Arthritis and you

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PROFESSOR ANTHONY WOOLF Anxiety and musculoskeletal pain P2

PARALYMPIAN PAMELA RELPH Double gold with psoriatic arthritis P4

“I COULDN’T PICK MY KIDS UP” The emotional reality of arthritis P12

Arthritis and You Miriam Margolyes “It’s been more of a struggle to remain me than I thought it would be.”

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PHOTO CREDIT: JENNIFER ROBERTSON - KYTE PHOTOGRAPHY 028

The UK charity offering an integrated self-management approach to help people with arthritis lead a fuller life with less pain.

Find out more: www.arthritisaction.org.uk 0203 781 7120

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IN THIS ISSUE

Professor David Barrett Using software normally used for cars and aircraft to design knee implants.

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BOA: Hip surgery has changed a lot since the ‘60s Now, the op can take just 55 minutes under spinal anaesthetic.

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“Go along and give them a try!”

How joinging exercise classes at her local village hall has boosted Miriam’s social life.

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It’s time to take the UK’s musculoskeletal health seriously As the global impact of musculoskeletal conditions increases, the sector must use the opportunity to take big steps towards reducing the impact on people and the economy.

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iving with arthritis, or one of the 150 other musculoskeletal conditions that affect the locomotor system, can have multiple effects on a person’s life, going well beyond the physical symptoms.

Thankfully, today we have a greater understanding of the interaction between someone’s musculoskeletal health and their mental health.

A painful condition that limits a person’s abilities to work or enjoy life can see their mental health suffer. By taking a more holistic approach to treatment, we combat both the causes and symptoms of musculoskeletal conditions.

Anxiety and depression will sometimes manifest themselves as musculoskeletal pain. We now know that improving an individual’s mood may help them cope better with that pain.

Similarly, increasing an individual’s physical activity levels could positively affect their mental health.

Professor Anthony Woolf, Chairman of the Arthritis and Musculoskeletal Alliance (ARMA), says raising awareness of both the personal and economic costs of living with a musculoskeletal condition is vital in the effort to combat their wider impact on society.

“Musculoskeletal conditions are the biggest cause of disability both globally and in the UK, and measuring the increasingly broad impact of what are often invisible conditions is something that those in the sector have worked tirelessly for,” he says.

“There’s the personal cost to the individual to think about, but also the economic cost of the healthcare that person will require, and the impact of them being out of work.

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Professor Anthony Woolf Chairman, Arthritis and Musculoskeletal Alliance (ARMA)

“Anxiety and depression will sometimes manifest themselves as musculoskeletal pain.”

working to improve musculoskeletal health in the UK.” Indeed, there is a positive side to this increased prevalence for arthritis and similar conditions. Realising their increased impact should see developments in the sector, leading to further innovations in technology and other treatments. Those innovations are already present to an extent, with cost-effective surgical interventions and dramatic improvements in biologics that target inflammatory conditions.

A recent study in the World Health Organization bulletin calling for a ‘global response’ to musculoskeletal conditions confirmed their impact is growing, with ageing populations exacerbating the impact over people’s lifetimes.

Professor Woolf insists it is time to take a positive, pragmatic approach to the issue.

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“There’s much more of a focus now on how we can actually manage these problems more effectively and help people to help themselves,” he says.

“There are a lot of high value, simple measures that need to be made more available, such as self management and physiotherapy.”

Providing clearer treatment pathways for patients is a priority, as a condition’s impact is lessened if patients can access the help they need more quickly.

“If they do get a problem, they can see the right person at the right time to get the right treatment,” Woolf says.

ARMA continue to work closely with NHS England and Public Health England to build those clearer pathways, making treatment more accessible while also helping individuals in managing their own conditions.

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Joint it bu

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Joint replacement — what patients don’t know Anyone who has had a hip or knee replacement knows what a vital, life-enhancing operation it can be. But anyone preparing for joint replacement may not be aware they CAN choose which implant and surgeon they get and what difference it can make. It’s time to do some research.

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s we age, degenerative arthritis can take a devastating toll on our bodies, and particularly our hips and knees.

