Arthritis Matters Winter 2013 issue by Nick Quirke

www.arthritisnsw.org.au RRP $5.95

ARTHRITIS WINTER 2013

& OSTEOPOROSIS

MATTERS

Focus on: Polymyalgia Rheumatica

Peptides

in Sport & Arthritis

William's Walk IN REVIEW

How to: manage your stress

Yoga & Arthritis

Limbering up to tackle your arthritis

The Alternative Health Issue

Acupuncture, complementary therapies & all things natural

ARTHRITIS MATTERS / WINTER 2013

Contents

Seniors Funeral Plan

Peace of mind for you and your family

Upcoming Events

REGULARS

Affordable funeral insurance to help protect your family from $2.84* per week.

JUNE 2013 Wednesday 5: Moving On program, St Leonards

From the CEO

Q&A

Recipes

Osteoporosis 18

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Kids Corner

Out of Joint

Local Happenings

Branch Listings

Health & Fitness

(7 weeks)

Thursday 6: Osteoarthritis of the Knee Program (OAK), Malabar (4 weeks)

Friday 7: Moving On program, Seaforth (7 weeks)

JULY 2013 Tuesday 16: Rheumatoid Arthritis Program (RAP) Jubilee Community Centre, Kogarah (6 weeks)

Friday 19: Osteoporosis Self-Management Program, Taree

Saturday 20: Kidsflix, Hoyts Cinema,

Entertainment Quarter/Fox Studios

AUGUST 2013

FEATURES

Sunday 12: City2Surf Charity Challenge, Sydney CBD

Focus: Polymyalgia Rheumatica

Saturday 17: Ballina Fair Cinema, Ballina Thursday 22: Osteoarthritis of the Knee Program

Natural Complementary Medicines

Acupuncture

Thursday 22: Arthritis Seminar, Dubbo

Yoga & Arthritis

SEPTEMBER 2013

The Three Keys to Bone Health

Saturday 14: Kidsflix, Odeon 5/Metro/Reading

Stress Management

Sunday 22: Blackmores Sydney Running Festival,

Peptides in Sport & Arthritis

(OAK), Blacktown (4 weeks)

cinemas, Orange/Bathurst/Dubbo Milsons Point

For more information or to register for any of these events, contact Arthritis NSW on 1800 011 041 or visit www.arthritisnsw.org.au

Why choose Australian Seniors Insurance Agency

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* Age based premium providing $5,000 benefit under a single plan for a person aged 50. This is general advice only. Please consider the Product Disclosure Statement to ensure the product suits your needs. This information is provided by Australian Seniors Insurance Agency Pty Ltd (AR 270983), an authorised representative of Hollard Financial Services Pty Ltd, AFSL 343079. The Australian Seniors Funeral Plan is issued by Hannover Life Re of Australasia Ltd, ABN 37 062 395 484. Terms and conditions apply.

Arthritis NSW can help improve your quality of life. Become a member today!

ARTHRITIS MATTERS / WINTER 2013

ARTHRITIS & OSTEOPOROSIS

MATTERS

WINTER 2013 Arthritis NSW & Osteoporosis NSW Locked Bag 2216, North Ryde NSW 1670 1.15/32 Delhi Road, North Ryde NSW 2113 Phone: 02 9857 3300 Fax: 02 9857 3399 Web: www.arthritisnsw.org.au ABN 64 528 634 894 CAN 000587299 CFN 12845 Copyright© 2013 Arthritis NSW Arthritis Matters is mailed out to members and subscribers throughout NSW. Information & Helplines Arthritis: 1800 011 041 Osteoporosis: 1800 242 141 Advertising: To advertise in Arthritis Matters call 02 9857 3300 Contribution and Advertising Closing Dates: Spring 2013: 30 August Summer 2014: 1 November Patron: Her Excellency Prof Marie Bashir AC, Governor of NSW President: Mr Greg Monaghan Vice President: Ms Judith Cantor Hon. Treasurer: Mr Dennis Messner Company Secretary: Mr Evan Manolios Directors Assoc. Prof. Nick Manolios, Ms Cosi Pupo, Mrs Doris Carrall and Mr Allan Ryan

Farewell and Thank You, Karen On behalf of Arthritis NSW staff, our board, volunteers and members, we would like to say a sincere thank you to Karen for all her efforts as Chief Executive of Arthritis NSW over the last five years. She has overseen the organisation through a period of immense positive change and has been pivotal in driving Arthritis NSW to bigger and better things. Under Karen, the organisation has gone from strength to strength and have been able to support members of the community who has some form of arthritis. We wish Karen all the very best in her future endeavours and thank her for her service.

FAREWELL FROM THE CEO This is my last Chief Executive’s column as I am leaving Arthritis NSW at the end of June, having been here just over five years – where did that time go? I have enjoyed my time here and met wonderful people throughout NSW, who make a real difference to our organisation. Meeting members of our support groups and branches, as well as our wonderful, generous donors has enriched my experience in the organisation. I have also had the pleasure of working with some very dedicated clinicians like Dr Davinder Singh-Grewal, Dr Jeff Chaitow, Professor David Hunter, Professor Lyn March, Robyn Speerin from the Agency for Clinical Innovation and many others. These are people who don’t just want to treat people, but want to change the system to improve the overall patient experience and long term health outcomes for people with arthritis. They also give so generously of their time to help Arthritis NSW.

Chief Executive: Karen Filocamo Manager Health Promotion & Service Development: Di Spragg Marketing and Fundraising Manager: Rob Novotny Senior Fundraising Officer: Bianca Elhage Communications Officer: Nick Quirke Senior Health Promotion Officer: Eloise Milthorpe Health Promotion Officers: Alex Jaksetic and Jenny Ly Business Manager: Michael Fazio Finance Assistant: Clarissa Jones Receptionist/ Information Officer: Ingrid Player Membership Officer: Melissa Denham Executive Assistant: Clare Riordan Community Liaison Officer: Nena Doyle Design: Sensory Creative

My decision to leave is because I feel the time is right. I would like to thank everyone for all the support you have given me and finish my last column with some thoughts I’d like to share.

Advertising Policy Statement

Even many of our own groups around NSW direct their fundraising to our children’s activities and research programs, rather than to services we provide for adults of all ages including warm water sessions, wellness programs, tai chi, webinars, seminars, new resources, the telephone information service, arthritis education for health professionals, etc.

Products and services advertised in Arthritis Matters are not necessarily recommended or endorsed by Arthritis NSW. Some readers may assume that anything advertised in these pages has been cleared, vetted or in some way approved by the charity. This is not so. Arthritis NSW is not equipped to test and approve products and services that are available to the general public. Please exercise careful judgment about whether the item or service is likely to help you personally, and where appropriate, take professional advice from your doctor or specialist before making a purchase. Whilst all reasonable care has been taken to ensure the accuracy of information inside Arthritis Matters, no warranties or guarantees are given nor any responsibility accepted by the publishers, its agents or anyone else involved in its production for any errors which may occur. Nothing contained inside is intended as medical advice – always consult your doctor regarding treatment or medicines.

It is very difficult to raise funds for arthritis services. We compete with a range of high profile charities. There are over 600,000 not for profit organisations in Australia. While many community members and corporate sponsors are prepared to give readily to children’s activities and research – few seem to want to invest in the health of older people, who still comprise the majority of our members.

Because of this, we struggle to maintain our adult arthritis health promotion services. These are services that can help the majority of our membership to age well, manage their pain and stay active - yet it is hard to attract financial support for them. It is also true that arthritis has an image problem. Many people see it as only an older person’s condition. However this is far from the truth. Arthritis affects infants, children, teenagers, young adults, working age people, as well as older people. One in five Australians has arthritis, but many, particularly working aged people, do not want to talk about it. There are also high profile people in the community who prefer not to admit they have arthritis for fear of how they may be seen. This needs to change. I encourage all of you to do what you can locally and within your means, to raise awareness about the scope of this massive chronic disease. With an ageing population and a growing obesity problem amongst people of all ages (every kilo that you are overweight, raises the pressure on your joints significantly and increases your pain), arthritis is likely to be the major health issue of the future. As someone who has lived with osteoarthritis for the last 12 years, I will continue to advocate personally for greater government investment in arthritis services and I encourage you all to do the same. Thank you for giving me the honour of representing all of you for the last five years. It has been a privilege.

Karen Filocamo NEXT ISSUE Out October 2013 Front Cover: Melissa Paddison Location: Coogee Beach Photographer: Nick Bowers

Do you have any feedback or suggestions for Arthritis Matters? If you do, e-mail info@arthritisnsw.org.au

Q&A recipes

Q&A

What is the difference between fish oil & krill oil?

Welcome to Q&A, a section providing you with the opportunity to ask any question you may have regarding arthritis or osteoporosis. If you do have a question, please e-mail us at info@ arthritisnsw.org.au or call 1800 011 041.

ARTHRITIS MATTERS / WINTER 2013

RECIPES

Do you have a healthy recipe you’d like to share? Simply post it to Locked Bag 2216, North Ryde 1670 or e-mail info@arthritisnsw.org.au.

Please note: not all questions will be answered in the magazine.

Fish oil is made from tissues of fatty fish, such as sardines and salmon. Krill oil is not made from fatty fish, but from small crustaceans that are similar to prawns. Unlike fish oil, krill oil also contains a strong antioxidant, astaxanthin. They both contain the omega-3 essential fatty acids, EPA and DHA. These omega-3 fatty acids have been shown to have various health benefits, particularly in reducing inflammation associated with certain forms of arthritis. Another difference is in krill oil’s structure, which makes it a richer source of EPA and DHA than fish oil. The EPA and DHA in krill oil are surrounded by a strong membrane of substances that increase the absorption of krill oil by the body. It is believed that this structure makes krill oil more easily absorbed than fish oil, such that fewer capsules are needed to have an anti-inflammatory effect. Surprisingly, there is a lack of clinical research comparing krill oil to fish oil. It is unclear whether the antioxidant components or the unique structure of krill oil provides any added health benefits over fish oil. There is strong evidence for fish oil in rheumatoid arthritis, but the bottom line is that more clinical research is needed about krill oil. Krill oil appears to have potential side effects and drug interactions that are similar to fish oil. These side effects include stomach upset, flatulence, bloating and/or diarrhoea. References Arthritis Research UK (2013). Complementary and alternative medicines for the treatment of rheumatoid arthritis, osteoarthritis and fibromyalgia. Alternative Medicine Review (2010). Krill Oil Monograph. 15(1): 84-86.

