By Dr David Delvin

Do you get rheumatism? Well, so do I! And so, at one time or another, do most people aged over 40.

But what exactly is it? What does this much-used word 'rheumatism' actually mean? Well, I need to do a bit of clarification here, because the word 'rheumatism' is much misunderstood.

First thing to appreciate is this. There is no single disease called rheumatism. The word covers a whole range of conditions, all of which cause pain. These conditions affect the joints, the muscles and the ligaments. And nearly all of them are much commoner in middle aged and elderly people.

So what are these 'rheumatic' disorders? Well, they include:

· Osteo-arthritis
· Gout
· Fibromyalgia / Fibrositis
· Tennis elbow and golfer's elbow
· Tendonitis
· Rotator Cuff Syndrome
· Frozen shoulder
· Bursitis
· Tenosynovitis
· Polymyalgia Rheumatica
· Rheumatoid arthritis
· Disc trouble
· Carpal Tunnel Syndrome
· Cervical Spondylitis

Do you suffer from any of the above conditions? If so, I'm going to give you a brief guide to each of them. Here goes!

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OSTEO-ARTHRITIS
This is the really common type of arthritis, which nearly everyone gets to some extent, as they grow older - though they may not realise it. By the age of 60, the vast majority of people have some degree of Osteo-arthritis in their joints.

The main cause is plain, simple wear and tear. Being overweight makes you more liable to it. Symptoms include variable amounts of pain and swelling in such joints as the knees and hips, as well as the small joints of the hands.

Treatments include weight loss, exercise, physiotherapy, warmth, and anti-rheumatic drugs. Fortunately, in many people the condition just 'flares up' from time to time, and then subsides.

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GOUT
Extremely common these days, particularly in males. At a recent reunion dinner for 20 ex-officers, no less than six had a degree of gout! Gout can affect various joints, but is notorious for causing excruciating pain in the big toe.

The chief cause is too high a level of uric acid in the blood. This is not due to leading a disreputable life (as many people imagine). However, it is true that gout is commoner in people who eat a lot of red mead and game, and who like a drink.

Treatment involves modification of your diet, and using anti-inflammatory pills when attacks occur. However, if they keep on happening, your GP or rheumatologist will certainly want to put you on long-term (i.e., lifelong) medication with a drug like allopurinol, which keeps the uric acid continuously low.

FIBROMYALGIA or FIBROSITIS
These two words mean pain and inflammation in muscle fibres. Unfortunately, this diagnosis is quite controversial. Although many members of the public talk about having friends who have 'Fibrositis', quite a few doctors don't accept that any such condition exists. Be that as it may, lots of patients have pain in their muscles, typically with tender spots, which are agonising when pressed.

Useful treatments include osteopathy, chiropractic and physiotherapy, plus the application of soothing 'rubs'. Some people swear by acupuncture or reflexology.

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TENNIS ELBOW and GOLFER'S ELBOW
Extremely common in the over-40s (though rare in young tennis players and golfers), these two conditions cause intense pain in the elbow. Tennis elbow affects the outside of the elbow joint, while golfer's elbow affects the part nearest to the body, close to the 'funny bond'.

Fortunately, many people do eventually get better, whether they are treated or not. All sorts of remedies are enthusiastically advocated by their supporters, for instance, warmth, ice packs, painkillers, slings, strapping and splints.

Personally, I've found that the only thing which produced dramatic improvement in myself was having a small steroid injection into the painful area - administered by a knowledgeable doctor who does this kind of jab regularly.

TENDONITIS
This means inflammation of a tendon. Tendons are the 'cords', which run between bones and muscles. (Some older folk still call them by the traditional English names of 'leaders'). This inflammation can affect all sorts of tendons, but particularly the Achilles - located at the back of the heel.

Treatment of tendonitis may involve rest, warmth and physiotherapy. Sometimes injected steroids may help. Often it's essential to modify your activities in some way; for instance joggers may have to get rid of trainers, which are rubbing on the Achilles tendon.

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ROTATOR CUFF SYNDROME
This is an extremely common condition in the over 40s. It causes pain in the shoulder and upper arm, which is often worse at night. Typically, the person can't lift his arm sideways very far.

Treatment consists in rest, warmth and painkillers. Massage may help. If matters don't clear up, ask about having a steroid injection.

FROZEN SHOULDER
Quite common among the 50-plus age group. There is severe shoulder pain and stiffness, so that the shoulder can scarcely be moved at all. Anti-inflammatory drugs and injections into the shoulder joint may be helpful. Some specialists recommend manipulation of the shoulder while the patient is asleep under a general anaesthetic.

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BURSITIS
This means inflammation of a 'sac' (that is, a little bag of fluid). Commonest site for bursitis is just below the knee-cap, the famous condition called 'housemaid's knee'. Many cases are caused by recurrent friction.

Treatment includes prescribing painkillers and possibly steroid injections. Occasionally, a very painful sac may need to be drained or removed.

TENOSYNOVITIS
This is inflammation of the 'sheathes' through which tendons run. It's painful, and it's often caused by unaccustomed or excessive usage of part of the body. For instance, Tenosynovitis of the wrist is quite common in extremely enthusiastic golfers!

Treatment may include warmth, physiotherapy osteopathy and injection of steroids into the space alongside the tendon (not into the tendon itself). This should only be done by a specialist who is expert in the technique.

