Bones, Muscles & Joints

Q&A

When did you first get diagnosed with rheumatoid arthritis?

I was first diagnosed with rheumatoid arthritis (RA) in December 2011.

I was going to school for fashion design at the Fashion Institute of Design and Merchandising (FIDM) in Los Angeles when I had a sharp pain in my back which led me to seek medical assistance. That physician then referred me to see a rheumatologist for testing to see if I had rheumatoid arthritis, which the tests showed I did. I then went for more testing and a second, plus a third opinion from other rheumatologists to make sure I was diagnosed correctly.

What has your experience been like dealing with the condition?

At first, when I was diagnosed with RA, I was scared about the unknown of this disease; however, since becoming more active within the arthritis community, I've found that keeping my daily routine really helps with my arthritis. Staying healthy, eating the right foods, staying hydrated, and ensuring I keep my body and mind active is very important in reducing flare-ups of this disease.

As a brand builder and leading fashion designer who pursues an active life, how has your lifestyle changed after being diagnosed?

When I started taking medication for my arthritis in 2011, my life changed dramatically by slowing me down and sometimes being unable to get out of bed. I needed to find the correct medicine and combination of medications

that worked with my body and fastpaced lifestyle. It took many years for me to find this right combination; however, once I did, I could live the active lifestyle required for my profession. I still listen to my body every day and make adjustments when needed.

What motivates you to advocate for arthritis patients?

After being diagnosed with RA, I tried to find more information about the condition, and also for other younger patients like me whom I could relate to. Unfortunately, social media was not as present back then as it is now, so it was very difficult to find other arthritis patients like myself. After establishing myself in my career, I decided I could take the next step in telling my personal arthritis story to the public, which could be inspiring to other newly diagnosed patients or other younger patients that can relate.

The motivation of other arthritis patients keeps me going each day.

In your opinion, are there any misconceptions amongst men in society dealing with arthritis?

I feel men in society have to hide their arthritis. The stigma that could come along with this disease and the pain they feel with arthritis makes many men not want to show others in society their true feelings. Society still has an expectation for men to stay strong and stoic. I think men can be more vulnerable and should speak out about their arthritis. Being vocal about your arthritis helps society move forward.

Lives of patients with RA can be improved by being a part of the arthritis community and really getting invovled in patient care — even if it's your own. A safe place to which others can relate is important and can be very beneficial physically and mentally.

Ever since my story came out, I really found a place in the arthritis community for my voice to be heard and also for it to help others. Since this disease cannot be seen all the time, patient voices, advocacy, and stories are extremely important.

How can the lives of patients dealing with RA be improved?

Lives of patients with RA can be improved by being a part of the arthritis community and really getting involved in patient care — even if it's your own. A safe place to which others can relate is important and can be very beneficial physically and mentally.

Also, with new arthritis medications becoming available, arthritis patients with their rheumatologists should seek the best medication to cope with their arthritis.

with Michael Kuluva Fashion Designer & Arthritis Advocate

Better Cardiovascular Health Improves Rheumatoid Arthritis

Abigal Cukier

Carrie Barnes has always been active. She used to play volleyball regularly and jog up to 10 kilometres a day. When she developed rheumatoid arthritis (RA), Barnes had to find other activities that weren't as hard on her most affected joints. She has played in a ball hockey league, trained for and participated in several extreme trail runs, walks or bikes to work, and logs hundreds of kilometres a year of cross-country skiing and hiking. “When you're diagnosed with a chronic illness, it can be quite overwhelming,” she says. “What helps me is being active, eating well, and having strong relationships with the people around me. This helps me remember that I'm so much more than the fact that I have RA.” While these habits help Barnes feel better in her daily life, they're also beneficial for her long-term health, says Dr. Yan Yeung, a rheumatologist in Waterloo, Ont.

RA increases your risk of heart attack “Managing cardiovascular health is crucial in patients with RA. RA increases your risk of heart attack, perhaps to the same degree as having diabetes,” Dr. Yeung says. “The best way to avoid that higher risk is to take your medication, because that controls the added inflammation. But we also have to address lifestyle factors to improve cardiovascular health and RA.”