That’s because articular cartilage, the low friction lining in our joints, wears away over time. Unfortunately, unlike other tissue, cartilage doesn’t have the ability to repair itself. “Once it’s gone, it’s gone,” says Michael Tuke, founder and chairman of Orthopaedic company, MatOrtho Ltd. “And as it wears out, the trouble — and pain — begins.”

Yet joint degeneration isn’t only an issue for people in their 60s, 70s or 80s. It can happen to those in EADING their 30s, 40s and 50s, too.

“We are all living longer and want to be more active, so this is a condition that will affect more and more of us,” says Tuke. “Joints can also be damaged by excessive physical activity or injury in earlier life. Whatever age you are, when joint cartilage wears away and bone begins rubbing on bone, it’s extremely painful.”

Deformity can also occur as the joint starts to collapse.

A life-changing operation In the end, it may become so painful that even moving around becomes a problem. “This is severely limiting, of course, and can lead to all sorts of other health issues,” says Tuke. “We

have to keep our bodies active. If we don’t move much because of pain and prefer to sit in a chair all day, it can shorten our lives. That’s the bottom line.”

Which is why joint replacement can be so life-enhancing for patients with degenerative arthritis. “It’s not simply a way out of pain,” says Tuke. “Joint replacement can help us live longer especially by being active in later life.”

Yet there’s something that people with the condition may not realise, says Tuke. When it comes to a hip or knee operation, we don’t have to accept the first surgeon we are sent to and whatever implant they happen to use. Times have moved on over the last few decades; GPs and clinicians are more beholden to their patients these days. After all, we demand choice in every other area of our lives.

So why would we simply accept the surgeon we are sent to? Or the implant that he or his hospital like to use routinely but which may not be the best?

Michael A Tuke FREng Chairman and Owner, MatOrtho Ltd

“Deformity can also occur as the joint starts to collapse.”

Choose your implant – then your surgeon Indeed, Tuke believes that anyone who is prescribed for hip or knee replacement surgery should first choose the best implant.

This requires a certain amount of research, but is easier than you might imagine, thanks to The National Joint Registry (NJR) and the internet.

“This is a government database, open to everyone, which records information on all joint replacement surgery in the UK,” says Tuke.

“If anyone needs a follow-up procedure, information about that is

also registered. It records why the surgery was necessary and which hospital carried out the operations. It then shows how long each implant brand is likely to be effective, because some underperform against national averages and some consistently have lower re-operation (revision) rates year on year.

“Then there is the Orthopaedic Data Evaluation Panel — or ODEP — which provides a scoring system for devices and their success rates.”

Manufacturer websites also provide information, which can be

evaluated for marketing vs factual content, so patients should not be put off learning how implants work. Try finding which total knee implants provide the optimum medial stability in the walking range of motion, there are only three! Patients can have better function and greater chance of being able to forget about their knee while doing every day activities if the implant provides the normal amount of stability and allows the normal range of motion needed for those activities.

Once patients have chosen the implant they believe is best, they can ask to receive treatment from a surgeon who has demonstrated good results with that particular device.

It shouldn’t be surprising to do it that way around, says Tuke, because most consumers will look for a brand they prefer first — from the coffee they drink to the car they drive — and then find out where to get it. While the total cost of a hip or knee replacement in the UK is around £10,000 – £12,000, the implant itself is only around £1,000 - £2,000. “The best implants do, generally, cost a bit more but are not the big part of the operation cost,” says Tuke. “But why would anyone want anything but the best device?”

The National Joint Registry also records information about individual surgeons so anyone can see the results of their operations. “It’s tempting to think that all medical practitioners have the same level of experience and skill — but that’s simply not the case,” says Tuke. “For example, if a surgeon has only performed six knee operations a year when the national average is 56, a patient may decide to go elsewhere.”

Joint replacement surgery can be a life changing experience. Many people want to know more about it but finding answers that are easy to understand can be difficult.

KnowledgeBase™ is a unique resource for anyone interested in joint replacement, connecting you to information you should Cominghave, soon... for the best experience and outcome.

The importance of physiotherapy The fact is that a knee or hip replacement is a major operation; so, ideally, a patient will only want to have it done once and some implants have the potential to last longer than others.

“That’s why it’s so vital to get the right one the first time at any time of life,” says Tuke. “This is an implant that it is hoped is going to be an integral part of your body for the rest of your life.

