be a very valuable tool for everyone, as we all have the potential of having this terrible crippling disease called arthritis.

 

My sister suffers terribly with arthritis and it has affected her knees so badly that she has had several surgeries on her knees, but the surgeries have not irradiated the pain. The arthritis she has is now in her lower back with so much pain she is suffering day and night. Her doctors have finally told her that there was nothing else they could do for her and she would just have to manage the pain. Their idea of managing the pain is for her to take some form of painkiller. She has never mentioned any natural cures or relief that her doctor has recommended, and I think that very odd and negligent on the doctor's part of her treatment.

I am distressed over her pain and the discomfort it is causing her so I decided to do some research on arthritis to see if I could come up with some natural cures and management for her pain.

 

After researching arthritis, I believe that your diet plays a very important role in every aspect of your health and this includes arthritis. I hope my research on arthritis will help people all over the world regain their health and their control over living a long and happy pain free life.

In any disease we must treat the body as a whole living organ. So to fight arthritis we must get control over our body through diet, nutrition and exercise. To accomplish this goal we must go over our diet and lifestyle to see if we are eating or doing something to hinder us from being in our very best health.

So let us begin by learning all we can about arthritis, what it is and how we can help our body in its fight against any disease.

Rheumatoid Arthritis

 

In the disease of rheumatoid arthritis there is chronic inflammation in the synovial membrane and periarticular structures. It is characterized by atrophy and rarefaction of the bones. When you first notice the disease you will probably experience some migratory swelling and stiffness in your joints. Since arthritis affects your collagen substance of your connective tissue, we are looking at a disease that could be called a collagen disease.

It seems that rheumatoid arthritis is more prevalent in women than men, and occurs more likely in the temperate zone but rare in the tropics. It seems to have some inherited roots as it can run in families.

There is really no known cause for the disease of rheumatoid arthritis but this disease has been 

the focus of many studies and the following interesting facts have been presented

Shock. If you have suffered a severe emotional shock such as a death in the family, a difficult

job, surgery, or business failure, this could bring on an attack of arthritis.

Heredity. This disease has a tendency to run in the offspring of persons with arthritis

Exposure. Being exposed to wet, damp, and cold conditions can bring about attacks of arthritis

Trauma. If you have damaged a joint you could very well develop arthritis

Fatigue. Prolonged physical or mental activity in which you become overtired can bring about an attack of arthritis.

Hormones. Some disturbance in your hormone balance could bring about an attack of arthritis. It has been proven that a person with arthritis has the condition lessen when they become pregnant.

Food Allergies. Food allergies could very well be one of the culprits in bringing on attacks of arthritis.

Chronic Low Grade Infection. You may experience a chronic low grade infection which might lead to your having a bacterial invasion of some kind.

 

Even though all these subjects have been studied, it has not been determined within a shadow of a doubt which of them is causing your attacks of arthritis. An arthritis patient can often determine when the onset of their attacks began by have a disturbance in their equilibrium after the following:

Acute Infection

Emotional Strain

Exposure To Cold

Fatigue

Overwork

Surgery

Degenerative Arthritis

 

Degenerative arthritis is much like its partner rheumatoid arthritis but here are some very plain differences. Degenerative arthritis will display the following symptoms:

 

Absence Of Inflammatory Swelling

Disease Does Not Spread But Remains In A General Area Or Joint

Increased Deposits Of Calcium Around The Joints

History Of Tonsillitis Followed By Acute History Of Arthritis With Fever and Swelling Of Joints

Less Fever and Less Sweating As In Rheumatic

Less Cardiac Involvement as In Rheumatic

Your doctor will look for the following conditions in :degenerative arthritis

 

You Are Most Likely To Be In Your Fifth And Sixth Decades

You Are Usually Overweight

Your Arthritis Is Mostly In Your Knees, Spine And Fingers

 