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POLYMYALGIA RHEUMATICA
This is a distressing cause of severe pain in the over-50s. Typically, the person suddenly develops intense painful spasm in the shoulders, neck, hip area and lower spine - which is usually worse in the mornings. There is tiredness, fever, and often depression.

Blood tests are necessary to confirm the diagnosis. Steroid drugs by mouth usually give much needed relief. The rheumatologist may well suggest other drugs too.

RHEUMATOID ARTHRITIS
This condition is more likely to arise in younger people than in those of retirement age. It can be very disabling, but fortunately it may 'burn itself out' as you get into your 60s or 70s. Treatment is a matter for a specialist in rheumatology to decide. But these days, it quite often involves surgical replacement of painful joints.

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DISC TROUBLE
This is fantastically common - indeed, I've had a couple of 'slipped discs' myself! Discs are actually shock absorbers, located between the bones of the spine. What goes wrong is that a disc bulges out from its normal place and presses on a nerve. Result; horrendous pain - often down the part of the leg which is supplied by the sciatic nerve. (this is called 'sciatica').

If you have been diagnosed as having a disc problem, I advise you to go to an osteopath or a chiropractor (make sure you get a properly qualified one). There are no medications, which will make a disc 'go back' into place. Occasionally, injections into the spine may help. But for many people, the only real cure is an operation.

CARPAL TUNNEL SYNDROME
Many people aged over 45, particularly women, are affected by this condition. Typically, the person complains of night-time pain, tingling and numbness in the hand and forearm. This is due to the fact that a nerve (the median nerve) is getting compressed as it runs through the wrist. It's important to look for underlying causes for this compression - such as obesity, diabetes, or an under-active thyroid gland.

Initial treatment is with splints worn at night, then (if necessary) with steroid injections. Some patients eventually need an operation, to remove the pressure on the nerve.

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CERVICAL SPONDYLITIS
This is a very frequent condition in people of middle years and beyond. Basically, it's a degeneration (linked to wear and tear) in the bones and discs of the neck. This causes pain, stiffness and numbness - often running down the arms. If symptoms are severe, the special type of scan known as an 'MRI' may be necessary. Warmth, neck collars, anti-inflammatory drugs and traction ('lengthening' of the spine by a physio) may be needed.

SUMMING UP
So you can see that there are many, many types of 'rheumatism'. I've only dealt with the more common ones here. But if you have some other kind of rheumatic disorder, do please email me here at Retirement Matters, and I'll try to answer any questions you may have.

However, it is important that you follow the advice of your own GP, rheumatologist or orthopaedic surgeon.

What about alternative practitioners? Well, we deal with them in the Q & A Section

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Q. My doctor hasn't been able to help my rheumatism much. So how would I find a good osteopath or chiropractor?
A. Look in the Yellow Pages. There are still some not very well qualified people who call themselves 'osteopaths' or 'chiropractors', but properly qualified ones are usually listed in a special 'box'. A fully qualified osteopath has the letters. 'MRO' and 'DO' after her/his name. In the case of a chiropractor, look for the letters 'DC'.

Q. Is it true that rheumatism can be helped by Ayurvedic herbs?
A. Well, doctors who practise Ayurvedic medicine (an ancient Indian systems of healing) certainly think so. They speak particularly highly of Turmeric and Shallaki in helping various forms of arthritis. But it's best to find yourself an expert practitioner, and see what he/she says.

Q. My wife swears by something called 'the green-lipped New Zealand sea mussel' an as alternative remedy for rheumatism. Is it any good?
A. Yes. It's not the 'miracle worker' that people once claimed it to be. But it does contain an ingredient, which is rather similar to aspirin in its effects. So if your doc (or other therapist) approves, give it a go.

Q. Could acupuncture be any good for my rheumatism, as I have heard?
A. Acupuncture can certainly be very useful in relieving pain. Don't expect it to provide a cure for your rheumatic problem, but it may well be worth investing in a few sessions.

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Q. My husband has got himself very worried about the possibility of an Anthrax attack. It is true that the thing to watch out for is something that seems like 'flu'?
A. At present, the commonest type of anthrax symptom is a painless, itchy, red lump on the skin - like an insect bite. It rapidly forms a blister, which then turns black. At the time of writing, a major anthrax attack on Britain seems unlikely. But things have reached the stage where doctors have been put 'on the alert'.

Q. I'm female, and a retired executive. Am I right in thinking that now I am 65, I need no longer check myself for breast cancer?
A. No, ma'am! The risk of breast cancer remains very high in women who are over 60. You should continue to be 'breast aware' (and to check yourself regularly for lumps or anything odd) throughout your life.

Q. I'm a man of 58, and I smoke 40 a day - always have! Recently, I've had slight problems in bed, with my body not 'performing' when I want it to. My doctor says that this is because of my smoking. Is that correct?
A. Well sir, smoking does greatly increase the risk of impotence. So it would be well worthwhile trying to give up - and see what happens to your potency. If that doesn't help, you should have an assessment by a doctor who is used to treating erection problems.

Q. My husband is worried about the fact that I don't drink! He says that it's been proven that drinking alcohol makes you live longer. Is this really true?
A. The evidence on this point is still a bit sketchy. But it does seem probably that in the over 55s, two glasses of red wine per day does give some protection against heart attacks - and so increase your chances of longer life. Cheers!

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