RA is an autoimmune disease in which the body’s immune system mistakenly attacks the lining of the joints. It's an inflammatory disease that can affect multiple joints in the body. The same inflammation that causes pain, stiffness, swelling, and joint damage also increases the risk of heart disease. This risk increases further in people with RA who smoke, are overweight, or have high blood pressure. Dr. Yeung recommends that people with RA eat a diet rich in fruits, vegetables, whole grains, beans, nuts, and seeds — for example, a Mediterranean diet, which may improve cardiovascular health. He also suggests practising meditation or taking short mindfulness breaks. “It's about learning to just stop and take a breath or a moment to reflect,” he says. “This can reduce stress.” Smoking cessation is also important for improving your cardiovascular health.

“There's also higher risk of lung cancer in RA and there are connections between smoking and RA,” Dr. Yeung says. “Smoking has been shown to possibly increase your risk of getting RA and once you get it, smoking can make it more difficult to control your disease.” Dr. Yeung also recommends regular exercise. If new to exercise, he suggests starting with short walks a few days a week. “In addition to cardiovascular health, exercise has benefits for RA,” he says. “Strength training can improve the structures around

the joints, so that they're not so easily strained. Walking or cycling can enhance cartilage integrity. Mobility exercise, like tai chi and yoga, can improve the range of motion of your joints.”

“The fact that I keep moving keeps me moving” Barnes, who has completed several 100 Mile Wilderness challenges, says people sometimes worry that so much activity might make her RA worse. “I tell them, the fact that I keep moving keeps me moving,” she says. “It maintains the strength around my joints and improves my stability. It keeps my weight down and it keeps my heart healthy.”

Dr. Yeung says lifestyle changes can be difficult. “It requires a lot of persistence, but my patients who make these changes seem to be happier,” he says. “They're more active and live with less pain. There's less missed work and they can do more things around the house and more activities with friends and family. Medications are important, but lifestyle changes help improve overall function, happiness, and quality of life.”

From Biologics to Biosimilars: The Art of Equivalence

D.F. McCourt

As patents on some biologics expire, pharmaceutical companies are bringing their own, less costly versions of these treatments, known as biosimilars, to market.

Different but equivalent Biosimilars, by definition, aren't perfect molecular copies of the drugs they mimic. The validation standards for similarity, however, are very high. “The biosimilar molecules must be demonstrated to have the same basic protein structure, with only minor folding or side-chain differences,” says Dr. Janet Pope, a rheumatologist at St. Joseph’s Health Centre and a Professor of Medicine at Western University. The onus of responsibility is on drug manufacturers to demonstrate that minor differences between biosimilars and the original biologic won't affect patient treatment outcomes, meaning that health care providers can have confidence in the safety and efficacy of the biosimilar. Moreover, according to the Patented Medicine Prices Review Board, the use of biosimilars can save the Canadian health care system

What is i nflammatory a rthritis (IA)?

IA is a group of conditions wherein

approximately $1.8 billion per year.

As they come to market, biosimilars are providing new options for treating a wide variety of conditions, including ulcerative colitis. “Characteristic symptoms of ulcerative colitis include rectal bleeding, reduced stool consistency, and increased frequency and urgency of bowel movements,” explains Dr. Neeraj Narula, Director of the IBD clinic at McMaster University and President of the Canadian IBD Research Consortium. “Biologics have changed the landscape of ulcerative colitis and are very effective therapies. Biosimilars are effective and they work in the same fashion as the originator molecule, so I don't have concerns when using biosimilars for patients in need of biologic therapy.”

More choices, better outcomes

Rheumatology is another field of medical care where biologics and biosimilars are changing the treatment landscape. Biologics have proven to be very effective in managing severe cases of rheumatoid arthritis, and some of the first biosimilars to be approved in Canada were indicated for arthritis. As a result, rheumatologists have been on the front lines of patient

concerns about switching.