Death by Rheumatoid Arthritis

Introduction

The intent of writing this eBook is to bring awareness to the fact that people can and have died from complications, due to rheumatoid arthritis. Sadly, I experienced this reality firsthand. I lost one of my closest family member's to the disease--my Mother. The rheumatoid arthritis eroded the vertebra of her cervical spine. This deterioration resulted in spinal cord syndrome. The neurologist that treated her informed us that if caught earlier by way of a cervical spine x-ray that my mother would still be alive today. If my sister and I hadn't investigated her unusual symptoms full circle, we wouldn't have had any idea how she died; thankfully we did. My eBook chronicles her medical and personal journey as she valiantly and gracefully fought RA. It also highlights potential deadly ties with the disease. My hope and prayer is that the information in my story will save at least one person from dying such an excruciatingly painful and unnecessary death.
As I worked on medical research for this book I discovered, not one major media outlet covered the deadly complications that rheumatoid arthritis can bring. Perhaps it's fear. The fear of alarming those with RA that they should have even more to worry about than dealing with continual lifelong pain and facing complete immobility. If I was diagnosed with RA, I'd want to be completely informed of the complications associated .with the condition

My Mother

Digging through all my paperwork after she had died I needed to find it. Social Security needed to know the cause of her death. After wading through old cell phone bills and greeting cards, there it was. Tucked in a yellow manila envelope, I found her Death Certificate. I knew what she died from, but it was still strangely confusing. Were they looking for something more technical? Opening it carefully, I read Celia Veno's death certificate, "Cause of Death: Rheumatoid Arthritis" She died from complications, due to the arthritis that deteriorated her cervical spine, causing irreversible spinal cord damage.

Celia Veno was my mother and my best friend. The kind of mother every child dreams of having: loving, kind, encouraging, and gentle. Exceptionally calm with a disarming smile, the medium built brunette of Ukrainian lineage had a graceful demeanor and a quiet tolerance for the adversities life would hand her. Being a content soldier in her own personal war, she was extraordinarily selfless and giving.

Life had not been easy for my mother, a daughter to a family of ten. Her father, Stanley, left his poverty stricken home in the Ukraine in 1921 for the promised land of America. His hometown, the city of Kiev was then a founding republic of The Soviet Union. Ironically, her mother Veronica was on the same ship. Shortly after meeting, they fell in love. Two weeks later, they married.

This tall, lean, strong man with milky blue eyes would land in Olean, New York and find a job as a laborer in a poisoned, air-polluted glass plant moving lime from boxcars to the warehouse. In the process, he withstood unendurable lime dust, a destroyer of lung tissues and a breeder of silicosis.

Stanley and Veronica were quiet, loving, mild mannered parents. They weren't given to yelling and cursing. They were a happy bunch, older children helped care for the younger siblings. During balmy summers, Mom would sit on her father's lap while he read the paper. Children scattered about, playing in the yard, dancing in the sunlight.

For her daughters, Veronica would hand weave together clover crowns made of the flower and a few spare bobby pins. Neatly she'd tuck the small crown ends behind the girls' ears. This family ritual of "crown making" would be emulated by generations yet to come.

Following her back to the kitchen, the brood watched as she whipped up homemade breads and fresh halupki's. Halupki's are a favorite dish of those from the Baltic countries. A dish composed of cabbage leafs filled with fried beef, bacon, and rice, smothered in tomato sauce.

Weekly, the large-framed, jovial Veronica would set out on her usual bus ride to the downtown shops of Olean. She'd return with groceries and a small brown paper bag. As she approached the home, all those little eyes locked onto the smaller bag, knowing it's all too familiar contents--candy. The children would sample its goods, licorice and assorted hard candies.