You don’t want it to wear out early and need a re-operation when old and frail.

People should have more control and more say about what kind and brand of implant it is, and who will be carrying out the surgery. It’s about being brave enough to say something to your GP and/or consultant — and realising that if you don’t ask, you don’t get.”

Something else that joint replacement patients might not realise is that pre- and post-op physiotherapy is hugely important for early rehabilitation. Physiotherapy isn’t always available because of cutbacks; but Tuke insists that its long-term benefits should not be underestimated.

“These can be immense,” he says.

“Keeping the blood flowing and the joints moving without overdoing it is key. It might hurt a bit to stay active right up to the operation, but much more satisfactory outcomes can be achieved as a result. That’s particularly true for people who want to get back to any sporting activities. I’ve seen squash players get back on the court within months of a joint replacement operation. With the right implant and the right care, almost anything is possible.”

Tony Greenway Read more on matortho.com

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Know your limits, but squeeze everything out of life

Miriam Margolyes Actress

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iriam Margolyes has an attitude to life that many would envy. Making the most of the one life she has is made harder by arthritis, but she refuses to let it put out her fire.

Three years ago, celebrated actress Miriam Margolyes underwent surgery to replace her troublesome left knee. The pain had got to a stage where she was trying to avoid moving altogether.

Osteoarthritis has made getting older more stressful than she’d hoped, often battling pain in her legs, hands and back.

Her weight is also something she admits she struggles with.

If I’m honest, my weight hasn’t helped “I thought I could carry on being overweight and getting through, but it’s not quite like that,” she said.

“It limits you and diminishes you. It’s been more of a struggle to remain me than I thought it would be.”

However, her inextinguishable passion for life is coupled with an underlying determination not to let her arthritis halt an acting career that continues to flourish. Albeit frustratingly late for Margolyes’s liking. “I’m more popular now than I’ve ever been, it’s just a shame it’s come 30 years too late!”

Exercise has to suit you and your needs Margolyes says exercise is vital in managing her arthritis, enabling her to live the life she wishes to lead.

She swims and has recently invested in a brand new exercise bike, while personal training sessions contribute to staying as mobile as she can. Knowing her limits has become increasingly important.

“When you get older, things start failing you. One of the things to go is my bladder! I used to walk a lot until about a year and a half ago, but I’m fearful of going on long walks now in case I p**s myself! With my exercise bike though, I can just hop off and go to the loo.”

Making the most of your mobility Margolyes spoke about not letting her condition stop her, but regrets that certain things are now beyond her.

“I have a show called ‘Dickens’ Women’. One of the characters, Mrs Mowcher, requires me to crouch and bend my knees for around 12 minutes. I just can’t do it any more.”

Margolyes splits her time between London, Australia and Tuscany and you’d be forgiven for presuming trips to warmer climes were to tame her arthritis.

“No, it’s because I’m greedy and I want everything,” she joked.

“If I could have three lives, I’d ask for three lives. But I’ve only got one and I want to make every moment count.”

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Arthritis cost me my army career, but I went on to win gold (twice) it looked deformed. I had to have a scribe in exams.

But nothing was going to stop me from the army career I had in my sights.”

Pam was accepted into a military sixth form college when she was 16 years old.

“The army was happy to take me despite my diagnosis as I had been assured it would resolve when I stopped growing,” she says. Two years later, however, Pam had stopped growing but her condition had not improved. “I’d noticed that, when I was stressed or run down, I would experience a little psoriasis. It wasn’t long before I was diagnosed with psoriatic arthritis,” says Pam. “Still, I saw no reason why I shouldn’t continue to pursue my goal to be in the army.” The military, however, disagreed.

“I had to explain my psoriatic arthritis to the army in a medical evaluation. I was told I was no longer eligible because I was reliant on medication and because my condition would never be cured.

“Devastated, I appealed a number of times, and even came off my medication to try to show that I didn’t need it. But, within six months, I effectively ground to a halt, proving to both the military,

“I was no longer eligible for the army because my condition would never be cured.”

Pamela Relph Paralympian Pam first had arthritic symptoms when she was just seven years old. “I was convinced I had arthritis and told my father, but he replied that ‘arthritis is an old person’s disease’,” she says.

