Arthritis

Arthritis is a common condition that causes pain and inflammation in a joint.

In the UK, around 10 million people have arthritis. It affects people of all ages, including children (see below).

Types of Arthritis

The two most common types of arthritis are:

• osteoarthritis
• rheumatoid arthritis

Osteoarthritis

Osteoarthritis is the most common type of arthritis in the UK, affecting around 8 million people.

It most often develops in adults who are in their late 40s or older. It's also more common in women and people with a family history of the condition. However, it can occur at any age as a result of an injury or be associated with other joint-related conditions, such as gout or rheumatoid arthritis.

Osteoarthritis initially affects the smooth cartilage lining of the joint. This makes movement more difficult than usual, leading to pain and stiffness.

Once the cartilage lining starts to roughen and thin out, the tendons and ligaments have to work harder. This can cause swelling and the formation of bony spurs, called osteophytes.

Severe loss of cartilage can lead to bone rubbing on bone, altering the shape of the joint and forcing the bones out of their normal position.

The most commonly affected joints are those in the:

• hands
• spine
• knees
• hips

Rheumatoid arthritis

In the UK, rheumatoid arthritis affects more than 400,000 people. It often starts when a person is between 40 and 50 years old. Women are three times more likely to be affected than men.

Rheumatoid and osteoarthritis are two different conditions. Rheumatoid arthritis occurs when the body's immune system targets affected joints, which leads to pain and swelling. 

The outer covering (synovium) of the joint is the first place affected. This can then spread across the joint, leading to further swelling and a change in the joint's shape. This may cause the bone and cartilage to break down.

People with rheumatoid arthritis can also develop problems with other tissues and organs in their body. 

Other types of arthritis and related conditions

• Ankylosing spondylitis – a long-term inflammatory condition that mainly affects the bones, muscles and ligaments of the spine, leading to stiffness and joints fusing together. Other problems can include the swelling of tendons, eyes and large joints.
• Cervical spondylosis – also known as degenerative osteoarthritis, cervical spondylitis affects the joints and bones in the neck, which can lead to pain and stiffness.
• Fibromyalgia – causes pain in the body's muscles, ligaments and tendons.
• Lupus – an autoimmune condition that can affect many different organs and the body's tissues.
• Gout – a type of arthritis caused by too much uric acid in the body. This can be left in joints (usually affecting the big toe) but can develop in any joint. It causes intense pain, redness and swelling.
• Psoriatic arthritis – an inflammatory joint condition that can affect people with psoriasis.
• Enteropathic arthritis – a form of chronic, inflammatory arthritis associated with inflammatory bowel disease (IBD), the two best-known types being ulcerative colitis and Crohn's disease. About one in five people with Crohn's or ulcerative colitis will develop enteropathic arthritis. The most common areas affected by inflammation are the peripheral (limb) joints and the spine.
• Reactive arthritis – this can cause inflammation of the joints, eyes and urethra (the tube that urine passes through). It develops shortly after an infection of the bowel, genital tract or, less frequently, after a throat infection.
• Secondary arthritis – a type of arthritis that can develop after a joint injury and sometimes occurs many years afterwards.
• Polymyalgia rheumatica – a condition that almost always affects people over 50 years of age, where the immune system causes muscle pain and stiffness, usually across the shoulders and tops of the legs. It can also cause joint inflammation.

Symptoms of Arthritis

The symptoms of arthritis you experience will vary depending on the type you have.

This is why it's important to have an accurate diagnosis if you have:

• joint pain, tenderness and stiffness
• inflammation in and around the joints
• restricted movement of the joints
• warm, red skin over the affected joint
• weakness and muscle wasting

Arthritis and children

Arthritis is often associated with older people, but it can also affect children. In the UK, about 15,000 children and young people are affected by arthritis.

Most types of childhood arthritis are known as juvenile idiopathic arthritis (JIA). JIA causes pain and inflammation in one or more joints for at least six weeks.

Although the exact cause of JIA is unknown, the symptoms often improve as a child gets older, meaning they can lead a normal life.

The main types of JIA are discussed below. Arthritis Research UK has more information about the different types of juvenile idiopathic arthritis.

Oligo-articular JIA

Oligo-articular JIA is the most common type of JIA. It affects fewer than five joints in the body – most commonly in the knees, ankles and wrists.

Oligo-articular JIA has good recovery rates and long-term effects are rare. However, there's a risk that children with the condition may develop eye problems, so regular eye tests with an ophthalmologist (eye care specialist) are recommended.

Polyarticular JIA (polyarthritis)

Polyarticular JIA, or polyarthritis, affects five or more joints. It can develop at any age during childhood.