“There was a time when the public and some physicians didn't understand that generics would save a lot of money without putting someone at risk,” says Dr. John Esdaile, Scientific Director of Arthritis Research Canada. “Those on a chronic prescription for a drug often don’t notice when they're being switched back and forth among the generics. No one thinks much about this anymore. The main difference today is that the injection system to administer a biosimilar is different from the originator’s. In the future, we'll talk of biogenerics and no one will care. Both the rheumatologist and their pharmacist will be knowledgeable about the topic and help their patient make the transition.”

Biosimilars are expanding the breadth of treatments available to patients and health providers in rheumatology, ulcerative colitis, and many other medical disciplines, but there remains a need for public education. It's essential that patients taking or considering biologics have an informed dialogue with their doctors about biosimilars and whether they may be a wise option in their personalized treatment plans.

Dr. Yan Yeung Rheumatologist, Waterloo Rheumatology

Dr. Janet Pope Division Head in Rheumatology, St. Joseph's Health Centre & Professor of Medicine, Western University

Dr. Neeraj Narula Director, IBD Clinic, McMaster University & President, Canadian IBD Research Consortium Dr. John Esdaile Scientific Director, Arthritis Research Canada

Carrie Barnes Rheumatoid Arthritis Patient

How Canadian Athletes Keep Playing the Sports They Love While Dealing with Pain

Pain from injuries, arthritis, and muscle overuse are things athletes deal with constantly. However, it doesn’t stop them from playing the sport they love.

Canadian athletes are a source of national pride. Thanks to access to public and private sector support, highlevel training facilities, and some of the best coaches, our athletes are able to succeed in their chosen sport and distinguish themselves both in their home country and on the international stage.

Being able to play or compete in the sport you love is an honour and a privilege and, for many, a dream come true. But it takes years of intense physical and mental conditioning,

What inspired you to play

Sport was always important for my family and was a way to create connections. I have four older siblings (three brothers and one sister) who played hockey, so I wanted to be just like them. In addition, it was a way for us to spend energy and have a healthy lifestyle.

What has been the most memorable moment of your career thus far?

The most memorable moment of my career has been winning the Olympic Gold in 2022. After the 2018 Olympics, I retired, so I never thought that being

Anne Papmehl

commitment, and sacrifice to get to the top of your game.

To us spectators watching our athletes accept an Olympic medal, receive a coveted trophy, or celebrate a team win, they may appear to be strong, fit, and leading a pain-free life.

What we often don’t see is what goes on behind the scenes. With constant wear and tear on their bodies, injuries and strains, pain becomes an inevitable part of life for Canadian athletes — and pain can be a major hurdle to success.

Whether you’re playing professionally or just for fun, proper rest and

recovery are important to healing, but that can sometimes be a challenge. Fortunately, many safe and effective over-the-counter topical products can make it easier for athletes to manage their pain and continue to play the sport they love.

Mediaplanet recently spoke with three Canadian athletes to learn more about what attracted them to their respective sports, what drives their commitment and motivation, and how they turn to solutions like Deep Relief® topical products and physical therapy to manage their pain.

an Olympic Gold Medalist was a possibility. So when I decided to come back 18 months after retiring, I was excited about new challenges. And then, the COVID-19 pandemic happened. I was glad to have all my teammates during those difficult moments and to be able to celebrate winning gold all together made that moment even more special.

How has your career as an ice hockey goalie physically affected your body?

My body is definitely stronger because of sports and all the workouts. However, after 23-plus years as a goalie, I have to deal with chronic pain in my day-today life and the soreness from all the workouts, practices, games, and travel.

What helps you manage your pain?

I used treatment and specialists to

help manage my pain. Depending on the situation, the best solution is sometimes to ice or use a cold spray and heating pads or hot spray in other cases. It’s also important to use strengthening exercises and stretches to help in the long term. Every athlete has their own preferences, and it’s important to find the right solution for yourself.

Why is effective pain management crucial for professional athletes?

Pain management is very important for athletes since our body is what does the work for us. Being pain-free helps keep the focus on performing to the highest of our abilities. Often, pain is what slows us down and can be an important hurdle to being successful.