As well as a stiff and painful wrist, Pam was coping with terrible fatigue. Eventually, she was diagnosed with juvenile idiopathic arthritis, which would disappear when she stopped growing.

Arthritis began to affect Pam’s right knee and left ankle; places she had injured playing sport at a high level. “As a child, the pain was relatively bad as I was on no medication for the first six years,” she says. “My wrist was so swollen

and myself, that I could no longer consider an army career.”

Meanwhile, Monica Relph, Pam’s sister, was in the British Olympic rowing team. Monica asked her coach if Pam could be eligible for the Paralympic squad.

As Pam’s condition is permanent, progressive and restricts her movement, she classified, and was soon training for London 2012.

A gold medal win was followed, four years later, by another gold at the 2016 Rio Paralympic Games, making Pam the first double gold medallist in Paralympic rowing. It’s a far cry from the army career she had dreamed of, but as Pam says, “everything happens for a reason”.

Supported by Arthritis Digest Magazine, Essential reading for anyone affected by arthritis arthritisdigest.co.uk tel 0845 643 8470

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Why we all need to be more aware of ankylosing spondylitis

Ankylosing spondylitis is a painful form of arthritis — and you should be aware of its symptoms in order to receive an early diagnosis and the most beneficial treatments.

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The symptoms to look out for

Unfortunately, there is, on average, an eight and a half year delay from onset of symptoms to diagnosis.”

The effect of ankylosing spondylitis

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f you have four out of five symptoms of ankylosing spondylitis, visit your GP. Early diagnosis can improve the outcome of this painful and incurable form of arthritis.

Ankylosing spondylitis (AS) — a painful and incurable form of inflammatory arthritis that mainly affects the spine but can affect other joints — isn’t a well-known condition. Yet people should be aware of it and of its debilitating symptoms, says Dr Dale Webb, CEO of the National Ankylosing Spondylitis Society (NASS). That’s because the earlier it is diagnosed, the better the outcomes for patients.

“AS isn’t a rare disease,” says Webb. “One in 200 people have it.

Ankylosing spondylitis usually develops in the late teens and early twenties. Symptoms can include back pain and/or stiffness, fatigue, impaired vision, bowel function and even psoriasis. For some people, pain and symptoms will be constant, while others will experience ‘flare ups’.

Over time, repeated inflammation can lead to a fusion of the vertebrae, which in turn causes more pain, further reduces mobility and creates a forward stoop in posture known as kyphosis.

“AS can affect daily living and, for some people, reduce their ability to drive or even work,” says Webb. “It can be hell to live with. Imagine if you are in your early twenties with your whole life ahead of you, but are suddenly faced with worries about your career, relationships and body image. And because AS causes

Dr Dale Webb CEO, National Ankylosing Spondylitis Society (NASS)

“Early diagnosis can improve the outcome of this painful and incurable form of arthritis.” fatigue, it can stop people going out, which means they can become socially isolated.”

Unfortunately, because back pain is so common, it can be a difficult condition to diagnose. This means that people who go to their GP with lower back pain are in danger of having their symptoms dismissed.

However, if someone has four out of the five following symptoms, they should ask their GP to refer them to a rheumatologist, says Webb.

First, if your symptoms began before the age of 40. Second, if the pain started slowly and built up.

Third, if exercising helps alleviate the pain. Fourth, if there is no improvement when you are resting; and fifth, if you have pain at night, which improves when you get up and move around.

Increased risk if AS is in your family “If you have four of these symptoms, don’t hesitate: go to your GP,” says Webb. “And be sure to tell them if someone in your family has AS, because this increases your risk.”

The good news is that AS treatment has changed over the last 15

years, and there is now much that can be done to improve the condition. “Initial treatment is with anti-inflammatory medication,” says Webb. “If this is not effective, biologic therapy is available. AS also responds well to physiotherapy, hydrotherapy and exercise, because regular stretching helps with flexibility, movement and posture and can reduce stiffness and pain. The long-term outlook for patients with AS is considerably better than it was 20 years ago.”

