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By
Dr David Delvin
PART
ONE: ARTHRITIS
If you have
reached retirement age, you almost certainly have some degree of
arthritis in your body.
That statement
astonishes the majority of people.
Why? Because
most members of the British public don’t understand what arthritis
is – and think that it is a very serious, but uncommon disease.
In
fact, arthritis is so widespread that pretty well all of us would
get it, if we lived long enough!
But I am not talking about the severe form of arthritis,
which most people think of when they hear the word.
Fortunately,
severe arthritis is quite rare.
The type which most people develop as they get older is, as a
rule, relatively mild, though it is a blooming nuisance!
(And I am speaking from personal experience here…).
But what is it?
What does the word ‘arthritis’ actually mean?
Well it means
‘inflammation of a joint’, and a joint is a place where two or
more bones join, like the knee, the elbow or the ankle.
So arthritis means any kind of inflammation of a joint, and
that includes osteoarthritis.
Osteoarthritis
is by far the commonest type of arthritis.
This is the kind that affects so many of us as we get a bit
older! It is just
caused by ‘wear and tear’, in other words, the constant rubbing
of one bone against another over a period of many years.
The most
frequently affected joints are the weight bearing ones, which are:
Ø
The hips;
Ø
The knees;
Ø
The joints of the
spine;
Ø
Less commonly, the
ankles.
Factors
What
are the main factors which cause osteoarthritis?
Well, common ones are:
Ø
Being overweight,
because the joints have more to carry;
Ø
Having spent a lot of
time on sport in your youth – yes, although most doctors extol the
health giving properties of sport, there is no doubt that athletics,
jogging, football and so on do increase the chances of
osteoarthritis of the knee and hip in midlife;
Ø
Injury, which is
another reason why so many footballers get knee arthritis and the
same applies to dancers!
Symptoms of
osteoarthritis are pain, stiffness and swelling of the joints, often
varying a lot from day to day.
After many years, the poor old joints may become misshapen;
this is why so many people develop ‘knobbly knees’ in middle
age!
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OTHER
TYPES OF ARTHRITIS
It is important
to realise that ‘ordinary’ osteoarthritis which most people over
the age of 60 have, is about 100 times as common as any other type
of arthritis. But other kinds of arthritis do often affect folk who are in
the retirement age group and they cause a great deal of pain,
inconvenience and disability.
They include:
Ø
Gout – yes,
this is a form of arthritis. The
joint inflammation is caused by too high a level of a chemical
called ‘uric acid’ in the blood.
90% of sufferers are male, and nearly all are over 40.
The joint which is chiefly affected is the one at the base of
the big toe, but other joints, especially knees and the small joints
of the foot, can flare up. Treatment
of attacks is generally with NSAID drugs.
If you get recurrent attacks, it is worth going on a long
term, daily dose of a tablet that keeps your uric acid down, for
instance, allopurinol. Your
doctor will almost certainly advise you to keep your weight
down.
Ø
Rheumatoid
Arthritis – this very severe and often disabling disease is
what most people mean when they use the word ‘arthritis’.
The exact cause is unknown, but it is often associated with
certain inherited factors in the blood.
Rheumatoid causes pain, swelling, stiffness and often
deformity in the joints of the hands, wrists, elbows, knees,
shoulders and hips. Treatment
is with specially designed drugs plus physiotherapy and sometimes
splints. Steroid pills
and injections are often helpful, though you have to watch out for
side effects. Thank
heavens, surgery is of great help to a lot of people with
rheumatoid, for instance removing the inflamed lining of a joint, or
replacing it completely.
Ø
Sero-negative
arthritis – This is a rather cumbersome term, often used by
doctors these days to describe a whole group of joint disorders that
don’t have the same ‘markers’ in the blood as rheumatoid
arthritis does. These
conditions frequently affect the neck and the back.
There may be associated with psoriasis of the skin.
Treatment is generally with NSAID drugs, exercise and
physiotherapy.
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PART
TWO: RHEUMATISM
Let’s move on
from arthritis to rheumatism. Here
we meet a difficulty; though the public talk about ‘having
rheumatism’, the astonishing fact is that there isn’t actually
any disease called by the name of ‘rheumatism’.
Honestly – if you look in any medical textbook, you’ll
find that no disorder called ‘rheumatism’ is listed in the
contents or the index. But
don’t get me wrong. I
am not saying that rheumatism is imaginary!
No, the problem is that ‘rheumatism’ is a very OLD word -
and its meaning has got rather muddled over the last couple of
centuries.
So doctors no
longer use it when talking among themselves or when writing medical
papers. My own
favourite textbook of medicine advises medics not to employ the
word! You may well say
‘Well then, why did my doctor tell me that I’d got
rheumatism?’ Fair
question and there are two possible answers:-
1.