Now you can spend your time in the pool, not the changing room.

LAMB KORMA WITH RAITA

VEGIE LENTIL SOUP

INGREDIENTS (SERVES 4)

•

Olive oil spray

•

1 onion, chopped

•

1 brown onion, cut into wedges

•

1 clove garlic, crushed

•

2 tablespoons korma curry paste

•

1 carrot, diced

•

400g diced trim lamb or trimmed lamb leg steaks, cut into bite sized pieces

•

1 potato, diced

•

400g diced tomatoes

•

1 parsnip, peeled and diced

•

1 cup reduced salt liquid chicken stock

•

1 stick celery, diced

•

¾ cup fresh coriander leaves

•

125g red lentils

•

½ Lebanese cucumber, grated

•

6 cups chicken stock or water

•

½ small carrot, peeled and grated

•

1 tablespoon tomato paste

•

2 cups Australian reduced-fat natural yogurt

•

2 or 3 sprigs parsley, chopped

•

Steamed basmati rice and green beans, for serving

METHOD Spray a frying pan with oil, add onion and curry paste. Cook stirring for 2 minutes over medium heat. Add the lamb and cook over high heat for 5 minutes. Pour in tomatoes and stock, bring to boil, reduce heat and simmer uncovered for 30-40 minutes. To make raita, finely chop half the coriander leaves and combine with cucumber, carrot and half the yogurt. Remove curry from the heat and stir in remaining yogurt. Serve with rice, beans, raita, and garnish with remaining coriander. ®

Note: Sprinkle some slivered almonds on top for extra calcium and crunch.

METHOD Sauté onion and garlic in a large pot with a little water until onion is translucent. Add carrot, potato, parsnip and celery and cook for a further 5 minutes. Stir in lentils, stock and tomato paste. Bring to the boil, cover and simmer for 30-35 minutes, stirring occasionally. When lentils and vegetables are just cooked, add parsley.

Note: One teaspoon of dried herbs may be substituted for fresh herbs. Reference: Swap It, Don’t Stop It – An Australian Government Initiative. Healthy Food Fast, 2011.

Reference: Dairy Australia. Good health recipe book II. Melbourne: Dairy Australia, 2006

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Focus

ARTHRITIS MATTERS / WINTER 2013

Focus on arthritis:

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Polymyalgia Rheumatica

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Polymyalgia rheumatica generally affects people over the age of 50, however most people are usually diagnosed at around 70 years. It tends to be more common in women than men. People of all races can suffer from polymyalgia rheumatica, but it is most common in Caucasian people. It is a condition which tends to be heightened in the morning and improves as the day goes on. The condition causes inflammation of the joints and the tissues around the joints.

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The symptoms of polymyalgia rheumatica generally come on quickly over the period of a few days or weeks. The main symptoms are:

• muscle pain and stiffness in the upper arms, neck, buttocks and thighs on both sides of the body. • pain and stiffness which is worse in the morning and after not moving for a while. • fatigue and decreased appetite. • unexplained weight loss. • general feeling of malaise. • difficulty sleeping and doing daily activities such as getting up from a low chair due to stiffness.

The exact cause of polymyalgia rheumatica is still unknown. It may be associated with genetic factors or issues related to the immune system, such as an infection, however there is no research that supports this yet. Polymyalgia rheumatica cannot be diagnosed from any single test. A diagnosis is made from a combination of your symptoms, medical history, blood tests and a physical examination. Blood tests measure the erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) blood level. It should be noted that it may take several consultations with your doctor before you will be diagnosed with polymyalgia rheumatica as the symptoms may resemble other types of arthritis as well. Treatment for polymyalgia rheumatica may typically involve taking corticosteroids. Usually your doctor will start you on a program of corticosteroids designed to relieve the symptoms, and then reduce the dosage to the lowest possible amount that keeps symptoms from recurring. The good news is that within two to three years, polymyalgia rheumatica usually settles and there is improvement within days of treatment.

It is normal to keep the treatment going throughout this time, to keep the pain and stiffness under control. Corticosteroids can cause side effects so it is important to be reviewed regularly by your doctor while taking these medicines. Some other things you can do to manage your condition are to stay physically active, ideally with low-impact activities such as swimming or walking, and maintaining a healthy diet. Keeping a healthy diet is important because it will help maintain a healthy weight and also reduce your risk of other health related problems. Working to reduce your stress levels is also important in managing your pain.

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FEATURE

ARTHRITIS MATTERS / WINTER 2013

Glucosamine Glucosamine is a sugar naturally produced by the body. It is important in making substances that are essential building blocks of cartilage, ligaments, synovial fluid and tendons of joints. Glucosamine supplements are made from crab, lobster or shrimp shells. There are two forms of glucosamine supplements – glucosamine sulfate and glucosamine hydrochloride. They are available in capsule, tablet, liquid or powder form.

So you want to take something natural? It is no surprise given the potential side effects associated with long-term use of some medication and the ongoing pain and impaired function related to arthritis, that consumers are increasingly interested in trying complementary medicines. While their original source may be ‘natural’, complementary medicines still have the potential to cause side effects or interact with medicines (prescription or over-the-counter) and other complementary medicines. This article will focus on some popular complementary medicines and our current understanding of their role in arthritis. Despite the popularity of complementary medicines, there is limited information about how they actually work, how they compare with medications or other complementary medicines, what the effective dose is, how they interact with other medications, what side effects may occur and if there are any safety issues with long-term use. In some cases, the standard of scientific research available for a particular complementary medicine is of poor quality and it is not possible to formulate a solid conclusion. It is always a good idea to openly discuss any health treatments you are considering, including complementary medicines, with healthcare professionals such as your rheumatologist, doctor or pharmacist. They may be able to give you specific advice about a supplement’s safety, use and effectiveness.

Chondroitin Chondroitin occurs naturally in our bodies and is responsible for the elasticity of cartilage. It is believed to help draw water and nutrients into the cartilage, keeping it spongy and healthy. Chondroitin supplements are produced from the cartilage of cows, pigs and sharks.

Is it safe? Side effects may include stomach upset, headache, flatulence, diarrhoea and rashes, but these are mild and uncommon. People taking blood thinning medication should speak to their doctor beforehand, as chondroitin may increase the risk of bleeding. People with asthma or other breathing complications should also speak to their doctor about using chondroitin, as it may worsen breathing problems.

What does the research say? Research in animals has shown that chondroitin may prevent the breakdown of cartilage and help with repair of degenerated cartilage. Some studies have found that it may have anti-inflammatory properties. Currently, the evidence for its benefits is inconclusive – that is, some research showed that it did reduce pain and stiffness in osteoarthritis, but some research studies have shown that it didn’t.

Is it safe?

Fish oil Fish oils are high in omega-3 essential fatty acids, EPA and DHA, which have strong anti-inflammatory properties and may regulate the body’s immune system. Fish oil is available in a capsule or liquid form.

Is it safe? The most common side effects of fish oil supplements are stomach upset, flatulence and diarrhoea. People taking blood thinning medication should speak to their doctor beforehand, as fish oil may increase the risk of bleeding. Fish liver oil (e.g. cod liver oil) contains high amounts of vitamins A and D. Vitamin A is a strong antioxidant, but it can be dangerous if the dose exceeds the recommended daily intake.

What does the research say? There is good evidence that fish body oil is effective in those with inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. In inflammatory arthritis, 2.7g (EPA + DHA) daily of fish body oil can significantly reduce joint pain and inflammation, morning stiffness, fatigue and the use of pain medications. Unfortunately, there isn’t strong evidence for the use of fish oil in relieving osteoarthritis symptoms.

Side effects may include stomach upsets, constipation, diarrhoea, headaches and rashes, but they are mild and uncommon. Anyone with a shellfish allergy should be careful if considering a glucosamine supplement (there are shellfishfree types available). Diabetics should speak to their doctor beforehand because glucosamine might increase blood sugar levels in people with diabetes. People taking blood thinning medication should speak to their doctor before starting, stopping or changing their dose of glucosamine, as glucosamine may affect the ability of the blood to clot.

What does the research say? Research in animals has shown that glucosamine may delay the breakdown of cartilage and help rebuild it. This is yet to be confirmed in human research. Studies suggest that glucosamine hydrochloride may not be as effective in reducing pain as glucosamine sulfate. There have been few studies on glucosamine hydrochloride and of these, results showed that glucosamine hydrochloride did not help pain or physical function. Currently, the evidence on glucosamine sulfate is mixed. Some studies demonstrated that 1500mg daily of glucosamine sulfate was as effective as, or slightly more effective than, anti-inflammatory medications in reducing pain and improving physical function and with fewer side effects. Recent studies have also shown that the combination of glucosamine sulfate and chondroitin may be effective in reducing moderate to severe pain from osteoarthritis of the knee. This is promising; however, some previous studies showed that glucosamine sulfate was no better than placebo at reducing pain and improving physical function.

FEATURE

ARTHRITIS MATTERS / WINTER 2013

Acupuncture in the treatment of arthritis.

Acupuncture (needle puncture) is part of Oriental Medicine (OM) and has been used for over 2,500 years in the treatment of many health problems.

O Green-lipped mussel Rosehip Green-lipped mussel is a shellfish that originates from the New Zealand coast. It is unknown how green-lipped mussel works, but it is known that they contain omega-3 fatty acids. Omega-3 fatty acids have anti-inflammatory properties that may be helpful in some forms of arthritis. Green-lipped mussel is available in a powder or capsule form.