Tony Greenway About NASS NASS are the only charity in the UK dedicated to providing life-changing support to anyone affected by AS. • We empower people to manage their AS • We offer specialist physiotherapy volunteer-led sessions around the UK • We fund research and campaign for improved care

Read more on nass.co.uk Helpline 0208 741 1515

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Now, hip replacement patients can lead an active life again, more quickly

Mr Ananda Nanu President, British Orthopaedic Association, BOA Hip replacement surgery, technology and materials have improved immeasurably over the years, significantly speeding up hip operations and recuperation time.

Hip replacement operations have hit the headlines recently due to the Duke of Edinburgh’s successful hip replacement surgery in April this year. It has also brought to light various myths that have developed about how active one could be following a hip replacement operation, says Mr Ananda Nanu, Orthopaedic Surgeon and President of the British Orthopaedic Association.

“For instance,” he says, “when the procedure was in its infancy in the 1960s, patients were traditionally told not to bend their hip more than 90 degrees, or take part in certain activities — such as skiing or breast-stroke when swimming — for fear of dislocation. However, now that technology has moved on and techniques have improved, it’s no longer true today.”

Another myth is that both hip surgery and recuperation take a long time.

“With modern advances, most hip replacements are performed under spinal anaesthetic so that the patient can stay awake and talk or listen to music during the procedure,” says Nanu. “From beginning to end the surgery can now take between 45 and 55 minutes — and, post-surgery, the average length of stay in hospital is two days, which really improves the experience for patients.” If a programme of physiotherapy and exercise is diligently followed, full recovery can take around three months, depending on a patient’s age and fitness.

Patients should do their research. Any surgery must be a mutual decision by patient and surgeon It is important that patients are fully aware of all the positive and negative aspects of surgery. A hip replacement can provide welcome relief for a patient experiencing pain arising from their hip joint, as all affected bone is removed, helping them to lead a normal, active life again.

“Patients also need to be aware there is always a possibility that things will not go perfectly to plan,” says Nanu. “The biggest risk is infection.

There’s also the risk of a clot forming in the leg or that the surgeon’s technique may not be perfect. But we discuss this with the patient. We give them all the information; then they do their own research and come back with a list of questions. The point is that surgery is a joint decision. The old patriarchal system where the doctor tells the patient what to do has gone - a collaborative approach provides better outcomes for the patient.”

How long do modern hip replacements last?

Nowadays, the average age of patients undergoing a hip operation is 69 to 70, so a replacement for someone with arthritis is likely to last them the rest of their lives. “However, there isn’t a ‘one size fits all’ hip replacement,” says Nanu. “If someone needs surgery but is young and active, they could be offered a completely different type of joint that doesn’t wear out after 25 years — and which may indeed last 50 years or even their lifetime. However, this type of joint could cost the NHS twice as much.” Some clinical commissioning groups in the UK are restricting hip and knee replacements for budgetary reasons, says Nanu. “Funds are finite. So we need to make sure we are giving good value for money.”

Hip replacement surgery — plus the materials used in it and the technology surrounding it, including robotics and virtual reality — has advanced immeasurably over the years and should continue to do so. “We still don’t have the ability to inject stem cells into the hip so that cartilage can reform itself, and I can’t see that happening for decades,” says Nanu, “but when it does, it could transform hip replacement surgery.”

Tony Greenway

Knee surgery: new advances and better results Knee surgery has made significant advances in recent years, thanks to a pioneering procedure, technical breakthroughs and mindset techniques that transform patient care.

New advances in knee surgery mean better outcomes for patients and reduced recovery times, says Professor David Barrett, a lead consultant at Southampton University Hospital and one of the UK’s senior specialist knee surgeons.

Traditionally, arthritis was mainly a disease for the elderly. “Now, the patients we see are getting younger,” says Barrett. “That’s partly due to sports-related injuries and partly because people are getting heavier.

But it’s also because patients have become more demanding. Previously, people with knee issues would simply accept reduced mobility. The new breed of patient isn’t willing to do that. They want to be able to play golf and tennis in their retirement.”

Professor David Barrett Senior Knee Surgeon, Southampton University

Knee surgery where you can walk the same day

“We are employing the software used to design cars and aircrafts to design knee implants and predict how the human body will respond to them.”