While a man yet in his fifties, Stanley became tired and his bones ached. The doctor sat him down to tell him his diagnosis; the most aggressive type of arthritis-rheumatoid. That combined with his lungs wheezing from silicosis did not stop him from working. Bills had to be paid and a family to feed drove him on. He worked until he became crippled, unable to walk. In his early sixties he was confined to a county nursing home. Quietly, he endured, crying out frequently of the pain that ran through his aching body. The drug of choice for rheumatoid arthritis in the 1960's was Aspirin. At the time, some patients received twenty aspirin a day. This was the best they had to offer, knowing so little about the disease. Soon, his beloved Veronica was diagnosed with heart disease and high blood sugar. In their suffering, they eventually shared a room together at the nursing home.

The  Rheumatoid Arthritis Diet 

How I Stopped Hurting And Started Living Again

About five years ago I was told that I may be developing rheumatoid arthritis. As most of you reading this probably know, that's the crippling kind where your immune system starts attacking your joints.
Let me tell you, it's no cake-walk (and if you have RA you know what I’m talking about). I was a life-long athlete before RA, and my whole life has changed due to this disease. It has put a definite hamper on my physical activities, that's for sure.
Still, after I got through the denial phase ("that can't be right") and really did some research on it (that was my "oh crud" phase), I did the one thing I know to do that will improve your chances of success in any given situation.
That’s when I decided to control all the factors that were within my power to change, and then I gave the rest over to God.
So, I sat down and made a list of all the things that were in my power to change. Here’s what I came up with:
I can control how I think; in other words, my attitude. I realized I could choose to look at this disease from a “poor me” perspective, or I could wake up every day and choose to focus on all the blessings in my life. Which you do will make a tremendous impact on how you feel from day-to-day, as we’ll talk about in a minute.
I can control my activities. I was doing a lot of high-impact exercise, because that’s what I’d done all my life. That was an area that was in my direct control to change.
I can control my lifestyle. I could change certain things in my life to make my life less stressful and make it easier for me to deal with the ups and downs of the disease.
I can control what I eat. I knew from years as an athlete that nutrition has a tremendous impact on how you feel; so, I set about finding out how I should eat to help my body heal, or at least to maximize my energy levels and how I feel.
After making this list, I changed the following in an effort to improve my body's ability to heal:
I changed my attitude, to focus on what I had to be thankful for each day…
I changed my exercise intensity, to cut down on mechanical inflammation and to avoid increasing the “stress hormones” in my body...
I started doing low-impact exercise, to maintain the range of motion in my joints...
I started taking supplements to help my body heal...
I cut down on my stress, by eliminating things in my life that were stressing me out (stress alone can make you sick - be sure to breathe and de-stress every day)...
And, the most radical thing I did was that I revamped what I was eating, and adopted a strict rheumatoid arthritis diet of my own creation.
So, did it work? Well, I went from being basically bed-ridden most of the time, to being able to live a fairly normal life. I now enjoy doing many of the activities I used to enjoy before RA.
Definitely, the answer is “yes”!
Let’s talk about each of these in turn, to get an idea of why and how this had such a tremendous impact on how I feel from day-to-day.

Attitude

Your attitude is the first thing to change so you can come up with your own plan for managing your disease as an RA sufferer. Yes, RA sucks, yes it’s debilitating, yes it can lead to other problems…
But how in the world does it help you to dwell on all that? Obviously, it doesn’t, which is why you need to improve and adjust your attitude to focus on the positive things in your life.
Many studies have been done on the effects of attitude (and faith, I might add) on how well patients adapt to and recover from acute and chronic illnesses. Overwhelmingly, patients who adopt a positive mental attitude and outlook enjoy a much better quality of life.
So, however cliché this may sound, it is of the utmost importance that you adopt an “attitude of gratitude” and that you make a conscious decision each day to look on the bright side of things in your life.
I’ll definitely go deeper into this in a later section of this book, because attitude is vitally important to your health if you have RA.