Is it safe? Occasionally, stomach upsets, nausea and flatulence can occur in those who take green-lipped mussel supplements. Unfortunately, there is little information about how greenlipped mussel interacts with other medications, but it is possible that it can interact with blood thinning medication. Some green-lipped mussel powders contain a high amount of sea salt, so anyone with heart conditions, high blood pressure, or on a low-salt diet should keep an eye out for this.

What does the research say? Research has shown that green-lipped mussel is not effective in treating rheumatoid arthritis. Some low quality trials have shown that green-lipped mussel, when taken together with pain medication, may reduce pain, improve function and improve quality of life.

Rosehip is made from the fruits of a species of wild rose. Rosehip is rich in vitamin C, a well-known antioxidant. It is believed that rosehip reduces joint inflammation and may prevent joint damage. Rosehip is available in a powder or capsule form.

Is it safe? Side effects may include allergic reactions, constipation, diarrhoea and heartburn, but these are mild. Interactions with other medications have not been well studied.

What does the research say? There has been greater research on the benefits of rosehip in osteoarthritis than in other forms of arthritis. Research has shown promising results – 5 grams daily of rosehip may reduce pain, stiffness, physical disability and pain medication use in patients with osteoarthritis. It is unclear whether rosehip improves inflammation in rheumatoid arthritis. References Arthritis Research UK (2013). Complementary and alternative medicines for the treatment of rheumatoid arthritis, osteoarthritis and fibromyalgia. Arthritis Australia (2008). Glucosamine and Chondroitin. Arthritis information sheet.

riental Medicine (OM) encompasses the traditional medical systems from China, Japan and Korea. Exercise, a healthy diet, massage, acupuncture and related treatment strategies (moxibustion and cupping) are utilised appropriately to treat a wide range of illnesses and dysfunctions. This holistic approach is also used to maintain health and wellbeing. Although early research indicated acupuncture was useful in pain conditions, more recent research has shown it does much more than relieve pain. Acupuncture is a complex intervention which taps into the regulation and the rehabilitation of multiple organ systems involving brain to body and body to brain reflexes. Pain relief, immune regulation, hormonal regulation and mood regulation are some of its benefits. The anti-inflammatory effects are encompassed in these events. These regulatory mechanisms occur simultaneously by using both the spinal and autonomic nervous systems as the information freeways between the brain and body. Using functional magnetic resonance imaging (fMRI) the acupuncture brain effects have been shown to be significantly greater than placebo alone. In plain English, acupuncture works like an efficient housekeeper tidying up where required. So if there are lots of health problems, the housekeeping takes longer. If it is for a health

maintenance “top up” treatment, there is less housekeeping and less time needed before its positive effects are experienced. Acupuncture has to be delivered over a series of sessions to consolidate the body-brainbody changes. There is recognition now of the longer-term effects of acupuncture. After a series of acupuncture treatments, the benefits last for up to three months. The brain signalling effects are not permanent they fade out and need “topping up”. In arthritis, acupuncture is useful for its anti-inflammatory and analgesic effects. The pain relief includes regulation at the affective or emotional brain that helps improve mood. In other words, a more general rehabilitation occurs physically and emotionally. Empirically, before the pain of arthritis reduces, functionality or the ability to mobilise or to use the joint/s involved may improve first. A British study has shown that combined acupuncture and physical therapy is better than physical therapy alone. Although the initial health dollar costs are higher, the cost effectiveness is apparent for the longer term.

acupuncture. Laser acupuncture is a good alternative to those who are needle phobic. Laser application not only activates the brain-body reflexes as described above, it also has the added benefit of local anti-inflammatory and cellular regenerative properties. Dr Im Quah-Smith is a medical acupuncturist with an interest in wellbeing and health maintenance. Her belief is that treating the patient as a whole and not as isolated organ systems is the best approach for long lasting healing. In December 2011 she started Roseville Wellness Group (RWG). At RWG, patients are taught to recognize mind-body interactions and they are empowered to help themselves heal. She is an Honorary Research Fellow at Neuropsychiatric Institute, Prince of Wales Hospital and is on the editorial board of the American journal, Medical Acupuncture. Arthritis NSW would like to thank Im for contributing this article.

Other modalities of acupuncture are electro-acupuncture and laser acupuncture. There are also available microsystems of acupuncture such as ear and scalp microsystems. Electroacupuncture is the stimulation of needles with a small electrical current generated from a battery pack unit. Studies have shown this increases the brain activation patterns hence possibly augmenting the effects of

FEATURE

ARTHRITIS MATTERS / WINTER 2013

Yoga:

Flexibility

Is it beneficial for people with arthritis?

By Erika Morton*

Good flexibility will add to the quality of life of anyone suffering from muscle pain. When a muscle is well stretched and the flexibility of the associated joint increases, the range of motion is increased and the energy needed to move the joint is decreased. This allows for greater ease in day-to-day activities.

Balance Many of the yoga poses require physical balance, which has obvious benefits for people as they get older and who might be in danger of falling. Being confident with your ability to balance, coupled with having increased strength, will help you to feel more confident in general.

Quality of Life

oga is an ancient form of health exercise with many physical, emotional (psychological) and spiritual (or quality of life) benefits for people of all ages and abilities – including people whose lives are affected by arthritis. Various forms of yoga exist, but generally all involve positioning the body in a range of poses, combined with coordinated breathing and meditation exercises. Dr David Hunter, Professor of Medicine at the University of Sydney, is a rheumatologist epidemiologist specialising in osteoarthritis. He also practises yoga. He says regular, moderate exercise is critical for people with arthritis, particularly those with osteoarthritis. Exercise improves the integrity and function of the muscles around the joints, ultimately reducing stiffness, pain and swelling. “Simply by virtue of the activity involved in yoga, it can help with the performance and function of the musculoskeletal system,” he says. “In addition, yoga can help with breathing performance and increased mental energy. Anxiety and depression are common problems for people who have arthritis.” Dr Hunter acknowledges that arthritis can affect people in different ways and that yoga might not be suitable for everyone. The known benefits of yoga are not the only reason people like to do yoga. Some do it purely for the physical enjoyment, some for relaxation and others, who have been doing it for a while, find they come to enjoy it for spiritual or emotional reasons.

Some of the benefits specifically for people living with arthritis are as follows:

Movement & Exercise Yoga is definitely one option for improving or maintaining fitness for people with arthritis. It is a soothing form of physical exercise that is enjoyable enough to do on a regular basis, even for those with inflamed joints. Yoga is a gentle exercise that can be done within your own limitations. You can gradually increase the effort as your practice continues – this encourages a greater mind-body connection, leading to a better understanding of how your own body works and what you need to do to take better care of yourself.

Building Strength As many of the poses are weight-bearing, your muscle strength, endurance and bone density may improve through controlling your own body weight.

Relaxation It seems to be very well accepted that lowering stress has many benefits for a person’s health and well-being. As a result of being more relaxed, people experience more energy, greater concentration, more balanced emotions and enhanced immunity (resistance to illness). Knowing how to relax will help to improve your sleep quality, which is integral to how you perform during the day. Even 10 minutes of yoga before bedtime can help.

Most people who do yoga find it enjoyable. Yoga can lead to a healthier lifestyle and it is precious time in your week that you give to yourself. Ultimately it will allow you to have a strong and flexible body that you know how to use better to enjoy a wide range of everyday activities. As well as being more relaxed and in a better mood, you will be able to improve other areas in your life such as sleep quality, weight and digestion issues, fitness and flexibility. A great bonus is that yoga may enhance your immunity to illness. If you are concerned about launching into a yoga practice for the first time, talk to your yoga teacher about their experience in dealing with others with similar limitations to yourself and find out what their approach is. Keep in mind that while it is always good to push yourself a little, if it doesn’t feel right then it probably isn’t. A key benefit of yoga is enhanced mind-body connection. It is important to always be honest with yourself and work within your own abilities.

Common Concerns As a yoga teacher of seniors with a wide range of abilities and ailments, I often hear many concerns when people first begin. Once they learn to trust the yoga and their own bodies, many of these concerns are overcome. The most frequent concerns are:

• I can’t get down on the ground and then get back up again. • Am I too old? • Will I be able to keep up? – I’m not very flexible. • Will I be hurting myself? The best introduction to yoga is generally a beginner class led by a qualified teacher who can guide you in the safe and healthy execution of modified poses.

* Erika Morton, director of Yoga of the Age, teaches yoga to people over the age of 55 in classes at Maroubra. Arthritis NSW would like to thank Erika for contributing to this article. Model: Melissa Paddison

FEATURE

ARTHRITIS MATTERS / WINTER 2013

IMPROVE YOUR EVERYDAY LIFE WITH THESE

DISCLAIMER: This article is for informational and entertainment purposes only and is not a substitute for a qualified yoga therapy for arthritis instructor. The author is not a medical doctor and is not responsible for any consequences regarding your use or intended use of any information provided on this article. Always check with your medical professional or seek out a trained yoga instructor in person to tailor postures to your body as needed.

Yoga Poses

1. Down-face Warrior Pose

2. COBRA POSE

3. Tree Pose

Beautiful resting position, which aids in stretching the groin, improving hip joints and lower back.

Incredible strengthening for the spine. Provides a stretch through the chest, shoulders, and abdomen. * Avoid this pose if pregnant or you have Spondylolisthesis

Beautiful for creating balance in the body and mind. Creates stability and strength in the ankles and legs, whilst opening the hips.

(Child Pose) Adho Mukha Virasana

Bhujangasana

*Please be mindful of the knees

Instruction

• Lay down prone on the mat (front side to the mat), with legs stretching behind you, tops of feet on the floor, feet together.

• Sitting towards the back of your mat, big toes touching together, open your knees apart to the outer edges of your mat. • Rest your buttocks on your heels (if needed please use your blanket between your buttocks and calf muscles for support). • Inhale looking forward and opening the chest, exhale keeping your buttocks on your heels and walk your hands forward, hinging from the hips and rest your chest and head towards the floor. • Remembering to breathe, gently roll the forehead from side to side on the mat. To release, inhale looking forward and exhale walking the hands back by your side and sitting upright.