The symptoms of polyarticular JIA are similar to the symptoms of adult rheumatoid arthritis. The condition is often accompanied by a rash and a high temperature of 38C (100.4F) or above.

Systemic onset JIA

Systemic onset JIA begins with symptoms such as a fever, rash, lethargy (a lack of energy) and enlarged glands. Later on, joints can become swollen and inflamed.

Like polyarticular JIA, systemic onset JIA can affect children of any age.

Enthesitis-related arthritis

Enthesitis-related arthritis is a type of juvenile arthritis that affects older boys or teenagers. It can cause pain in the soles of the feet and around the knee and hip joints, where the ligaments attach to the bone.

Treating Arthritis

There's no cure for arthritis, but there are many treatments that can help slow down the condition.

For osteoarthritis, medications are often prescribed, including:

• painkillers
• non-steroidal anti-inflammatory drugs (NSAIDs)
• corticosteroids

In severe cases, the following surgical procedures may be recommended:

• arthroplasty (joint replacement)
• arthodesis (joint fusion)
• osteotomy (where a bone is cut and re-aligned)

Read more about how osteoarthritis is treated.

Treatment for rheumatoid arthritis aims to slow down the condition's progress and minimise joint inflammation or swelling. This is to try and prevent damage to the joints. Recommended treatments include:

• analgesics (painkillers)
• disease modifying anti-rheumatic drugs (DMARDs) – a combination of treatments is often recommended
• physiotherapy 
• regular exercise 

Living with Arthritis

Living with arthritis isn't easy and carrying out simple, everyday tasks can often be painful and difficult.

However, there are many things you can do to make sure you live a healthy lifestyle. A range of services and benefits are also available.

Work

Many people with arthritis want to continue working for many reasons, including better financial security and higher self-esteem.

Improved treatment approaches have helped ensure that many people who are diagnosed with arthritis can return to work. This is particularly the case if arthritis is diagnosed and treated at an early stage.

You may find work challenging, but your employer should help you with the training and support you need.

Help is also available if your arthritis is so severe that you're unable to work. Find out more about the Personal Independence Payment (formerly known as the Disability Living Allowance).

Arthritis Care has more useful information about working with arthritis.

Healthy eating

It's very important to eat a healthy, balanced diet if you have arthritis. Eating healthily will give you all the nutrients you need and help you maintain a healthy weight.

Your diet should consist of a variety of foods from all five food groups. These are:

• fruit and vegetables
• starchy foods – such as bread, rice, potatoes and pasta
• meat, fish, eggs and beans
• milk and dairy foods
• foods containing fat and sugar

Read more about how to have a healthy, balanced diet.

If you're overweight, losing weight can really help you cope with arthritis. Too much weight places excess pressure on the joints in your hips, knees, ankles and feet, leading to increased pain and mobility problems.

Read more about how you can lose weight using the weight loss guide.

Exercise

If your arthritis is painful, you may not feel like exercising. However, being active can help reduce and prevent pain. Regular exercise can also:

• improve your range of movement and joint mobility
• increase muscle strength
• reduce stiffness
• boost your energy

As long as you do the right type and level of exercise for your condition, your arthritis won't get any worse. Combined with a healthy, balanced diet (see above), regular exercise will help you lose weight and place less strain on your joints.

Your GP can advise about the type and level of exercise that's right for you. You can also download useful free booklets from Arthritis Care and Arthritis Research UK, including:

• Exercise and arthritis
• Pain and arthritis

Joint care

If you have arthritis, it's important to look after your joints so there's no further damage. For example, try to reduce the stress on your joints while carrying out everyday tasks like moving and lifting.

Some tips for protecting your joints, particularly if you have arthritis, include:

• use larger, stronger joints as levers – for example, take the pressure of opening a heavy door on your shoulder rather than on your hand
• use several joints to spread the weight of an object – for example, use both hands to carry your shopping or distribute the weight evenly in a shoulder bag or rucksack
• don't grip too tightly – grip as loosely as possible or use a padded handle to widen your grip

The Arthritis Care website has more information and advice about taking care of your joints.

It's also important to avoid sitting in the same position for long periods of time and to take regular breaks so you can move around.

Read more about good posture and how to sit correctly.

At home

If you have arthritis, carrying out tasks around the home can be a challenge. However, making some practical changes to your home and changing the way you work should make things easier.

Practical tips that could help include:

• keeping things in easy reach
• using a hand rail to help you get up and down the stairs
• using long-handled tools to pick things up or to clean
• fitting levers to taps to make them easier to turn
• using electric kitchen equipment, such as tin openers, when preparing food

You can find more useful information and advice about living independently at home on Arthritis Care.

Occupational therapy

An occupational therapist can help if you have severe arthritis that's affecting your ability to move around your home and carry out everyday tasks, such as cooking and cleaning.