Activities

For some who have lived with RA for a while, this may be obvious to you… but for those of you who are new to this disease (especially if you’ve been an athlete like I was), you should know –
All the intense exercise you used to do? You need to let that go.
Look, I know it’s hard. I was a professional martial arts instructor for most of my adult life. I finally had to realize that, although I could enjoy some of those activities with modification; however, all the hard contact and jarring on my joints was just accelerating my disease process.
I would go and attend a seminar over a weekend, load up on anti-inflammatory drugs, and then spend weeks recuperating. Plus, I was teaching martial arts full-time; everyday I’d take NSAIDs to cut down on my pain so I could get through four hours of classes and a full day at the school… only to go home on the weekend and lay in bed until I had to get up and do it again the next Monday.
That’s how badly I wanted to hang on to the life I had known. Finally, however, I came to realize that the only thing that mattered was my quality of life from this point on; and, clinging to the life I once knew was doing nothing to improve my current and future quality of life.
Once I came to that realization, I sold my martial arts school, gave up 95% of my martial arts practice that involved impact training, and started focusing on writing, blogging, and consulting as a means to support myself and my family. I’m not saying it was easy, but I am much healthier as a result.
So, adjust your activities to suit your current situation, and leave whatever you were able to do in the past behind. Believe me; you’ll be happier and healthier for it.

Exercise

Exercise – regular exercise – is extremely important when you have RA. The tendency is to sit around like a bump on a log and not do anything, because in most cases any significant movement is going to cause you pain.
Well, guess what? You are going to hurt anyway, so you may as well do it while doing something that will make you feel better.
That’s right, I said better!
Here’s the thing – your body needs to move to be healthy. And as someone who has RA, you are at a higher risk for heart disease and stroke. Do you know why?
It’s not only because of all the increased inflammation in your body… it’s also because most RA sufferers cut back considerably on physical activity after they get the disease!
The bottom line is you need to do some sort of gentle low-impact exercise every day – so MOVE YOUR BODY every day! Your mental outlook will improve, you’ll physically feel better, and overall you will stay much healthier, longer.
I’ll go into more detail on this in a later chapter, but for now just know you need to do some sort of appropriate exercise a few days a week if you want to enjoy the best quality of life with RA.

Supplements

There is a lot of quackery out there with regards to supplements that can make you feel better. I’m here to tell you right now, there’s no magic cure for RA.
That being said, there are supplements that can help you feel better on a daily basis, if taken regularly. Certain herbs, like ginger and curcumin can help reduce inflammation. And, taking a good B-complex and other vitamins can help your energy levels. Also, some enzymes have been shown to help reduce inflammation in the body.
One thing I’ve found is that some of the supplements commonly recommended for regular arthritis sufferers don’t help much for people with RA. So, it helps to know which ones do work best for RA sufferers.
I’ve spent a great deal of time testing different supplements and researching literature to find what works best for me, and I take those supplements every day.
And yes, I really do notice a difference in how I feel when I forget to take my supplements. Later in this book I’ll tell you exactly which supplements I take and why, as well as which ones I believe are of minimal benefit so you can avoid wasting your money on supplements that don’t work well for RA sufferers.

Stress

Stress can have a huge negative impact on you if you have RA. For one, stress can trigger flare-ups. Second, it increases the levels of stress hormones in the body, which are typically already elevated when you have rheumatoid arthritis due to your chronic pain.
The main stress hormone is cortisol, which suppresses the immune system. This may seem like a good thing since you have an autoimmune disease, but actually over a prolonged period it can be problematic. It also changes the way your body uses the glycogen (sugar) in your bloodstream, which can cause you to gain weight.
Also, cortisol can cause loss of collagen in the tissues, which is a real problem considering your joint connective tissue is made from collagen. It can contribute to osteoporosis over time, and can impair learning and alter your ability to process events clearly.

rheumatoid arthritis

rheumatoid arthritis

1- What is Rheumatoid Arthritis?