• Place the palms of your hands to the mat on either side of your shoulders, with your fingertips just under the shoulders. Draw your shoulder blades down your spine and keep your elbows bent and shoulder width apart. • Press the tops of your feet, thighs, and legs firmly into the floor. • Activate your core (draw the navel to the spine), inhale and lift your chest off the floor. • Keep your gaze in front of you on the floor, elongating the spine and neck, keeping the navel down on the floor, and drawing the shoulder blades back towards the kidneys. • Hold for a few breaths, exhale and release. You may sit back in Down-face Warrior Pose to release the lower back.

Melissa Paddison has been practising yoga for most of her life through meditation and asan. Melissa has kindly offered our arthritis readers four very easy poses for people who have arthritis. For further information or to ask Melissa a question, visit: www.risinglightyoga.com

Vrksasana

Instruction • Stand at the top of your mat, feet together, and place your hands on your hips. • Find your drishti (a focus point) directly in front of you to concentrate on. • Take your weight to your left foot. • Option 1: Gentle variation, turn the right foot to the side and place the ball of the foot on the mat and rest the right heal on the left ankle. • Option 2: Engage your core (navel to spine) and pulling up through the standing left leg, pick up the right ankle and place the right foot flat against the upper inner thigh. Keep your hip bones square towards the front of the mat and gently turn out your right knee. Inhale and float your hands together at your heart centre. Relax the shoulders down and lift and lengthen up through the crown of your head, whilst keeping your strong foundation in the standing leg. • Switch legs and repeat on the other side. Variation - Use the wall as a prop and aid in balancing. Stand in front of the wall with your backside to the wall and keep your gaze on a focal point in front of you. Use the support of the wall to help with your balance in either of the two options.

4. Lord of the Fish Pose

Ardha Matsyendrasana III

Releases toxins, nourishes the spine, and massages the internal organs *If you are pregnant, have a sore back, or prefer a gentle variation do the open variation

Instruction • Sit with legs in front of you on the mat. Keep your left leg extended with foot flexed back. • Take your right foot to the left shin and over the left leg. Keep the right foot resting against the left leg. • Open Twist - Place the left hand on the floor behind the body, place the right elbow on the inside of the right knee. Inhale, lift and lengthen the spine. Exhale slowly, twist and look over your left shoulder. • Closed Twist - Place the right hand on the floor behind the body, place the left elbow to the outside of the right knee. Inhale, lift and lengthen the spine. Exhale, slowly twist and look over your right shoulder. • To release both twist variations - inhale looking back towards the centre of the room, exhale and release. • Repeat on the other side.

osteoporosis

ARTHRITIS MATTERS / WINTER 2013

CAlcium, Vitamin D & exercise

THE THREE KEYS TO BONE HEALTH

Recommendations from the Guidelines published in MJA OPEN:

A recent article in the Medical Journal of Australia’s open access journal ‘MJA Open,’ presented key recommendations for building healthy bones throughout different stages of life. The 18 month body of work culminated in publication of key guidelines essential for bone health. This work began with a national Bone Summit in Sydney which brought together over 100 leading experts from a range of disciplines.

Building Healthy Bones in Children requirements steadily * Calcium increase based on age and peak

during the adolescent age spurt:

1-3 years 500mg/day

Bone health is a critical issue as 1.2 million Australians have osteoporosis and 6.3 million have osteopenia, which is low bone density. Over 80,000 Australians have a minimal trauma fracture each year. Fracturing a bone can have a significant impact on someone’s life, including a loss of independence and social isolation, because people become afraid to leave their home in case they fall again and incur further injury. Professor Peter Ebeling, Medical Director of Osteoporosis Australia, states that we must look at the whole life cycle in terms of promoting optimum bone health. Professor Ebeling states that the paper which was recently released clearly identifies the central role that a combination of adequate calcium, vitamin D and exercise provides at all life stages to improve bone health. Childhood plays an important role in determining future bone health. It is estimated that osteoporosis can be delayed by 13 years if a 10% increase in peak bone mass (bone bank) can be achieved in childhood and adolescence. Professor Ebeling said that, “It is also estimated that a 50% reduction in the risk of fracture later in life can be achieved if this gain is maintained.” We know that many people do not get enough calcium, have low vitamin D levels and are not exercising properly. The evidence which was reviewed as part of the guidelines shows that up to one third of adults have low vitamin D levels and many pregnant women have low vitamin D levels. While most people understand they need calcium for healthy bones, almost half of all adults do not reach their recommended level of calcium requirements. Professor Robin Daly, Chair in Exercise and Ageing at Deakin University and co-author of the article says, “Prolonged periods of sedentary behaviour should be avoided due to its detrimental effect on bone. Our bones respond to a level of stress placed upon them during

exercise. We now know that specific types of exercise have a positive effect on bones.” Professor Michael Kimlin, Faculty of Health at Queensland University of Technology and co-author said, “When it comes to vitamin D and the sun, we must balance our vitamin D needs and ensure we avoid any sun damage.” For consumers, it can be confusing to know how much sun we need for our bones, while at the same time not increasing our risk of skin cancer. Professor Kimlin says, “Generally with fair skin, five or so minutes in summer sun at mid morning or mid afternoon is enough and in winter, slightly longer, 7-30 minutes, depending on where you live. The timing is longer for darker skin .” The message is clear that we need appropriate levels of calcium and vitamin D along with regular physical activity to promote good health.

4-8 years 700mg/day

9-13 years 1,000- 1,300 mg/day

14-18 years 1,300 mg/day

vitamin D is as critical in * Adequate children as in adults. Regular and safe sun exposure is encouraged in accordance with ANZBMS/The Endocrine Society of Australia/ Osteoporosis Australia published recommendations.

exercises are * Specific encouraged. Schools are

encouraged to include a variety of weight bearing activities for short periods (5-10 minutes) such as jumping, skipping and hopping.

Parents and grandparents should think about how they can help the children in their family to develop good bone health during those formative childhood and adolescent years. The evidence is showing that the better our bones are at the beginning of our lives, the more likely they are to serve us well as we age.

Building Healthy Bones in Adults

intake recommended for adults is 1,000 mg/day. This increases to * Calcium 1,300 mg/day for women over 50 and men over 70. This should be obtained

from at least three serves of calcium rich foods. Dairy foods are considered a good source of calcium. People who can’t tolerate dairy are encouraged to incorporate more serves of other calcium containing foods such as specific vegetables, fish and nuts. A supplement may be needed for those who do not achieve adequate calcium through their diet.

D levels in adults should be over 50 nmol/L at the end of winter * Vitamin or early spring, so may be higher in summer. Vitamin D deficiency can be corrected with vitamin D supplementation.

should be physically active and undertake regular weight bearing and/or * Adults muscle strengthening exercises. Ideally, adults should participate in moderate

- high impact weight bearing exercise, for example, high impact training (e.g. 50-100 jumps) or impact - loading sports for at least 30 minutes per day, 3-5 times per week. Muscle strengthening exercises should be included on at least two days per week. For maximum benefit, the program should be at high intensity, gradually becoming more challenging over time. Evidence shows that targeting muscles around the spine and hip can be of particular benefit.

Building Healthy Bones in Older Adults & People with Osteopenia & Osteoporosis Adults with specific risk factors for low bone density or osteoporosis should seek medical advice. Calcium, vitamin D and exercise are important for this group but people with diagnosed osteoporosis also require drug treatment. requirement for people with osteoporosis or osteopenia is 1,300 * Calcium mg/day, the same for women over 50 and men over 70. Calcium intake from diet is preferred and three serves of dairy per day is encouraged with one serve being calcium fortified. If dietary intake is not adequate, a supplement of 500-600 mg may be required.

D level should be over 50 nmol/L at the end of winter or early * Vitamin spring. Vitamin D should only be tested in people with risk factors for low vitamin D. Low vitamin D levels can lead to falls in older people.

aims of exercise in this group is to slow bone loss and increase (or * Two maintain) muscle mass and strength. This helps improve muscle function,

mobility and thereby reduces the risk of falls and fractures. Participation in a prescribed and supervised exercise program that includes weight bearing activities, progressive resistance training and challenging balance activities is encouraged at least three times a week.

References: Recommendations: ‘Building Healthy Bones Throughout Life: an evidence-informed strategy to prevent osteoporosis in Australia’ MJA OPEN, February 2013, Supplement. Henry MJ, Pasco JA, Nicholson GC, Kotowicz MA. Prevalence of osteoporosis in Australian men and women: Geelong Osteoporosis Study. MJA September 19, 2011; 195 (6): 321-322. Australian Institute of Health and Welfare. Australia’s health 2010. Australia’s health series no 12. Canberra. AIHW, 2010. (Cat. No. AUS 122). Sun Exposure Recommendations for Vitamin D (based on skin type, season, location in Australia, area of skin exposed). Moderately Fair Skin: 5-10 minutes in summer, with arms or equivalent exposed, at mid-morning or mid-afternoon. In winter 7-30 minutes at midday (depending on location). People with darker skin require 3-6 times longer exposure. Adapted from Nowson et al, Vitamin D and health in adults in Australia and New Zealand: a position statement. MJA, 2012; 196: 686-687.

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Stress Management

Balancing the effects of stress Apart from the many stresses associated with everyday life, living with a chronic condition can bring additional demands. Finding ways to balance these demands can help in the overall management of your condition while enhancing your general health and wellbeing.

Understanding stress & the body’s response Stress is the body's way of rising to a challenge and preparing to meet a tough situation with focus, strength, stamina and heightened alertness. The body responds to events that cause feelings of pressure or provoke stress by activating hormones that speed up heart rate, breathing rate, blood pressure and metabolism. These physical changes prepare you to react quickly and effectively to handle the pressure of the moment. This natural reaction is known as the body’s stress response. Stress is not always a bad thing. A certain amount of stress is necessary for the health and proper functioning of the body and provides pleasant emotions such as anticipation and excitement. Stress can also be experienced as your body reacts to an immediate situation that is perceived as dangerous. When we feel under stress, our bodies kick into high gear to deal with the situation or immediate threat. The body usually recovers quickly from this acute form of stress. Where stress can become a problem is when competing demands begin to strain or exceed a person’s ability to cope. When you are called upon to deal with too many changes or demands at any one time, or over a long period of time, your ability to cope physically and emotionally can be diminished.