A lot of GP’s use the expression ‘you’ve got
rheumatism’ in a well-intentioned way when they are talking to
patients – but they really mean ‘you’ve got osteoarthritis.’
So they are employing a euphemism but they are doing it in a
kindly fashion, because they are trying to spare the person the
possible upset of hearing the word ‘arthritis’.
2.
The words ‘rheumatism’ and ‘the rheumatic diseases’
are still sometimes used in order to describe a whole range of
different conditions which affect the muscles, tendons and other
non-joint tissues of the body.
The one thing that all these disorders have in common is that
they cause pain! Also they are more frequently encountered among the
over-50’s and are rare in young people.
Well what are
these ‘rheumatic
disorders’? They
include:-
Ø
Polymyalgia Rheumatica
– in this disorder there is pain and stiffness in a lot of
different muscles, especially those around the shoulders.
It affects mainly the elderly.
There is usually an excellent response to steroid tablets.
Ø
Tenosynovitis – This
is an inflammation of the sheathes of the tendons – they are the
cord-like structures in the wrist and elsewhere, which many older
people call ‘leaders’. Injections
and manipulation may help.
Ø
Capsulitis – this is
an inflammation of the capsule (the covering) of the joint, often
the shoulder. If there
is no response to NSAID drugs or physio, it may be necessary to
inject the area with steroids.
Ø
Bursitis – This is
an inflammation caused by friction between soft tissues and
underlying bone. A
‘sac’ of fluid develops, often this has to be removed by a
surgeon.
There
are a lot of other conditions which are generally described as
‘rheumatic disorders.’ Doctors
who specialise in dealing with them are of course called ‘rheumatologists’.
Unfortunately very few people who live a long time are able
to avoid consulting a rheumatologist every now and again!
One final point about these ‘rheumatic’ diseases.
They are very much ‘up and down’.
So when you are having a dreadful day with lots of pain and
stiffness, it is always worth remembering that tomorrow may be very
much better…
Q.
My wife has various rheumatic ailments and the doctors
don’t seem to be doing her much good.
Would it be worth consulting an osteopath?
A
Yes. Osteopaths
can’t work ‘miracle cures’, any more than doctors can.
But very often, their manipulation techniques can help.
Please make sure that you go to a properly qualified
osteopath. Despite
recent reforms in the law, there are still some unqualified people
around, who may not really know what they are doing.
Registered osteopaths are usually listed in a large
‘Panel’ in the Yellow Pages, it is headed ‘General Osteopathic
Council’ or you can search on www.osteopathy.org.uk
Q.
My partner’s rheumatism is bad every morning, especially in
the muscles. Would there be any danger in me giving him a regular
morning massage?
A
Not at all! Gentle
massage without ‘forcing’ anything is most unlikely to do any
harm to anyone with arthritis or a rheumatic disorder.
Very often, the loving application of warm hands to the
painful tissues is far better than any drug.
Q.
I get awful aches in my joints.
Would going in a warm pool help?
A
Almost certainly, warmth is very good for most joint and
muscle pains and being in water is excellent because the water takes
the weight off those poor, tired tissues.
What I do not recommend is going in a perishing cold swimming
pool!
Q
I am male and aged 63. I
am too embarrassed to mention this to anyone else but recently I
have been dribbling a bit, so much that I wet my underpants.
What could be the cause of this?
A
This sort of waterworks problem in men is usually due to
enlargement of the prostate (not ‘prostrate’) gland.
Although you are embarrassed, you really do need to go and
see your GP for a check up.
Q
I am 69 and I have smoked all my life.
I am beginning to get a bit breathless these days.
But presumably it wouldn’t be worth giving up now, would
it?
A
It is always worth giving up except perhaps if you are 103! The breathlessness that you are experiencing could well be
the beginning of one of the common tobacco linked disorders like
Chronic Obstructive Pulmonary Disease.
So I do think you should go to your GP for tests.
Q
I had a hysterectomy last year and have now met a delightful
new man. Do you think
it would be safe to have intercourse with him?
A
Yes, it is a long time since the operation and everything
should have healed up. So
go ahead - I do advise you to use plenty of lubricant, such as Eros
or K-Y.
Q
I am female and recently retired.
I am having a little trouble with ‘hot flushes’ but I
don’t want to take ‘Hormone Replacement Therapy’ pills because
I gather there is a slight risk of cancer.
Would natural products help?
A
Very possibly. A
lot of women seem to be very pleased with the so called ‘Natural
HRT’ products, such as red clover, which you can obtain from any
herbalist and many large chemists.
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