Patients with knee issues usually present with pain, swelling and stiffness in their knees, which first inhibits sports and more strenuous activity but later begins to impact on their day-to-day lives: shopping, driving and even sleeping. “When bone begins grinding on bone it is extremely painful,” says Barrett.

Knee replacement surgery may be needed, but for younger patients, compartmental resurfacing (or partial knee surgery) — a procedure co-pioneered by Barrett — could be

an option. “This is surgery which resurfaces parts of the knee,” he explains. “Think of it as having tooth filled, rather than having all your teeth pulled out and false ones put in.” He believes it could be the future of knee surgery.

Compartmental resurfacing is carried out under general or spinal anaesthetic through an incision that is approximately three inches long

(rather than 12 inches for total knee replacement). The operation takes about an hour; and because it’s a less invasive procedure, patients are able to walk the same day, and possibly go home the next. Knee resurfacing, while niche, has been available for around 20 years. Although early results were mixed, more modern resurfacing techniques have been available over the last five–ten years, increasing success rates.

Using VR to increase accuracy during surgery Barrett points to three other advances that are changing the future of knee surgery. “Firstly, we are employing the computer software used to design cars and aircrafts to design knee implants and predict how the human body will respond to them,” says Barrett. “Robotics and virtual reality are also making surgeons’ jobs easier. At Southampton University, we are working with navigated robots to make accurate cuts in the patient’s knee; and we are also developing virtual reality to show the surgeon exactly where the implant needs to be.”

Finally, surgeons are rethinking patient care. “Knee surgery is a significant operation,” says Barrett.

“So we have been using high-performance mindset techniques with the patients before surgery, during anaesthesia and after surgery to prepare them for what they are about to go through. What we can show is that a properly prepared and relaxed patient enjoys a quicker recovery time and a much better outcome.”

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Iris and her surgeon, Raghbir Khakha, have become great friends through her knee surgery process.

PHOTO: KATE JARVIS

My personal trainer thought he’d never see me again

How a knee replacement enabled 78-year old Iris to continue her active lifestyle.

Iris Stewart Osteoarthritis Patient

Raghbir Khakha Consultant Orthopaedic Surgeon

The average age of patients is 69-years In 2016, 108,713 knee replacement procedures were recorded in England and Wales (up 3.8% on the year before) with the average age of patients being 69-years-old.

“I went into surgery last October and five weeks after my operation, I was travelling on the bus to the gym without the need of a stick. It surprised my personal trainer – he didn’t expect to see me again, ever!” says Iris. “By week eight, I was back on the spin bike and using free weights as well as doing some high-intensity exercises.” Iris was back at the gym within two months but this was largely thanks to her excellent level of fitness prior to her surgery.

The consultant orthopaedic surgeon who has supported her throughout her journey is Raghbir Khakha, who is thrilled by how quickly she has recovered.

“Negative stories and false information can deter people from exploring knee replacement

surgery despite their worsening osteoarthritis,” says Raghbir. “The main reason for anyone to have knee replacement surgery is to remove pain so they can get back to doing the things they love to do.

That is certainly the case with Iris.”

patient pathway, i.e. the process to prepare for and recover from surgery.

“People worry about different things, such as how long they will have to take off work after surgery,” says Raghbir. “But there is excellent aftercare from nurses, physiotherapists, occupational therapists and pharmacists. I will see my patients six weeks after their surgery and then at regular intervals over the next 18 months.”

Home visits are also organised through the Trust’s knee replacement outreach and support service. This initiative is reducing the length of hospital stays and releasing beds because it encourages people to recover at home. Occupational therapists will check that rooms have been properly adapted so patients can use the stairs or bathroom while they recover.

Surgery is more accurate now than 10 years ago “This area of surgery has moved on incredibly in the last decade thanks to technology,” he says. “The surgery is more precise and accurate and the implants are precision engineered to better match the patient’s anatomy and to replicate as closely as possible the natural knee.”

Anyone considering surgery needs to understand the procedure so they can ask the right questions. Patients should also understand that they can choose the surgeon who is right for them. At Guy’s and St Thomas’ NHS Foundation Trust, patients have a close relationship with the complete healthcare team so they can be informed throughout the entire

So when should someone consider knee replacement surgery?