Restoring a balance

Ideas for keeping stress at bay

affects people in different ways and how we * Stress manage and react to stress varies from person to

healthy by exercising regularly, eating a balanced Manage your time. Poor time management can cause * Stay * and nutritious diet, and maintaining a good sleep routine. a lot of unnecessary stress.

person. Some people thrive on stress and even need a certain amount of pressure to get things done. The level of stress a person feels can also be influenced by their attitude to a particular situation. An event which is extremely stressful for one person may not be perceived as stressful for another.

people living with a chronic condition, situations * For that are perceived as stressful may also lead to an

increase in symptoms of pain, fatigue, muscle tension, sleep disturbance, anxiety or depression. Similarly, a flare of your symptoms may contribute to an increased level of stress. The challenge is to find ways to boost or restore your physical and emotional reserves in preparation for and during times of stress.

Learning how to keep stress at a manageable level involves: the causes or situations that make you * Identifying feel stressed, some of which may be avoided and

you feel good.

ahead for stressful situations that are * Preparing unavoidable, by planning out each small step required

Identifying coping strategies that are healthy and helpful, as well as those that are not.

your priorities. If too many things are * Reassess on your to-do-list, drop the tasks that aren’t truly necessary or plan them for another day.

aside time for relaxation. Go for a walk, sit outside your standards. Perfectionism is a major source * Set * Adjust with a cup of tea, or read a newspaper or book. Take of avoidable stress. Perhaps “good enough” is okay. a bath, listen to calming music, watch a movie or focus on a puzzle or crossword. Practice breathing techniques, yoga or meditation.

control of your environment. Declutter or * Take reorganise a room or work space. Turn off the TV or

lower the volume. Avoid peak hour traffic or take a road less travelled. If shopping is stressful, try ordering your groceries online.

the way you do things. Break big jobs into * Change smaller tasks, spread household chores across the week rather than tackling them all in one day, and balance activity with regular rest breaks.

others which may be out of your control.

to overcome potential obstacles or situations that might cause additional stress.

life and have fun. Choose activities that bring * Enjoy you pleasure and spend time with people who make

how to say “no”. Know your limits and * Learn stick to them. for help from supportive family, * Ask friends and colleagues. on the positive. When situations or people are * Focus getting you down, take a moment to reflect on all the

things you appreciate in life and that make you feel happy.

Talk to your doctor or a healthcare professional if you feel stressed often or have been feeling stressed over a long period of time, or if prolonged stress is affecting quality of sleep or making you feel excessively worried, anxious or depressed. Your doctor can discuss your feelings and concerns and refer you to additional sources of information or support.

References Arthritis NSW. Challenging arthritis: Stress management and relaxation [module 7], 2nd ed. Sydney: Arthritis NSW, 2010. Better Health Channel. Stress in everyday life; Stress affects us in many ways; Stress can become a serious illness [fact sheets]. Available from Better Health Channel: www.betterhealth.vic.gov.au, accessed 10/04/13. Reach Out. Managing stress [web page]. Available from Reach Out: https://au.reachout.com/managingstress, accessed 17/04/13. Smith MA, Segal R. Stress management: How to reduce, prevent and cope with stress [web page]. Available from Helpguide: www.helpguide.org, accessed 17/04/13.

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Krill oil and its role in arthritis By Jason Tang, Rheumatology Department Westmead Hospital Krill, also known as Euphausia superba, is the world’s most abundant crustacean. They form an essential part of the food chain in the ocean and are known to be of abundance in the extremely cold waters of the Arctic and Antarctic Ocean1. The size of their body ranges from one centimetre to fourteen centimetres in length. Their survival in such extreme environments has been attributed to the presence of long-chain polyunsaturated fatty acids (including omega-3 fatty acids), which are attached to the krill’s cell membranes giving the membranes fluidity in extremely low temperatures. In addition to the fish-oils currently available Krill oil has provided a new and alternative source of omega-3 fatty acids that is available in commercial preparations. There are some pharmacokinetic differences between krill oil and other omega-3 fatty acid products. These include differences in absorption and metabolism with krill oil being absorbed better across the gastrointestinal mucosa and once absorbed being metabolised slower because of the presence of “astaxanthin” which protects long chain fatty acids.2

Indications The beneficial effects of krill oil rely upon pre-existing data and support of the use of fish oil derived omega-3 fatty acids, eicosapentanoic acid (EPA) and docosahexanoic acid (DHA) in diet. The reported effects of omega-3 fatty acids include anti-inflammatory effects, immunosuppressive effects and decreasing platelet activity. Current recommendations favour the use of fish oil derived omega-3 fatty acids in rheumatology with chronic inflammatory conditions, allowing lower doses of non-steroidal antiinflammatory drugs as well as disease modifying anti-rheumatic drugs10, 11. It is also stated that anti-inflammatory doses can be achieved with greater than 2.7g of omega-3 fatty acids. Other indications for krill oil include dyslipidaemia (abnormal lipids in the blood) and premenstrual syndrome.2

Side effects & Comparison with major interactions fish oil Gastrointestinal effects include flatulence, bad breath (halitosis), nausea, bloating and diarrhoea3. Since omega-3 fatty acids have an impact on platelet activity, caution is advised when using krill oil in conjunction with other antiplatelet or anticoagulant medications (clopedigral, warfarin, aspirin) as it may alter bleeding and clotting profiles.

Data available for krill oil use in arthritis A randomised, double blind, placebocontrolled human study conducted by Deutsch et al. in 20074, showed a statistically significant reduction in the inflammatory marker C-Reactive Protein (CRP) over a period of 30 days as well as improvement in inflammatory symptoms at a daily dose of 300mg of krill oil. The study was conducted with a sample size of 90 patients. The improvement was seen within a period of 7 to 14 days. A study by Ierna et al. investigating the effects of krill oil on experimental rheumatoid arthritis in mice showed a positive outcome5. The histopathological findings demonstrated lower infiltration of inflammatory cells into the joint, with reduction in hyperplasia of the joint and synovial tissue when compared to control. This was also followed by reduction in clinical symptoms of arthritis, calculated via arthritic scores and paw swelling.

Bioavailability Studies by Ulven et al9. investigating the metabolic effects of krill oil and fish oil in healthy volunteers showed that similar or higher blood levels of omega-3 fatty acids were achieved with krill oil administration compared to fish oil. More studies are required to investigate the effects of the astaxanthin and the phospholipid carrier of EPA and DHA.

Efficacy There is an abundance of literature and reviews that demonstrate efficacy of omega-3 fatty acids in cardiovascular6 and rheumatological7 conditions. Are these data supporting the use of fish oil applicable to the use of krill oil since omega-3 is the major component providing the benefit? With the lack of large calibre studies to support the equivalence or superiority of krill oil over fish oil, the differences are largely unknown. Whether this would act as a hindrance to society using krill oil presents as another question. The ease and increasing availability of these products, coupled by extensive advertising by companies, have increased the popularity of these products.

What is available in Australia

Is new always better?

Adapted directly from the Therapeutic Goods Administration (TGA) website8,

With the evidence-based practice accepted as gold standard, clinicians often prefer to have a good body of evidence before recommending a product with the intention to improve health outcomes. However, an alternative argument exists where the lack of current studies available is not a foolproof reason to confidently conclude that it is not an effective alternative. The use of krill oil in arthritis is still in its early stages, and its body of evidence is still relatively young. Hopefully future studies will provide more information regarding its use in chronic diseases involving inflammation and cardiovascular health.

• AUST R medicines are assessed for safety, quality and effectiveness. They include all prescription only medicines and many over-the-counter products such as those for pain relief, coughs and colds and antiseptic creams. • AUST L medicines are much lower risk self-medication products. They are used for minor health problems and are reviewed for safety and quality. They include sunscreens over SPF4 and many vitamin, mineral, herbal and homoeopathic products. A purpose must be included on the label. Krill oil is now available from many health food companies in 500mg and 1000mg doses. They are being advertised for the use of dyslipidaemia, arthritis and cardiovascular health. Thus far, these products are only listed by the TGA as AUST L products. They show that the medicines are accepted by the TGA for supply in Australia and are included in the Register. The number is printed on the outer packaging so that it can be seen easily. In comparison, fish oil is commercially available in liquid and capsule forms. While most fish oil products are AUST L products, fish oil containing EPA and DHA are approved as AUST R products.

Opinion for use Factors affecting the use of non-prescription supplements that promote health include:

References: Australian Antarctic Division. Krill. Department of Sustainability, Environment, Water, Population and Communities, Australian Government. (http://www.antarctica.gov.au/about-antarctica/wildlife/ animals/krill, accessed October 2012)

Alternative Medicine Review. Krill Oil Monograph. 2010; 15(1): 84-86

WebMD. Krill Oil. (http://www.webmd.com/vitamins-supplements/ ingredientmono-1172-KRILL%20OIL.aspx?activeIngredientId=1172&ac tiveIngredientName=KRILL%20OIL, accessed online October 2012)

Deutsch L. Evaluation of the Effect of Neptune Krill Oil on Chronic Inflammation and Arthritic Symptoms. Journal of the American College of Nutrition. 2007; 26(1): 39-48.

Cost: The availability of fish oil products has increased. This includes availability in different dose form, brands and quantities. Prices of these products have become increasingly competitive, with the push to buy these products in very large quantity per package.

Ierna M et al. Supplementation of diet with krill oil protects against experimental rheumatoid arthritis. BMC Musculoskeletal Disorders. 2010; 11: 136

Colquhoun D, Ferrerira-Jardim A, Udell T, Eden B and Nutrition and Metabolism Committee of the Heart Foundation. Fish, fish oils, n-3 polyunsaturated fatty acids and cardiovascular health. National Heart Foundation of Australia. 2008.