They can advise about equipment you may need to help you live independently.

Depending on the exact nature of your condition, your GP may be able to refer you to an NHS occupational therapist. However, you may need to access this type of therapy through your local council. 

Find your local council on GOV.UK.

Case Study 1 "Dancing got me through the roughest times"

Paul Casimir has been living with arthritis for half his life, but doesn't let it stop him doing the things he enjoys. He tells his story.

Paul was diagnosed with rheumatoid arthritis at 20. He was a fast runner throughout his teens, but at 19 his body started to stiffen up.

"I had been feeling a little bit strange for about a year before I was diagnosed with arthritis," says Paul. "I just seemed to move at the pace of a distracted goat. I didn't really know what was going on. I was at drama school at the time and I kept getting cast as octogenarians."

One day, after finishing a play, he collapsed into bed, completely exhausted. When he woke up, his knees had swollen to the size of dumplings, and he was in bed for four days. His doctor was puzzled.

"It then went away for a while, but returned with a vengeance a couple of months later," says Paul. "I was referred to a rheumatologist, who diagnosed rheumatoid arthritis. It was something I'd never heard of and I didn't know why it was happening to me. I had tears in my eyes when she told me."    

Paul managed his condition with painkillers and anti-inflammatory medication for the next few years. It was difficult for him to move properly. "Dancing was what got me through the roughest times," he says. "Even when I could barely move, I could still dance. Standing still was excruciating, but transferring my weight from one leg to the other was bearable."

One day, he decided to see how he would get on without medication. He has never looked back.

"I didn't really notice much of a difference with the medication," he says. "People diagnosed now would be offered different kinds of medication, such as disease-modifying medication, but I guess that wasn't around when I was diagnosed.

"After a while it became really important to me to start challenging the condition, to take back control of my life."

He started swimming and going out dancing, and stopped worrying about what other people thought. It's been five years since the last big flare-up.

"I just learnt to get on with life," he says."It's easy to dwell on the pain and misfortune and to think 'why me'. But in the end, that's really quite futile. What's important is to focus on all the things you enjoy. I swim regularly and enjoy a ramble in the woods, whereas 20 years ago I'd have thought 'Let's go for a walk' was the most ridiculous suggestion someone could make! The richer your experiences in life, the more you're distracted from the pain.

"And I still look good on the dancefloor, dancing like a robot from 1984!" 

Case Study 2 - "Osteoarthritis affects almost every part of my life"

Jo has been living with osteoarthritis for 15 years. When she felt her independence slipping away, she knew she had to take stock of her life.

"I broke my ankle in 1990 and was warned by an orthopedic surgeon to expect the onset of osteoarthritis. What I didn't anticipate was that within five years, not only both my ankle joints, but also my knees and hips would be affected. I currently live with a dull constant pain, which will continue for the rest of my life."

"I was lucky to be diagnosed by my GP on the second visit. My doctor was very thorough and sent me to a rheumatology clinic for tests, to be certain that the condition I had was osteoarthritis."

"Osteoarthritis affects almost every part of my life. My favourite pastime is making wooden toys. Unfortunately, I now also experience pain in my finger joints. My aim now is to keep my hands moving and try to lessen the damage, so I can continue to enjoy my hobbies for as long as possible.

"I have now been living, struggling and sometimes laughing with and at osteoarthritis for the last 15 years. In the last two years, my osteoarthritis has worsened significantly. My knees are beginning to give way, my left calf muscle has become wasted and my feet are 'turning over'. I enjoy walking, as I'm a country girl at heart, but it's increasingly becoming agony even to pop to the supermarket in the next street.

"In the past, my 'disability' went seemingly unnoticed by others. I was pushed out of the way and ranted at on buses for asking for a seat. I began to fear that I was losing control of my independence. I had to take stock of my life and my future. 

"At this time, a good friend gave me a walking stick. It stayed consigned to the corner for several months because I wasn't prepared to carry a symbol of my increasing disability. One day I was unable to stand up and needed friends to help me to my feet. The shock and the embarrassment were what I needed to shake me out of my pride and into the stark reality of my situation. 

"I started to use the stick to come in to work. I immediately noticed that with a visible sign of my problems, people were more patient, the pushing stopped and I got offered a seat on the bus. The stick has given me back my confidence for walking. Although other people notice it, I'm gradually becoming less aware of my constant companion and friend. Everyone needs a friend they can lean on!" 

"I feel passionately about the need for good quality care for patients with osteoarthritis across the country. It's important to me that everyone gets the same sort of attention and treatment from the NHS that I have had. Early diagnosis is crucial, but so is swift access to the right treatment, information and programmes."