Living with arthritis, causes, types and treatments

Arthritis Knee: Living with arthritis

Affecting around 10 million people in the UK, living with arthritis can have a debilitating impact on those who live with the condition.

Arthritis causes pain, inflammation and stiffness in the body’s joints but is not considered a single condition, as there are numerous types.

Approximately 10 million people in the UK are thought to have some form of arthritis. Although it is commonly considered a condition affecting older people, it can affect people of any age, including children and teenagers.

“To help mobility, wellbeing, reduce pain, stiffness and swelling, people with arthritis are encouraged to be physically active”

What causes arthritis?

Although it can be difficult to pinpoint the causes of arthritis, or to predict if a person will experience a form of the condition, there are a number of factors that can increase the risk of developing a type of arthritis. These include:

  • Genetics: Osteoarthritis, for example, may run in families.
  • Gender: Some types of arthritis are more prevalent in women.
  • Age: Risk of developing arthritis can increase with age.
  • Joint injury: Post-traumatic or secondary arthritis can occur after a joint is physically injured and doesn’t heal properly.Arthritis: The stats
There are many different types of arthritis, however some are more prevalent than others.
Osteoarthritis

Osteoarthritis is the most common type of arthritis. It can cause small fragments of bone (osteophytes) to grow in the joints, fluid to build-up in the joint or can affect the joint capsule, leading to pain and stiffness.

Osteoarthritis: The Facts
  • 8.75 million people in the UK have seen a doctor about the condition.
  • It commonly affects the knees, hands, hips and back.
  • Women are more likely to experience osteoarthritis.
  • It is more prevalent in people aged 45 or over.
  • It may not cause pain in early stages.
  • It can run in families.
Rheumatoid arthritis

Rheumatoid arthritis is the most common form of autoimmune arthritis. As with other autoimmune conditions, the immune system attacks the body. In the case of rheumatoid arthritis, it attacks the joints and causes inflammation leading to the joint capsule becoming misshapen, unstable or difficult to move.

Rheumatoid Arthritis: The Facts
  • Rheumatoid arthritis affects more than 400,000 people in the UK.
  • It is more likely to affect women than men.
  • It usually starts between the ages of 40 and 50.
  • The main symptoms are joint pain, swelling or stiffness.
  • It can affect any joint in the body but may be felt in the hands and feet first.
  • Some people develop rheumatoid nodules; fleshy lumps that develop under the skin around joints.

Another autoimmune arthritis is psoriatic arthritis. As well as swelling and stiffness around the joints, psoriatic arthritis may cause psoriasis and fatigue.

Gout

Gout is a form of inflammatory arthritis caused by increased levels of urate, uric acid, in the body. The uric acid build-up can cause crystals to form inside and around the joints. This leads to sudden, painful swelling in the joints.

Gout: The Facts
  • Gout typically affects the joints towards the ends of the limbs –toes, ankles or fingers.
  • Joints can become red and hot.
  • Skin may peel or look shiny.
  • It mainly affects men over 30.
  • It can affect women after the menopause.
  • Symptoms can develop rapidly and last for up to 10 days.
Childhood arthritis

Arthritis can also affect children and in most cases, it is called juvenile idiopathic arthritis (JIA). JIA is an autoimmune type of arthritis. There are four main types of JIA: oligo-articular, polyarticular, systemic onset and enthesitis-related arthritis. Children may also experience psoriatic arthritis.

Childhood Arthritis: The Facts
  • Childhood arthritis affects more than 12,000 children in the UK.
  • The exact cause is usually unknown.
  • Symptoms can improve with age but for one in three, the arthritis may continue into adult life.
  • Oligo-articular JIA is the most common childhood arthritis and usually affects the knees.
  • Polyarticular JIA, or polyarthritis causes painful swelling in fingers, toes, wrists, ankles, hips, knees, neck and jaw.
  • Enthesitis-related JIA often affects the legs and spine, causing inflammation where the tendons attach to the bone.
  • Systemic onset JIA can come on with a fever, rash, enlarged glands, spleen, liver and occasionally the covering of the heart.

Other types of arthritis

Enteropathic arthritis is linked to irritable bowel syndrome and is a form of chronic inflammatory arthritis. Around one in five people with Crohn’s disease or ulcerative colitis will develop this form of arthritis.