Perceived benefit: How does one learn about benefits of a supplement? Sources can include through reading, television, advertising or researching for evidence based material.

James M, Proudman S, Cieland L. Fish oil and rheumatoid arthritis, past, present and future. Proceedings of the Nutrition Society. 2010; 69: 316-323.

Therapeutic Goods Administration. What’s on a medicine label? Department of Health and Ageing, Australian Government. (http:// www.tga.gov.au/consumers/information-medicines-label.htm, accessed online October 2012)

Health promotion: Society is increasingly moving towards preventative medicine. A supplement today for a healthier tomorrow? Reduction or replacement of pharmacotherapy by supplements that appear less modified from its natural occurrence than ‘chemical drugs’.

Ulven SM, Kirkhus B, Lamglait A et al. Metabolic Effects of Krill Oil are Essentially Similar to Those of Fish Oil but at Lower Dose of EPA and DHA, in Healthy Volunteers. Lipids. 2011; 46:37-46

Therapeutic Guidelines – Cardiology (accessed online October 2012)

Therapeutic Guidelines – Rheumatology (accessed online October 2012)

FEATURE

ARTHRITIS MATTERS / WINTER 2013

Doping agencies urged Australian sporting cheats to come clean as they probed the extent of drug use in professional sport. Some headlines read "Blackest day in sport"1 others screamed, "Sport on Trial". The focus then turned to sport scientists2 and performance staff, with possible links to these findings tainting the reputation of sporting codes and their administrators from the top of the organisation to the bottom. The two sporting codes mainly affected were the Australian Football League (AFL) and National Rugby League (NRL). Sporting staff lost their jobs while others were placed on suspension pending further investigation. There were initially six NRL clubs linked to the doping scandal3. The Daily Telegraph reported Cronulla Sharks stood down its coach including some other senior sporting staff4. News outlet reported that as many as 31 NRL players could be impacted by this controversy5. Australian Sports Anti-Doping Authority (ASDA) is currently continuing to play a vital role in the ongoing investigation of this scandal.

PEPTIDES IN SPORT

& Arthritis

In 2012, the Australian Crime Commission conducted an investigation into the use of performance enhancement drugs in Australian sport and reported the outcome of the investigation in February 2013. The results were astounding and the impact felt nationally. Media ran rampant stating that illicit drugs including peptides, hormones and others were in common usage across multiple sporting codes throughout Australia. 24

As our fascination with sport increases, sporting codes have become highly competitive as the professional athlete aims to achieve glory, reputation and endorsement. In many sporting codes, as the expectation of performing greater and better each week, the athletes are exposed to more wear and tear to their body, whilst having less recovery time to be ready for the next match. Sport scientists and high performance staff aim to improve not only performance but also find methods to reduce recovery time and time taken to repair the athleteâ&#x20AC;&#x2122;s body. These measures may take several forms including drugs, injections, allied health therapies, hyperbaric oxygen therapy, special diets, etc. With respect to medications, most performance-enhancing drugs banned by the World Anti Doping Agency's 2004 can be broken down into eight categories and these are listed in Table 1. Depending on the type of peptide and the time taken during competition, peptides can be vitally useful to the athlete giving them unfair competitive advantage6. So what are peptides and how do they enhance performance?

Peptides and how they work Simply, the body is composed of proteins that are essential for tissues, repair of tissues, immune system, enzymes and cells. Proteins are made up of a sequence of amino acids, which bind together by peptide bonds. Like beads on a rosary, the length of a protein will vary depending on the constituent number of amino acids it is composed of. Peptides are short amino acid fragments, less than 50, that have the same sequence as the parent protein7. Usually it is only a small portion of the protein that is necessary for function and this functional attribute can be ascribed to the peptide equivalent instead of the whole protein. Instead of injecting the whole protein, fragments of the protein (peptides) can be injected to cause the same effect. In addition there are peptide hormones that are substances produced by glands in the body that, after circulating through the blood, can affect other organs and tissues to change bodily functions. For instance, in the Tour de France, cyclists who injected EPO peptide had an unfair advantage because the peptide caused the body to produce a lot more red cells which have the ability to carry more oxygen and therefore the cyclists can perform for longer and better before feeling tired. Similarly in body builders, runners and swimmers, by taking anabolic steroids the muscles bulk-up and get stronger. The function of peptides depends upon their size and amino acid sequence which act on tissue or their receptors to stimulate the production of naturally occurring hormones, increase muscle growth and strength, and increase the production of red blood cells to improve the blood's ability to carry oxygen. They also function to regulate appetite, and protection of bones and muscles8. The most potent agent we have for the treatment of osteoporosis is a peptide called teraparatide (Forteo), which when administered by injection stimulates the production of new bone formation. This peptide is a small fragment (34 amino acids) of the naturally produced parathyroid hormone (84 amino acids) in the body, which has the same effect of increasing bone mass.

Peptides as therapeutic agents for arthritis The Westmead Hospital rheumatology research group are researching peptides. Peptides are vital for fundamental physiological and biochemical function of life and, as scientists we are examining the use of peptides as therapeutic agents for the treatment of arthritis (reviewed by Ali and Manolios, 2007)9. The reasons for examining peptides are that currently available rheumatoid arthritis therapeutics such as prednisone, methotrexate and leflunomide (Arava) are often characterised by unfavourable side-effects. Biological therapies have proven encouraging but as yet provide a significant magnitude of response (American College of Rheumatology 50% response or better) in only 40-50% of patients10, 11. Therefore, there remains an unmet clinical need for novel therapies, better monitoring, improved imaging and a faster translation of research into health care practice. Peptides based therapeutic agent can be more effective on their target receptor with fewer side effects as they match well with their receptors. With the aid of Arthritis NSW funding and its members contributing to our research effort (through Joint Initiative) we have been able to show that when we inject specific peptides that we have developed into arthritic rats, their arthritis can be prevented or treated depending on the stage of the disease. The effectiveness of this treatment is as good as some of the more commonly used drugs such as cyclosporine in clinical practise. We have also defined a new peptide able to localize to synovium and subsequently developed a targeted drug delivery system capable of taking and releasing drugs directly to inflamed joints. This system will broaden our approach to the treatment of common rheumatic conditions such as rheumatoid and osteoarthritis. Ideally, what this means to the person with arthritis is that we can load drugs into small â&#x20AC;&#x153;ping-pongâ&#x20AC;? ball like particles and then deliver these directly to joints overcoming any general systemic side-effects.

FEATURE ADVERTORIAL References 1

ordon M. (February 2013). “This is the blackest day in Australian G sport.” Retrieved from http://www.smh.com.au/national/this-is-theblackest-day-in-australian-sport.

assoud J. (March 2013). “Assistant to sports scientist Stephen M Dank named “ The Gazelle” key figure in ASADA NRL doping investigation.“ Retrieved from www.dailytelegraph.com.au/sport/nrl/ assistant-to-sports-scientist-stephen-dank-named-the-gazelle-keyfigure-in-asada-nrl-doping-investigation. iccio D. (February 2013). “Six NRL clubs linked to doping as it is R revealed NRL the focus of ACC report into drugs sport.” Retrieved from www.foxsports.com.au/league/nrl-premiership/nrl-the-focusof-autralian-crime-commission-report-into-drugs-in-sport-with-sixclubs-implicated.

othfield P. (March 2013). “Cronulla Sharks stand down coach R Shane Flanagan, name Bruno Cullen as interim CEO.” Retrieved from www.dailytelegraph.com.au/sport/nrl/cronulla-sharks-sackshane-flanagan. J ancetic S. (March 2013). “ASADA targeting 31 NRL players in probe.” Retrieved from www.nrl.com/asada-targeting-31-nrl-players-in-probe.

adel P. (February 2013). “Peptides pointless because they B don’t improve performance, says expert.” Retrieved from www. theaustralian.com.au/news/peptides-pointless-because-they-dontimprove-performance-says-expert.

ennelly P, Rodwell V. Amino acids and peptides. Harper’s K illustrated biochemistry. 29e. Chapters 3, 4.

rosier M. (2010). “What are the functions of peptides?” Retrieved C from www.livestrong.com/article/248310-what-are-the-functionsof-peptides.

li M, Manolios N. (2007).Peptide based therapies for arthritis. A Future Rheumatology :2 (3); 287-296.

ARTHRITIS MATTERS / WINTER 2013

WORKING TO FILL LIVES WITH MORE YEARS AND YEARS WITH MORE LIFE.

Bathon, J., R. Martin, et al. (2000). "A comparison of etanecept and methotrexate in patients with early rheumatoid arthritis." N Engl J Med. 343: 1586.

L ipsky, P., D. van der Heijde, et al. (2000). "Infliximab and methotrexate in the treatment of rheumatoid arthritis:anti-tumour necrosis factor trial in rheumatoid arthritis with concomitant therapy study group." N Engl J Med. 343(22): 1594-1602.

Table 1: Different categories of drugs banned from sport*. DRUG

WHAT DO THEY DO

WHY ARE THEY BANNED?

EXAMPLE

Stimulants

Boost alertness and physical activity

Artificially stimulate the mind and body

Cocaine

Narcotic analgesics

Eliminate pain and make the athlete try harder

Reduce and eliminate pain so that the athlete performs longer and harder

Codeine, tramadol, morphine

Cannabinoids

Reduce inhibitions, increase recovery time after exercise

Compromises the safety of the athlete by reducing inhibitions

Marijuana, hashish

Anabolic steroids

Increase muscle bulk and strength

Enhances athletes performance. Long term sideeffects may develop.