What prompted you to start playing lacrosse?

I was playing ball hockey, and my dad’s best friend at the time was a lacrosse coach. So, the coach bought me a stick and asked me to come to practice. From there, it was history!

In what ways has playing lacrosse affected your body? My legs for sure. I have Osgood-Schlat-

ter disease, and my knees get sore after training or playing a game.

What motivates you to push through recovery and remain competitive?

People are always trying to be better than me, and I wouldn’t like to let that happen. Being sore won’t stop me from getting active and improving. Unless I can’t walk or run, I will always try to improve myself.

What sets Canadian athletes apart from the rest of the world? Canadians’ attitude is to be the best. At all times, we’re representing Canada and want to give our best performance.

People are always trying to be better than me, and I wouldn't like to let that happen.

What sparked your interest in My interest came from being born into a family that loved basketball. So just seeing my family play and talk about the game at a young age sparked my interest to follow suit.

Watching the Toronto Raptors also heightened my interest in the era where Vince Carter was our star player.

What has been the most memorable moment of your career thus far?

So far, the most memorable moment of my career has been scoring 30 points, making eight 3-pointers in my first game, and winning with the River Lions.

When operating at peak performance levels, pain is often inevitable. What has been your experience with this?

Injuries and pain are things that come with the sport. For example, basketball has affected my joints because of the constant impact, but as athletes, we also do a lot of muscle and joint exercises to strengthen those areas to sustain what we put our bodies through.

What helps you manage your pain?

We have top-tier physiotherapists, so I get the areas of need massaged and stretched out to manage pain. I also try to rest the area that's in pain until it feels better. Sometimes rest isn't an option, and if the injury isn't too serious and there is just minor pain on a joint or muscle, I will use Deep Relief® spray to treat the area of pain so that I'm able to play and not feel the pain.

When living under constant strain, what pushes you to keep playing?

My love for the game pushes me through strain. Basketball is also a team sport, and my unwillingness to let my team mates down motivates and pushes me as well.

What sets Canadians up to become great athletes?

Having something to look to, a goal, a destination, for Canadians in their home country plays a big role in stay ing motivated and trying to achieve greatness in athletics. The more oppor tunities that Canadians have (facilities, leagues, education, money), the greater athletes we will

With Deep Relief® Ice Gel™, Spray, and Patches as part of an athlete’s tool kit, there’s nothing to stop Canadian professional athletes – or any sports enthusiasts – from doing the things they love. Deep Relief® is a Canadian brand and trusted pain reliever for 50+

years - Available in all major retailers and amazon.ca, DEEP RELIEF® is a complete line of fast-acting, long-lasting, penetrating pain relievers designed to target your source of pain — and the only pain reliever endorsed by the Canadian Chiropractic Association.

Q&A with Ann-Renée Desbiens Ice Hockey Goalie & Canadian Olympic Gold Medalist

Q&A with Latrell Harris Defender, Toronto Rock

Q&A with Jaylen Babb-Harrison Basketball Guard, Niagara River Lions

Innovative New Cream Taps into Plant-Based Ingredients for Pain Relief

Michele Sponagle

Many Canadians live with chronic pain, a condition with many significant impacts.

As a result, several people are looking to natural, drugfree options when seeking solutions.

Awaye Pain Relief Cream is a new therapeutic product that has been introduced into the market. Developed by Lumiera Health Inc., Awaye is suitable for those suffering from painful ligament or tendon sprains, muscle strain, backache, joint pain, and arthritis. Awaye is a ground-breaking product — the first specially designed product to leverage the body's pain defence mechanism, known as the endocannabinoid system (ECS).

More Canadians seeking natural solutions for chronic pain

Approved by Health Canada as a natural health product, Awaye has been clinically tested to be safe and effective. In addition, Awaye is indicative of the natural approach to health that many people have embraced. Health Canada data shows that 71 per cent of Canadians have used natural health products. Natural products' appeal is multi-faceted and offers alternatives to prescription medications, which can come with side effects, impair daily

functioning, and cause drowsiness or addiction.