Reactive arthritis can develop after an infection of the bowel or urogenital tract. It can cause inflammation of the joints, eyes and urethra.

Spondyloarthritis is a collective term for conditions that cause pain and swelling around the joints of the spine. The most common form is ankylosing spondylitis which occurs when inflammation leads to calcium forming around the ligaments of the spine. This may lead to the vertebrae fusing together.

Treatment

There are a range of treatments for different types of arthritis including painkillers, non-steroidal anti-inflammatory drug, steroids, disease-modifying anti-rheumatic drugs (DMARDs) or biological therapies.

DMARDs do not treat the pain associated with arthritis, but they do reduce symptoms over time by changing the underlying disease, and the effect it has on the joints.

Biological therapies, whilst being a type of DMARD, can target individual molecules in the body and work more quickly. Biological therapies target different proteins in the body and one group, anti-TNF drugs, target a protein called tumour necrosis factor (TNF) which is responsible for increasing inflammation.

AbbVie’s Humira (adalimumab) is an anti-TNF biological therapy for some types of arthritis including severe rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and moderate to severe JIA. In October 2018, its patent expired leading to a number of biosimilars entering the market.

Bristol-Myers Squibb’s Orencia (abatacept) is a biological therapy targeting the causes of inflammation and reduces immune system activity. It can be prescribed for rheumatoid arthritis, polyarticular JIA, or psoriatic arthritis but usually not until two DMARDs have been tried.

Biological therapies are rarely a first-line treatment and are usually prescribed if the individual hasn’t responded well to other treatments. Conventional DMARDs may be given in combination with biological therapies.

To help mobility, wellbeing, reduce pain, stiffness and swelling, people with arthritis are encouraged to be physically active. Individuals may also have access to physiotherapy, occupational therapy or podiatry, and be encouraged to consider non-medicinal pain relievers, modifying their posture, and protecting their joints.

In severe cases of arthritis, surgery may be necessary.


The right treatment for George

George Ivil, 21, is about to finish his final year at university studying politics. He was diagnosed with enthesitis-related arthritis when he was 15. The two to three years following his diagnosis were a whirlwind and he experienced feelings of depression and loneliness which made life at home and at school difficult.

“I felt so low; I didn’t want to see or talk to anyone. My condition became severe very quickly and affected my whole body. I started treatment, and everything went downhill.

“The side effects made me very sick and I experienced extreme weight loss and bad acne, which knocked my confidence. I was in a lot of pain and under lots of stress physically and emotionally. I felt I had lost all my independence.

“Things improved when I changed medication. I was referred to a different hospital where I was put on Humira; this was a turning point for me.

“I had reached a point where I wanted to drop out of school. I couldn’t even watch football because it was too painful and exhausting to travel there. My head of sixth form gave me a confidence boost and talking to him really helped push me in the right direction. He reminded me that I could achieve so much. Now I want to share my story with other young people going through a similar thing.

“I think I still struggle coming to terms with having arthritis sometimes. It can upset me when people ask about it, because I don’t want them to make any kind of judgement based on my condition. And sometimes I try to do too much despite it.

“But I think it’s so important that people understand more about the impact of this condition. I want to share my story with other young people going through a similar thing. I open up about my condition more now. My family and my girlfriend are very supportive, and my friends will often ask how I am, but not make a big deal out of it. I know they’re here for me, but it’s nice feeling like I’m not being treated differently because of my condition.”

Sources: https://www.nhs.uk/conditions/ankylosing-spondylitis/ https://www.nhs.uk/conditions/arthritis/
https://www.nhs.uk/conditions/psoriatic-arthritis/ | https://www.nhs.uk/conditions/rheumatoid-arthritis/ | https://www.nhsinform.scot/illnesses-and-conditions/muscle-bone-and-joints/conditions/gout | https://www.versusarthritis.org/about-arthritis/conditions/arthritis/ | https://www.versusarthritis.org/about-arthritis/conditions/osteoarthritis/ | https://www.versusarthritis.org/about-arthritis/conditions/rheumatoid-arthritis/
| https://www.versusarthritis.org/about-arthritis/treatments/drugs/ | https://www.versusarthritis.org/about-arthritis/treatments/drugs/disease-modifying-anti-rheumatic-drugs-dmards/