Dehydroepiandrosterone (dhea), testosterone analogues

Peptide hormones

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LOCAL

ARTHRITIS MATTERS / WINTER 2013

Local Happenings

Out of Joint

Nena Doyle Community Liaison Officer

It is always exciting when a new support group is formed and the latest one to be added to our growing list is Kogarah support group. Thanks to Clare, a long standing member of the previous St George branch who felt we needed a support group in the Kogarah area, we now have one up and running. Clare has kindly offered to convene this new support group and with help from Arthritis NSW, should see it prosper. If you are interested in joining this group please contact Nena Doyle for more information. The regional meetings for 2013 are now completed and we would like to thank you for attending. The meetings this year were well attended and the members especially enjoyed the educational component of the meeting on Shoulder Pain, which Di Spragg and Karen Filocamo presented. Each year at regional meetings President’s awards are handed out, and this year eight of these were presented. These awards recognise people who make a contribution to the success of their support group or branch. Often they are the unsung heroes of a group who quietly go about their tasks, seeking no recognition.

Nena Doyle

Congratulations to the following recipients of the President's Award:

Mary and Kevin Ryan WARILLA/SHELLHARBOUR BRANCH Elizabeth Evens WOLLONGONG BRANCH Ethel Meggs PENRITH BRANCH Fran Schneider ALBURY SUPPORT GROUP Gwen Skinner WOY WOY BRANCH Frances Pavy TUGGERAH LAKES SUPPORT GROUP Patricia Upton MAITLAND BRANCH

Correction: In our ‘Local Happenings’ section last issue (pages 30-31, Autumn 2013), a photo was mistakenly listed and captioned under the Albury/Wodonga support group. The photo is actually of Linda Nash and Beryl Evans of Long Jetty being awarded their Life Membership Award. Congratulations to both Linda and Beryl and we apologise for any confusion.

Albury/Wodonga Albury/Wodonga has been very socially active these last few months. We attended a seminar presented by Arthritis NSW and a regional meeting in Albury, where our Chairperson Fran Schneider received a President's Award for her contribution to our branch. Our Christmas lunch has been booked for 20th November, and to top it all off, our 30 year anniversary will be happening this year. More details to follow.

Armidale By Ron Bradbury.

Cycle for Disability 2013 Cycle Vietnam to Cambodia! In November 2013, cycle through Vietnam and Cambodia, raising money for Arthritis NSW while embarking on a fascinating, challenging and rewarding adventure. On this trip you will cycle through villages and the stunning rural landscapes in Cambodia and the Mekong Delta. You will volunteer at an orphanage in Saigon and be there for sunrise at Angkor Wat. The 2013 Cycle for Disability is your chance to support the activities of Arthritis NSW, raising money and awareness for our organisation and helping to improve the quality of life for the 1.4m people in NSW who have some form of arthritis. The money raised goes towards supporting research and the provision of information and support services for the community.

Dates: 15-28 November 2013 Registration fee: $700 Fundraising target: $6,500 (including travel costs) Travel costs: $3,325 + taxes of $470 Donation to charity: $3,175 Trip duration: 14 days Physical activity: 6 days cycling Challenge grade: moderate Accommodation: 3-4 star hotels

For the April meeting of the Armidale Arthritis Support Group, people were invited to bring tools, gadgets and gizmos they used to open jars and bottles. Interestingly, no two people brought the same thing. While there was universal acclaim for the idea that packaging was troublesome, people had found their individual ways of tackling the problem and there was no consensus on the universal best way to open these things. Several tools, ones that looked like giant nut-crackers for example, required such high hand grip strength to operate that we had to wonder about the point of them. Anyone strong enough to use the tool would probably be strong enough to simply open the jar anyway. Another type required three hands to operate.

A “strap wrench”, bought from a hardware shop, may work but came with no instructions at all, not even a picture. I think we worked it out. My personal favourite was a Cuisena (brand) Jar Opener because it doesn’t slip off and has good leverage. Another type with a handle that gave good leverage and a strap that can be tightened around the lid also seemed very effective. A quick look at the internet shows similar devices in other brands. The two simplest ideas that worked rather well were giving the lid a good tap and using thin silicone rubber sheeting in the hands to provide extra grip. We were not able to try any types that normally attached under a shelf. It seems that these could be used onehanded, which might suit some users. One suggestion was to ask the supermarket checkout people to loosen the lids. Certainly, I have asked at my pharmacy for ‘child-proof’ (read: human-proof) lids to be taken off medication. With one brand of coffee, both the jar and the outside of the lid are square; that’s no trouble. Can’t they all be like that? Editor's Note: Arthritis NSW has some wonderful products that can make your everyday life easier. To find out more, please visit the Arthritis NSW website and go to our online shop.

Castle Hill The Castle Hill support group had its first meeting in February and has had steady member numbers since. We meet in the Pioneer room at the Community Centre, just below the Castle Hill Library at 10am on the third Friday of each month. We have our guest speakers organised for the year, which include Council on the Ageing (COTA), Australian Hearing, Heart Foundation, Osteoporosis

NSW, Alzheimer’s Australia and the Guide Dogs Association. Our support group is based on friendship building and we welcome any new or old members to our group.

Coffs Harbour By Nancy Strickland Our year has started well with great enthusiasm. Our warm water exercises are going well and Tai Chi resumed at the beginning of April. Our member Yvonne Hamilton-Smith wrote a very comprehensive report on the BAM, which was well received at our first meeting for the year. March saw Dave Allen giving a talk to the Woolgoolga Neighbourhood Centre on how we function and what resources we can provide. It was pleasing that our eminent Rheumatologist Dr. Hanish Bagga was in the audience gaining this knowledge as well. Congratulations to member Nancy Strickland and her husband Tom who both were in the Australia Day Honour list receiving OAMs for service to community through various organisations. Nancy has been past secretary of our branch, recipient of the President’s Award and a volunteer pool leader for the Warm Water Exercise classes for the past seven years. They will receive their medals at Government House, Sydney on 3rd May. Our March outing was a wonderful morning tea and lunch at our Jetty Foreshores. We thoroughly enjoyed a brief respite from the rain with the sun helping us get over “cabin fever”.

Holroyd We have recently celebrated the birthdays of Ray Chin, who turned 90 and Joe Cassar, who turned 80. We had a birthday cake to celebrate. Alma Weber from Heartmoves gave good exercise to our members and we also had Michelle Payne from the Heart

LOCAL

SUPPORT GROUP & branch listings**

Local Happenings Foundation who gave some excellent information to our members. Our warm water classes have started and we have 10 new members and a further 20 on a waiting list. Our next bus trip is on 29 July to Fairground Follies.

for meetings later in the year. We supported one of our members who took part in William’s Walk at Penrith Regatta Centre. We hope all walkers enjoyed the day.

Maitland By Veronica Pannowitz Maitland Branch continues to gain in strength with two new men and four new ladies attending our branch meetings. Best wishes to Beverlie See for a speedy recovery and happy holidaying to Antoinette and Ben who are going to Italy for three months. Also happy 50th wedding anniversary to Ben and Antoinette. Since our last report we have to extend our sympathy to Shirley and family on the passing of her husband Leon. Leon was our first vice chairperson in 2004. We have had some very good guest speakers on various subjects. Elaine and Lionel do a great job with our trading table to raise funds for research. We are all looking forward to the regional meeting in May, being hosted by our branch, then it’s Xmas in July.

Parramatta

By Anita Fetherstonhaugh Parramatta support group has decided to continue their “coffee and chat” mornings, with the former committee members meeting at Constitution Hill Retirement Village a week before our scheduled meeting. With the new format of our meetings we find them more relaxed and enjoyable. Our speaker from COTA on “Internet safety - be confident online” was interesting to those with computers, and the handouts could be given to friends of those who weren’t so interested. Mother’s Day will be our theme for May, with lucky door prizes. We are also looking to our members for some suggestions

Back Row: Barbara, Naomi, Dorothy, Onelia, June, Marilyn, Joy, Wilf. Front Row: Betty, Pam, Anita

Penrith By Diane Norman. In April we had a visit and talk from Lauren Harris, who spoke about “William’s Walk”. Both walks this year happened in Bondi and Penrith. We have been lucky this year to have had some very interesting speakers who were eager to impart their knowledge on varied subjects. One of the most memorable was the Fraud Squad who spoke to us on the protection of our EFTPOS and credit cards.

Woy Woy By Valda Iverson We have had a good year so far. We have been organising our Christmas in July luncheon and we are all looking forward to attending. All our meetings are going well and we have had a few really good speakers. Warm Water exercise classes are going well and they certainly appear to be beneficial to all. We are having our regional meeting in May and will be running a raffle on the day. We will be the hosts and hope to see other “coasties” there. A few of us went to the High Tea with the Governor at the Queen Victoria Building’s Tea Rooms. It was a wonderful afternoon for all with plenty of lovely food and tea to drink. Also we presented our wonderful and thoughtful member Ronald Miller, who is our assistant treasurer, with a certificate of appreciation at our 21st birthday party which we celebrated in December at our Christmas party last year. Thank you Ron.

It is with sadness that we inform our members and the wider Arthritis community of the death of long term member Dot Falconer. The following are future speakers to our branch and we encourage members to attend. Theo, Priceline, 12 June; Dr. Peter Johnson, 10 July; Nena Doyle, 14 Aug; Alzheimer’s Australia, 11 Sept; Archaeology Nepean, 9 Oct; Dr A Sheen, 13 Nov.

Ron Miller receiving his certificate of appreciation

Wollongong By Lee McKinnon A member of Wollongong Branch, Marlene Scott, received the Volunteer of the Year Medal on Australia Day this year for her untiring community work. This is a very well earned reward.