Getting back to everyday life, pain-free Many people with chronic pain want something that'll allow them to enjoy everyday life. “No matter the exertion, it's always good to follow up rigorous exercise with a topical remedy to ease muscle tenderness,” says Dr. Maher Obeid, a chiropractor from The Healing Path Chiropractic and Wellness Centre in Burlington, Ont.

For those seeking safe and effective relief from acute and chronic pain caused by various conditions, Awaye is a low-odour, non-greasy, non-staining, and non-habit-forming solution that can complement existing pain treatments and therapies.

Awaye comes recommended by health-care professionals, like Dr. Obeid. “I like to use a topical cream like Awaye, which works with the body's ECS to relieve soreness and acute pain,” he says.

Discover a natural, drug-free way to help manage acute and chronic pain with Awaye Pain Relief Cream, available online at awaye.ca and amazon.ca without a prescription.

This article was sponsored by Lumiera Health.

How CAPA Has Been Working to Improve the Lives of Arthritis Patients

The Canadian Arthritis Patient Alliance (CAPA) is celebrating an incredible 20 years of working to improve the lives of millions of Canadians living with arthritis. We're a national, volunteer, and patient-led organization with all of our board members living with arthritis. In 2002, we began advocating and meeting with health care decision-makers across the country on the most urgent and pressing concerns affecting our patient community. The concerns range from timely access to medications and diagnosis by a rheumatologist to accessing health services such as surgery, tests, and physical and occupational therapy.

With the generous donation of time from our esteemed Medical Advisory Committee, our board has worked hard to identify gaps in knowledge that people living with arthritis experience daily. Once an information gap has been identified, we go on to develop resources to help other patients like us to be able to manage the disease effectively. We've created user-friendly tools like our methotrexate resource, pregnancy and parenting resource, and living with chronic pain resource. Please take a look at our website to check out all of our amazing tools and information.

Over the past few years, we’ve also worked hard with our rheumatologists to provide our patient community with the latest information on COVID-19 in immunocompromised patients. CAPA recently hosted a webinar with Dr. Janet Pope on  Vaccines for People Living with Autoimmune Disease , which can be found on our YouTube channel.

For the first time, CAPA has partnered with Sparkplug Coffee. During September, 10 to 15 per cent of all sales from the Coffee for CAPA fundraiser will go to helping our organization continue to provide people living with arthritis with practical tools and resources to help them better manage their disease. Please consider ordering some delicious coffee and supporting our work!  sparkplug.coffee/capa-fundraiser

Now more than ever, we need strong, informed voices from the patient community to ensure the needs of people with arthritis are at the forefront of health policy in Canada.

Linda Wilhelm, President, The Canadian Arthritis Patient Alliance

This article was supported by the Canadian Arthritis Patient Alliance.

A Canadian company has introduced a unique, topical product designed to tackle acute and chronic pain naturally without drugs.

Boosting Awareness of This Rare Genetic Condition Can Save Lives

Hypophosphatasia (HPP) is a rare genetic disease that’s caused by a lack of alkaline phosphatase, an enzyme that’s important for skeletal mineralization — for making bones hard, essentially. While the disease has a wide spectrum of presentations and the severity varies from patient to patient, its symptoms are often life-altering and, at times, fatal. Therefore, raising awareness about the disease is important as it can help to prevent diagnostic delays, decrease the burden of disease on HPP patients through effective treatment, and ultimately provide a better quality of life for those affected by the condition.

Understanding HPP

“The lay term for HPP is ‘soft bones,’” says Dr. Leanne Ward, Medical Director of the CHEO Genetic and Metabolic Bone Disease Clinic and Scientific Director of the Ottawa Pediatric Bone Health Research Group. “With the alkaline phosphatase deficiency, patients indeed have soft bones, which results in bone pain, poor growth in children, X-ray findings that look like rickets, premature loss of teeth with the root intact, and a whole host of other medical conditions that go along with the condition.”