 The immune system , The function of the joint ,How rheumatoid arthritis affects the joint Rheumatoid arthritis and osteoarthritis: the differences ,The importance of an early diagnosis ,The unpredictability of rheumatoid arthritis A personal scenario

2-Pain and Discomfort

    Coping with pain Understanding pain The pain gate The TENS machine  Massag Acupuncture 
 Distraction  Natural pain-killers  Nutrition     Relaxation     Posture     The pain diary     Splinting    Medication   Surgery A personal scenario 

3-Understanding Medication

    Non-steroidal anti-inflammatory drugs  Disease modifying anti-rheumatic drug  Biological therapies   New biological therapies  Corticosteroids (steriods) 

4 Complementary Approaches


    Beneficial foods and food supplements

    Nutrition

    Other dietary considerations

    Complementary therapies

    A personal scenario


5 How to Protect Your Joints and Reduce Pain

    Conserving your energy

    Avoiding static positions

    Discouraging deformities

    A personal scenario
6 Equipment and Adaptations

    Equipment for the kitchen

    Equipment and tips for personal care

    Clothing

    Selecting furniture

    Adaptations
7 The Importance of Exercise and Good Posture
    Planning your exercise

    Exercise at the table

    Useful yoga exercises

    Exercises for the car

    Exercises for the chair

    Standing exercises

    Exercises at the kitchen sink

    Exercises on the bed

    Exercises for the bath

    Hydrotherapy and swimming

    The benefits of exercise

    A personal scenario

    Good posture

    Guidelines for good posture



8 How to Relax and Manage Your Stress

    Symptoms of stress

    A definition of stress

    Why stress occurs

    Restoring the balance

    The fight or flight response

    Learning to relax

    The postures of stress

    Getting started

    A personal scenario



9 Work and Leisure

    The benefits of employment

    Factors that help you stay in employment

    Changing work

    Disability benefits

    A personal scenario

    Avoiding the downward spiral


10 Rheumatoid Arthritis and Relationships

    Asking for help

    Making changes

    Rheumatoid arthritis and sex

    A personal scenario



11 Achieving a Positive Outlook

    Dealing with the diagnosis

    How we deal with loss

    Becoming an expert patient

    The benefits of active coping

    Helpful support

    A personal scenario

    Helping yourself


Appendix

The Work of the Occupational Therapist

A-Z Guide to Well-being

Tips and Ideas for Easy Living

Useful Resources

Acknowledgements

I would like to thank Sue Morris for reading the text and giving me some very helpful suggestions. I would also like to thank Lynette Hartgill for doing the illustrations at such short notice. I am grateful to Dr Adam Young, my rheumatologist, for taking the time to read my book and ensuring that the medical information is accurate. He has also written a foreword for me.
A special thank you goes to Marian Ferguson for helping me to manage my rheumatoid arthritis and also for inspiring me to become an occupational therapist in the process. Finally I would like to thank Keith, my husband, as well as Carolyn, Sonia and Alison who encouraged me and supported me in writing this book as well as helping out with the editing.


Preface

This third edition is an easily readable, self-help guide for everyone with rheumatoid arthritis (RA), particularly those who are newly diagnosed. It is also useful for family carers, those working in the caring professions and health and social care students. In this new edition there are a few additions and changes as follows.
I have added in the new drugs that have become available since the last edition. There are still some new types of medication undergoing trials and it is important that people with RA contact the National Rheumatoid Arthritis Society (NRAS) by telephone or by using their website in order to keep informed.
I have also added a new chapter called Complementary Approaches in order to include some extra information on food, supplements and other complementary therapies. There is growing research in this field and I am hopeful that one day more of these therapies will be funded by the NHS. I have included the treatments that seem to be the most beneficial.
While I was thinking about what would be most useful for this new edition I came up with the idea of adding a new section of helpful suggestions and tips. I am grateful to the members of NRAS for their many suggestions and I have included these tips along with my own ideas.
Recently there has been a lot of discussion around the proposed changes to the disability employment benefits and other disability benefits like the Disability Living Allowance (DLA). I have therefore updated the disability benefits information to include some information on these latest changes.
Many of the contact details have gone out of date in the years since the last edition was published and I have therefore updated the contact details and added some new ones.
Apart from these new updates the format remains the same and I hope that it helps you to become an expert on rheumatoid arthritis.