Our anniversary cake for our 21st birthday

SUPPORT GROUP Albury/Wodonga* Armidale Bathurst Castle Hill Coffs Harbour*

MEETING DATE Social gatherings Warm Water ex. Only 3rd Monday 5pm 2nd Thurs 9am 3rd Fri 1st Tues 9.30am Bi-monthly, beg. Feb

ARTHRITIS MATTERS / WINTER 2013 LOCATION

CONTACT Fran: 02 6025 4301

Kent House, Armidale Bathurst RSL Castle Hill Library Community Centre

Ron: 0402 424 134 Elson: 02 6331 2562 Nena: 02 9857 3300 Nancy: 02 6652 3315

White House, Prince St Kogarah RSL Internet only

Joyce: 02 6342 5192 Noreen: 02 43236707 Margaret: 02 6643 3801 Nena: 02 9857 3300 Alex: kidswitharthritis@arthritisnsw.org.au Liz: 02 4332 5245

Cowra Gosford Grafton Kogarah Kids with Arthritis

Warm Water exercise only 3rd Thurs 10am 3rd Monday 10am

Long Jetty*

1st Thurs 10am

Lower Clarence* Macarthur Molong Mudgee Newcastle

4th Mon 9.30am 1st Wed 10am 2nd Mon 11am 4th Wed 10am 4th Wed 1pm

Nowra Orange Parkes Parramatta Quirindi Ryde

1st Thurs 10am 1st Mon 12pm, Bi-monthly Last Tues 10am, Bi-monthly 1st Mon 1pm 4th Tues 2pm 4th Thurs 1pm

Karagi Court Community Hall Yakalla Rd, Bateau Bay Com Hlth Centre Maclean H J Daley Library, Cambelltown Bowling Club Eucharenna Rd CWA Hall Market St Mayfield Seniors Centre 102 Hanbury St, Mayfield Shoalhaven Lib. Meeting Room HACC Centre, Lords/March Sts Parkes Hospital Education Centre Room C, Old Council, Admin Building Ingall Centre, Nowlend St, Quirindi Ryde/Eastwood Leagues Club

Scone Turramurra Tamworth Tuggerah Lakes* Woonona/Bulli BRANCHES Blue Mountains Cooma

1st Wed 11am 1st Friday 10am 3rd Tues 5pm 1st Friday 10am 1st Wed 9.30am

Bowling Club Senior Citizens Romms, Gilroy Lane Tamworth Community Centre, Darling St Uniting Church, Summerside St Toukley Bulli Community Centre, 328 Princes Hwy, Bulli

Margaret: 02 4423 4326 Noeline: 02 6361 7629 Fiona: 02 6862 1866 Val: 02 9632 6636 Val: 02 6747 4727 Doris: 02 9817 7470 Email: doris_carrall@tpg.com.au Fred: 02 6545 1701 Elizabeth: 02 9403 1708 Marina: 0403 759 148 Lorraine: 02 4390 2177 June: 02 4283 1450

Katoomba Hospital Education Centre Ex Servicemen’s Club

Adrienne: 02 4787 1124 Marion: 02 6452 1057

Corowa Dubbo Eastern Suburbs Hawksbury Holroyd Kincumber Lismore

3rd Tues 12pm 3rd Mon 11.15 am Bi-monthly, beg. Feb 1st Wed 10.30am 2nd Thurs 2pm Last Wed 10.15am 3rd Tues 10am 4th Wed 10am Last Fri 10am 2nd Tues 10am

Joan: 02 6033 3198 Norma: 02 6882 2506 Susan: 9389 8140 Julienne: 02 4574 1928 Betty: 02 9632 3302 Dorothy: 02 4368 1748 Marie: 02 6628 6692

Lithgow* Maitland District Milton/Ulladulla

3rd Wed 11am 1st Thurs 10am 3rd Wed 10am

Kalianna Social Enterprises Centre, 93 Guy St Masonic Hall Darby Cl Bondi Jt RSL Club Function Room Rozzdi Room, Windsor Library 300 George St Com. Hlth Centre 14 Memorial Ave Merrylands Brentwood Village Cedar Room, Neighbourhood Centre, Carrington St Lithgow Library Main St East Maitland Bowling Club Building 1 Comm Resources Centre, St Vincents St CWA Rooms Cnr Tindale St & Castlereagh St Senior Citizens Henrietta Rose Rm Bowral Uniting Church, Alber St. Taree Rules Club Warilla Bowling Club Wesley Auditorium Community Centre, John Hoare Ct. Uniting Church Hall, Young

Penrith Port Macquarie Southern Highlands* Taree Wagga Wagga* Warilla/Shellharbour Wollongong Woy Woy* Young

2nd Wed 9.30am 2nd Tues 10am 2nd Fri 10am 1st Fri 10am 1st Thurs 1pm 3rd Thurs 1.30pm 2nd Tues 10am 3rd Tues 10am 4th Wed 10.30am, Bi-monthly FIBROMYALGIA SUPPORT GROUPS Bowral 2nd Friday 12pm Charlestown Bi-monthly Wollongong FIBROMYALGIA INFORMAL SUPPORT GROUPS ACT 2nd Tues 12.30pm

* run warm water exercises

Ron: 02 6646 3067 Carol: 0400 439 505 Margaret: 02 63668045 Adele: 02 6374 0248 Judy: 02 4967 5694

Lorna: 02 6352 1984 Veronica: 02 4966 4649 Trish: 02 4454 0205 Norma: 02 4751 3417 Pam: 02 6584 6687 Margaret: 02 4885 1430 Marilyn: 02 6556 3839 Lorraine: 02 6926 3203 Sheila: 02 4296 1340 Lee: 02 4225 3521 Valda: 02 4341 5881 Brenda: 02 6382 3247

Henrietta Rose RM, Bowral Charlestown Multi Purpose Centre

Dianne: 02 4861 4639 Julie: 02 4982 5254 Winsome Stephenson: 02 4284 8890

Pearce Som. Cent. Collette St

Roz (Mon/Tues): 02 6290 1984

**correct as of 10 May 2013

KID's Corner review

Camp Twinkletoes 2013 Camp Twinkletoes was held this year from 1 – 3 February at The Tops Conference Centre, Stanwell Tops. Sixteen families attended, including nine new families. Activities included a scavenger hunt and a trip to the nearby Symbio Wildlife Park. Dr. Jeff Chaitow attended on the Saturday afternoon and provided a wonderful workshop for the parents on the latest treatments for Juvenile idiopathic arthritis (JIA). Despite the terrible rain all weekend, everyone had a wonderful time.

High Tea with the Governor Arthritis NSW had the pleasure of hosting our second annual High Tea with our patron, Governor of NSW Her Excellency, Professor Marie Bashir in early March 2013. A total of 90 members and supporters of the organisation attended the high tea at the QVB Tea Room as our way to say thank you to our members and supporters. A big thank you goes to all of our wonderful supporters, ambassadors, corporate sponsors and volunteers in making this a successful event. Stay tuned for High Tea in April 2014.

A huge thank you must go to our volunteers who assisted us on the Saturday, Arthritis NSW community groups who fundraised for the camp and to William’s Wish, which allowed families to attend at a much subsidised rate. Camp Twinkletoes costs approximately $1,000 per JIA child each year so the assistance of William’s Wish and our community groups is vital to allowing families to attend. Photo L-R: Bianca Elhage, Clare Riordan, Governor of New South Wales, Her Excellency Professor Marie Bashir, Rob Novotny, Nena Doyle, Karen Filocamo

Sudoku (answers page 34)

ARTHRITIS MATTERS / WINTER 2013

Arthritis NSW Fundraiser helps children go to children’s camps

William’s Walk was held on the 27 April at Bondi Beach and the 28 April at the International Regatta Centre, Penrith and was a huge success, raising vital funds for kids with arthritis. There was a fantastic turnout on both days, with 400 people walking the Bondi to Bronte walk on the Saturday, and more than 350 people either walking or completing a 5km fun run at the International Regatta Centre on Sunday. Across the two days, more than $75,000 was raised, which will go towards running two special camps for children with arthritis, Camp Twinkletoes and Camp Footloose.

The camps are aimed at children who have been diagnosed with Juvenile Idiopathic Arthritis (JIA). The goal of the camps is to give children an opportunity to relax, develop their social skills in an understanding environment and help them to better manage their lives. Running these camps would not be possible without the generous involvement of all the people who attended the William’s Walk events and helped raise money for kids with JIA.

There are more than 4,000 children in Australia with some form of arthritis and due to the success of William’s Walk, 55 special children will be able to attend one of these camps.

William’s Walk has just completed its second year and is held in memory of William Harris, who passed away, aged 6, from complications due to his arthritis.

William’s mother, Lauren Harris, saw how happy William was at camp and is so happy other children can experience the same joy. “William loved being at camp. It allowed him the freedom to forget about his pain, even for a moment, and be as loud as possible with other kids with arthritis. He was so happy on these trips and I am excited for other kids and their families to experience it too,” said Lauren.

Stay tuned for William’s Walk 2014!

Abel Heymeijer and Governor of New South Wales, Her Excellency Professor Marie Bashir

The Sun-Herald City2Surf and Blackmores Sydney Running Festival Get involved and run for Arthritis NSW in the City2Surf on 11 August or the Blackmores Sydney Running Festival on 22 September and get healthy while raising money for Arthritis NSW. Either run is the perfect opportunity to run or walk around some of the most scenic sights in Sydney for a great cause! For more information on how to get involved in either event and support the activities of Arthritis NSW, please visit: www.city2surf.com.au www.sydneyrunningfestival.com.au

health & fitness

ARTHRITIS MATTERS / WINTER 2013

Timetable for Term 3, 2013 Arthritis NSW coordinates a number of warm water exercise and Tai Chi classes at various locations across Sydney.

Warm Water exercise Venue

Day

Times

Mowll Village Retirement Village – Castle Hill

Monday

2.30pm

Tuesday

1.30pm, 2.30pm

Thursday

1.15pm, 2.15pm

Karonga School - Epping

Saturday

8.00am

Royal Prince Alfred Hospital – Camperdown

Monday

5.00pm, 6.00pm

St Lukes Hospital – Potts Point

Wednesday

12.30pm

Saturday

9.00am, 10.00am

Canterbury Hospital - Campsie

Wednesday

1.30pm, 2.30pm

Lane Cove Physio

Thursday

5.00pm

Venue

Day

Times

Salvation Army Church Hall - Hurstville

Saturday

9.00am

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34 ASIA NSW Arthritis Matters Mag2012.indd 1

16/05/12 10:41 AM

THE ORIGINAL