The features and symptoms of HPP depend on its severity. “Infants with a severe form of HPP have respiratory issues and may have other problems like seizures, failure to thrive, and striking X-ray findings, with the bones looking poorly mineralized and the growth plates appearing similar to rickets,” says Dr. Ward. In less severe cases, patients may not be diagnosed until childhood or even adulthood.

“In these cases, the classic presentation would be bone pain, poor growth in children, dental issues, problems walking and running, fatigue, and often deformity of the limbs and fractures,” notes Dr. Ward. Knowing what to look for can help patients get a quicker diagnosis and faster access to treatment.

The challenges of diagnosis

Diagnostic delays often arise with HPP because the condition is so rare, and so there’s a lack of general awareness. Therefore, educating health-care practitioners on the signs and symptoms to watch for is critical.

For Jennifer Boin, a 50-year-old

guidance counsellor and mother of two who lives in St. Thomas, Ont., her HPP diagnosis came early — around the age of two, after a dentist first noticed her unusual tooth loss — but “no one understood what it was, and there was no real follow-up because it didn’t seem to be affecting my long bones,” she relates. “Then, in my 20s, I started getting a lot of muscle and joint pain, and no one could explain why.” Boin researched independently and began connecting the dots, which led to her being re-diagnosed with HPP in 2013.

In my 20s, I started getting a lot of muscle and joint pain, and no one could explain why.

Boin’s journey to diagnosis included genetic testing and then family screening to see where her HPP had come from. “Unexpectedly, it turned out that both my parents had given me a bad gene,” she says. “There’s no history of HPP in my dad’s family as far as we know.”

Genetic testing and family screening

“This condition has different modes of inheritance,” notes Dr. Ward. “It can be inherited from a family member, or it can occur because of what’s called a ‘de novo pathogenic variant’ — when the variant has never occurred in the family before but occurs in an individual for the very first time — so the diagnosis is ultimately made based on genetic testing. Sometimes family members have HPP but their symptoms are so mild or so non-specific (like pain and lack of stamina) that they go undiagnosed for decades.”

Besides looking for the physical signs and symptoms of HPP along with testing for a low alkaline phosphatase level in the blood (which many children’s hospitals in Canada now “red flag” when there is a low value, helping to improve time to diagnosis), genetic testing of the ALPL gene is part of the diagnostic process. It’s important in the interpretation of alkaline phosphatase levels to know that they vary with the age and sex of an individual. Physicians have to make sure, for example, that a child’s alkaline phosphatase level

is benchmarked to pediatric normal ranges, and not to adult values.

Even with a conclusive diagnosis in hand, HPP patients face many challenges. Not only do they have to deal with the symptoms of HPP — which include loss of teeth, bone pain and deformity, poor growth, fractures, and challenges that go beyond dental and skeletal issues — but they must also find subspecialists who understand their condition.

The burden of disease “Because HPP has a multi-system effect, treatment requires multiple specialties,” says Dr. Ward. “Management of the disease and all its comorbidities is complex and quite challenging for both patients and physicians.”

To manage her HPP, Boin does yoga, sees a massage therapist and osteopath, and takes pain medication. She’s also on enzyme replacement therapy, the only HPP treatment currently available in Canada, but notes that accessing the treatment was a challenge. HPP can also be a burden financially, as Boin notes that the cost of her dental work and treatments — such as physiotherapy and massage — aren’t covered.

Soft Bones Canada helps HPP patients navigate these challenges. “We connect, empower, and educate patients and caregivers in the Canadian HPP community,” says Jennifer Paulson, one of the volunteer-based organization’s directors. “We do our best to provide whatever information and support our patients need.” From educational initiatives to patient gatherings to help accessing treatment, Soft Bones Canada aims to lessen the burden of HPP — because living with a rare condition isn’t easy, and we all have work to do when it comes to understanding and treating them.

Tania Amardeil

Sometimes family members have HPP but their symptoms are so mild or so nonspecific (like pain and lack of stamina) that they go undiagnosed for decades.

We connect, empower, and educate patients and caregivers in the Canadian HPP community.