Foreword

There have been some major changes and initiatives in the last few years in the management of rheumatoid arthritis. Some of these have been in a better understanding of the underlying mechanisms of inflammation and the development of new and effective drugs. Another very important area has been the opportunity for great patient and patient–carer involvement. Patient-led organisations have become a vital and driving force to improve the level of government funding for care of patients with rheumatoid arthritis in an ever increasing and competitive arena of health care.Rheumatoid arthritis is a complex condition and its effects vary considerably from patient to patient. It can last for decades, and best and possible therapies are continually changing. This book covers such an important aspect of the care of rheumatoid arthritis. It reflects the need for greater input from both patients and their carers. It is unique in that a highly trained occupational therapist offers her experience both as a patient and as a therapist in what to expect and how to cope with this condition. Patients, their relatives and carers, and therapists in training, will find this account very readable. It is illuminating, sensitive and reassuring. It comes at a most opportune time.

Introduction

Over 30 years ago, I visited my doctor. I had severe pain in my fingers, toes and wrists. The doctor gave me anti-inflammatory drugs but he gave me no indication at all of what was wrong. These attacks occurred three more times during the next ten years; each relapse happening when each of my three daughters was three months old. I was still not aware of why all this was happening and I still received anti-inflammatory medication and no explanation.

Ten years later I visited my doctor because I couldn’t understand why I had no movement in my wrist. I wanted to discover the reason for this and find out what I could do about it. I became more assertive and asked for an explanation for these attacks. Finally I was given a blood test and a referral to the consultant rheumatologist who consequently informed me that I had rheumatoid arthritis (RA). This was a devastating situation. I was 32 and I had three small children. I also had virtually no wrist movement and the joints in my fingers, toes and elbows were damaged. I was given a referral to the Occupational Therapy (OT) department. At that time I had not heard of Occupational Therapy but I decided to attend hoping that it might prove useful. I did not know then what a prominent part it would play in my life subsequently.

At the Occupational Therapy department I learnt all about my condition and how to look after my joints. I learnt exercises to improve my strength and to maintain the movements of my finger joints. I began to understand the importance of posture and how to problem solve. I was given equipment for the kitchen and I was able to discuss any problems that I had in my everyday life and find practical solutions to them. The OTdepartment made an impression on me. I enjoyed the calmness and the time that I was given for discussion as well as the practical help that I received.

I wanted to find out more about the therapist’s role in other areas of disability and I wanted to find out how to qualify. Eventually I started work as an OT assistant and later on I trained to become a fully qualified Occupational Therapist. At the time that I commenced training I was 40 and I had had rheumatoid arthritis for 18 years. It was a positive outcome from a very negative situation. I write this book from the perspective of practitioner and patient in the hope that it will enable others to gain a more positive outlook.

What is Rheumatoid Arthritis?

To know the disease is the commencement of the cure.

I am sure many readers are only too familiar with explanations about rheumatoid arthritis (RA). Nevertheless I feel that I need to explain about it to those people who are newly diagnosed or those who have not encountered the disease first hand.

Rheumatoid arthritis is a disease that occurs all over the world. The National Rheumatoid Arthritis Society1 confirms that at present 0.8% of the adult population of the UK has rheumatoid arthritis (NRAS, 2006). This is approximately 387,000 people. The Arthritis Care booklet on rheumatoid arthritis tells us that one to three people in every hundred develop rheumatoid arthritis (Arthritis Care, 2008).2 There are more females with the disease than males and onset is often between 30 and 55, although it can occur at any age. A study in 19993 stated, ‘Rheumatoid arthritis is rarely seen as a serious public health issue, yet it is the single largest cause of disability in the UK.’