Jennifer Paulson

Director, Soft Bones Canada

Photo of Jennifer Boin

Dr. Leanne Ward Medical Director, CHEO Genetic and Metabolic Bone Disease Clinic & Scientific Director, Ottawa Pediatric Bone Health Research Group

Arrey Registered Dietitian & Author

Six Ways Partnering in Research Improved My Life with Arthritis

Eileen Davidson

Being diagnosed at age 29 with rheumatoid arthritis opened my eyes to the challenges of living with a serious autoimmune disease. At the time of my diagnosis, I wasn't even aware arthritis involved autoimmune forms, was as serious as it is, and someone as young as me could be struck with it. Since then, I've discovered living with arthritis can often feel overwhelming.

These are some of the questions that I've had to deal with: How do I manage these debilitating symptoms of pain, fatigue, cognitive dysfunction, and malaise?

How do I navigate life and the medical system with a bumpy chronic illness?

How do I know what advice to listen to when so much is out there, often contradicting each other or very expensive and sometimes dangerous advice?

How do I get to learn more that will truly benefit my arthritis? Unfortunately, doctor appointments are often short and focus only on medications or referrals.

How do I connect with people who really get what I'm going through?

For me, the answer to better self-management and understanding of my disease started when I began participating in health research in 2018 by joining the Arthritis Research Canada patient advisory board.

Participating in research to connect with people living with arthritis Not everyone understands what living with an invisible illness is like, especially arthritis, which comes with many misconceptions and stigmas. During my involvement with arthritis research, I've

learned not only from research but also from people with lived experience dealing with arthritis. Connecting with people who understand the illness helped me feel less alone in my invisible struggles.

Volunteering for a sense of purpose and hope

Volunteering has helped me tremendously counterattack the depression that comes with living with this disease. Arthritis is the number 1 cause of longer-term disability in Canada. So, when I was placed on disability from the disease, I needed to find an outlet that made me feel a sense of purpose while giving back to my community, helping others like me, and hoping for a better future with arthritis.

Connecting with world-class clinicians and researchers

After joining the patient advisory board, I partnered with researchers and experts who focus on topics most important to people like me living with arthritis. For example, I was able to participate in studies to understand how exercise and monitoring my symptoms with a Fitbit would impact my RA. These studies gave me access to physiotherapists and kinesiologists with an interest in arthritis, who helped answer my questions and concerns about specific barriers I face with RA and exercise.

Self-management skills essential to living with arthritis

Chronic illness is bumpy; medications only go so far. Exercise has been one of my primary self-management skills in navigating life with arthritis. Thanks to participating in research, I feel much more confident in my ability to exercise safely and without exacerbating my symptoms. Exercise has helped reduce my symptoms and get stronger with RA.

Deeper understanding of symptom management

Through research, I’ve learned that movement is important for pain reduction, when before I thought it would be best to just rest. Understanding all the symptoms associated with arthritis has helped me know which self management strategies to try to find relief, if they don’t work and persist, I know it is time to bring this up to my doctor.

Increased understanding of arthritis and improved communication with doctors RA is so much more than joint pain, so learning to tackle and understand symptoms like brain fog, fatigue, sleep issues, mental health, or comorbidities common with RA is crucial to living well with the disease. Participating in research has taught me what a lot of medical terms mean and what to watch out for with my diagnosis. As a result, I can have much easier conversations with my health-care professionals knowing what questions to ask and what their answers mean.

Because of arthritis research, I feel more confident in living well with rheumatoid arthritis.

Q&A with Registered Dietitian and Nutritionist Kim Arrey

Mediaplanet sat down with Kim Arrey, registered dietitian and author, to discuss her experiences in helping patients with inflammatory arthritis manage their debilitating conditions.

I’ve been working with arthritis patients for many years. Initially, I was asked to do some presentations on diet and arthritis for AWISH, a local arthritis self-help group. That is where I first met Dr. Starr. Over the years, I’ve counselled many patients with different types of arthritis. Usually, they consulted me to help them to manage the conditions that go with arthritis, like heart disease, Type 2 diabetes, or even to help them manage their weight. And I spent a lot of time busting myths about what to eat when you have arthritis. But I also watched family members struggle with osteoarthritis, and now I have osteoarthritis in my shoulder.