There is no known cause for rheumatoid arthritis and it is not directly inherited, although some predisposing factors may be. This means that it is likely that a genetic trait is then triggered by other factors like an infection, or a chemical in food, or an injury, or stress or any other as yet unknown trigger. Maybe two or three triggers are needed together, no one really knows. All that is known is that rheumatoid arthritis is an autoimmune disease. This means that the immune system is faulty and does not behave in the way that it should.

The immune system

The immune system is an inate mechanism that enables our body to defend itself against bacteria, viruses and other organisms that want to invade it. A healthy immune system knows which particles are foreign to the body and which ones belong. In order to protect the body it will attack outsiders that do not belong. The body also protects itself when there is damage caused by an accident resulting in a burn or a broken bone. In this case inflammation occurs as a necessary part of the repair process. In rheumatoid arthritis something goes wrong and the immune system attacks its own joints.

The function of the joint

In order to understand what happens when rheumatoid arthritis attacks the joints it is first necessary to understand a little about what a joint is and what its function in the body is. I have drawn a picture of a simple joint to show what a joint looks like and what it consists of (see Figure 1). Joints can be simple, as in the elbow joint which only has movement in one direction, or complex as in the shoulder, a joint that can be moved in many ways. In any case, joints are always found at the point where different bones meet so that the bones on either side of the joint can move independently. For example, there is a joint between the upper arm bone (humerus) and the lower bones of the arm (radius/ulna bones) so that we can move the lower part of the arm independently from the upper arm. The cartilage and fluid act as a shock absorber between the bones and this helps to protect them.  

How rheumatoid arthritis affects the joint

During a flare-up of rheumatoid arthritis the synovial lining of the joint becomes inflamed although it is not known what triggers the inflammation. The synovial fluid that lubricates the joint, keeping the cartilage slippery, is overproduced. The lining of the joint becomes thicker and the cartilage is destroyed. The cartilage normally acts as a shock absorber between the bones, so there will be more pain on movement when it is destroyed. Eventually if it is all destroyed the bones will fuse together, preventing the joint from working at all. Even if the bones do not fuse together the increased amount of fluid in and around the joint means that the joints become swollen and feel uncomfortable. This restricts movement at the joints even before actual damage occurs. The joint capsule and ligaments also become stretched and loose and this leads to unstable joints and deformities.  

Rheumatoid arthritis and osteoarthritis

the differences I have found that many people confuse osteoarthritis and rheumatoid arthritis. Although they both cause damage to joints the damage occurs for different reasons. Rheumatoid arthritis differs from osteoarthritis (OA) because in rheumatoid arthritis it is the faulty immune system that causes inflammation, whereas in osteoarthritis the joints become damaged through wear and tear (although inflammation may still occur). This means that osteoarthritis normally starts later in life than rheumatoid arthritis although osteoarthritis may start at 40. (People with rheumatoid arthritis may also have osteoarthritis.) In rheumatoid arthritis the joint damage is usually symmetrical but in osteoarthritis it normally is not. Another difference is that some rheumatoid arthritis sufferers may feel tired or have a feeling of being generally unwell when the inflammation occurs. In rheumatoid arthritis it is also possible to have inflammation in other organs as well as the joints, for example, the lungs and blood vessels, but usually it is the joints that are affected.

The importance of an early diagnosis

It is important to go to the doctor and obtain a diagnosis as early as possible if joint pain occurs because, as explained previously, untreated inflammation can lead to joint destruction and deformities. The early signs of rheumatoid arthritis are usually:

pain or discomfort in the fingers or feet; and

early morning stiffness.

The stiffness makes the limbs feel heavy and the joints feel puffy, movement becomes sluggish and it is more difficult to move the joints at all. The stiffness tends to reduce when the joints are gently moved. The disease often progresses intermittently with:

relapses – when the symptoms occur;  and remissions (when the symptoms  stop for a period of time )