As a registered dietitian (RD), how can nutrition and diet help manage inflammatory arthritis?

I’m always surprised by the number of sure-fire cures for arthritis attributed to removing certain foods from the diet. But unfortunately, there are no scientific studies that actually suggest that these dramatic diets that eliminate specific foods like dairy or nightshade vegetables or even foods containing gluten will help the majority of people with arthritis to feel better. Instead, the research tells you that you must eat a balance of anti-inflammatory nutrients in your food.

Eating well can help you lower your inflammation levels and reduce the likelihood of you developing other comorbidities of arthritis like heart disease and Type 2 diabetes.

What key themes have you observed as an RD dealing with arthritis patients?

Many patients with arthritis have diffi-

culty grocery shopping and preparing food. Walking through the grocery store when you're aching and exhausted is tough. Preparing food brings other challenges. For example, how do you chop vegetables when your hands hurt?  How do you stand to wash your vegetables at the sink? Unfortunately, this often leads people to select foods that are highly processed.

A better option is to use an online grocery service. Doing your groceries online saves time and energy. Another option is using a meal delivery service. Some people will choose a service that delivers food that’s pre-portioned and often ready to cook, limiting the amount of preparation you have to do. Others choose to have meals that are already cooked, delivered to their door. I often suggest to people that they can do a mix of all the options. Have some ready-to-eat meals in the freezer, mealkits delivered, and extra vegetables and fruits delivered. Anything that will help you eat nutritious foods that are less processed is great. You might also want to invest in some special kitchen equipment that will help make food prep easier. There are many that are available. In my case chopping is difficult for me so I have a food processor on my counter so that I can easily chop any veggies. OXO Good Grips are amazing for people with arthritis in the hands and people with carpal tunnel syndrome. And they're easily available.

In your expert opinion, what are some healthy eating habits for people with arthritis?

Studies after studies tell us that the best anti-inflammatory diet is based on the Mediterranean diet. This eating pattern includes:

• Fatty fish

• Plant-based proteins like lentils,

chickpeas, tofu, and pulses

• Lots of vegetables and fruits

• Healthy sources of fats like olive oil, olives, avocados, nuts, and seeds

• Lots of herbs and spices

• Limit red meat and sweets

What are some of the key messages you’d like to give patients with inflammatory arthritis?

You will have a better chance of lowering your levels of inflammation if you include all the anti-inflammatory nutrients in your diet rather than by eliminating one or two foods or food groups from your diet. Taking foods out of your diet is more likely to reduce your ability to consume all the anti-inflammatory nutrients you need, while simultaneously causing you stress, which can lead to higher levels of inflammation. Unfortunately, there's no magic solution.

How can patients with the disease deal with challenges such as stress, cravings, and inadequate sleep?

Inadequate sleep can lead to more stress and increased appetite. It’s important to work with your medical team to ensure that your pain is well-managed so you can sleep well.

Take the time to learn techniques like meditation and relaxation, which have been found to help with pain management. That might mean consulting with a psychologist who focuses on cognitive behaviour therapy and with a kinesiologist who can help you design an exercise program suited to your physical capacity or finding a program designed to help people with arthritis be more active and learn to better manage their pain. A great place to start is the Arthritis Society of Canada. They offer many resources on their website.

Can you tell us about your involvement with rheumatology and arthritis?

Kim

Kim Arrey, Registered Dietitian and Author of The Complete Arthritis Health Diet

It takes collaboration

Pfizer Canada strives to profoundly impact the health of Canadians through the discovery, development and delivery of medicines and vaccines.

When it comes to research and improving patient care, collaboration is key. We work with the best and brightest scientists and healthcare professionals across the country through investments in independent research, partnerships, knowledge sharing, and clinical trials.

Through collaboration, we offer the possibility of a healthier world.