Raghbir says the number one reason for contemplating surgery is night pain. The pain can be so bad that it causes frequent sleepless nights. “If you are not sleeping well it can affect other parts of your life, such as your mental health,” he says. “Imagine how you might feel after a late night out. And then, imagine feeling like that every single day. The next reason is lifestyle. Are your painful knees stopping you going to the shops or playing with your grandchildren?”

He says patients have a responsibility to take steps to help their replacement knees to work effectively following surgery to help achieve the

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ith a growing aging population, more people will suffer from osteoarthritis – a painful condition affecting the joints that is often accepted as a sign of getting older. As one determined lady discovered, though, knee replacement can be the answer to enjoying life again.

A painful knee was never going to stop 78-year-old Iris Stewart from swimming, walking and doing high-intensity workouts at her local gym.

The former nurse was diagnosed with osteoarthritis (the most common form of arthritis) at the age of 50. She continued to keep active until the pain became too much and she nervously asked her GP about knee replacement surgery.“I used to walk a mile to the gym but my left knee would lock and it was very painful. I had avoided surgery because I’d heard horror stories from friends,” she says.

Her doctor referred her to Guy’s and St Thomas’ NHS Foundation Trust in London where the orthopaedic team put her mind at ease. The surgeons explained how this life-enhancing surgery is already helping thousands of UK sufferers become free of debilitating knee pain.

best outcomes. This means, not only attending physiotherapy sessions at the hospital, but also doing regular, prescribed exercises at home.

“I am frank and open with my patients and make a deal with them. I tell them they will get the best care and surgery the hospital can provide but they need to put in the work afterwards.”

The recovery time after knee replacement surgery varies from patient to patient. The knee replacement Iris received is associated with notable improvements in patients’ quality of life as early as six weeks following the operation that progressively increases over the next 18 months.

So, is Iris pleased with her new knee? “Absolutely. I would recommend anyone suffering from knee pain and who is unable to enjoy life as they used to, to ask their doctor about the procedure,” she says.

“I can even do squats in the gym now, whereas before I could only do them in the pool.”

With her new knee, it’s inspiring how this 78-year-old has no intention of slowing down.

Steve Hemsley Find out more on provingthepromise.com Dr Khakha chose the ATTUNE® Knee System (ATTUNE) for Iris’ knee replacement procedure. The ATTUNE is designed to optimise how a knee joint feels and moves by working with the natural knee anatomy; allowing muscles, bones, tendons and ligaments to continue to work together, with the aim to provide increased stability during movement.

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Robotics:

making knee surgery more accurate and cost-effective Robotics are revolutionising the way knee surgeries are carried out. Mr Simon Jennings says the benefits were immediately obvious.

Robot-assisted surgery may seem futuristic, but it’s already making a huge difference for total knee replacements and is proving to be something of a hit among specialists.

The technology works by first enabling the surgeon to build – in real-time – a three-dimensional image of the knee via sensors attached to the thigh and shin bones. Surgeons are able to

Mr Simon Jennings MB BS, FRCS (Orth), Dip Sports Med, MFSEM (UK) Deputy Clinical Director, Orthopaedics, Lead For Orthopaedic Enhanced Recovery, London North West Hospitals NHS Trust

“The improved accuracy of implant placement will further improve the longevity of implants, too.”

build an accurate blueprint of the knee and the leg’s alignment, as well as plan their course of action.

“On the computer, during the operation, I create a patient-specific plan. I’ve mapped out the knee, I’ve worked out what sizes of implants I need. I position them on the model to work out the perfect position and shape to restore the patient’s anatomy and functional range of movement,” Mr Jennings says.

handpiece – a computer-controlled, high-speed burr that cuts exactly and only where I have planned on the knee model I created.”

The level of accuracy for surgeons is what sets this technology apart from the older, more ‘analogue’ techniques. That accuracy allows surgeons to replicate exactly what they’ve planned, which simply wasn’t as accurately achievable when using the naked eye.

The robotic handpiece improves accuracy

Faster recovery time likely for total knee replacement patients

“The clever bit at the end of it, and the more robotic part, is the

Mr Jennings thinks that improving the accuracy of implant

The power of robotics-assisted knee replacement The NAVIO Surgical System brings the benefits of CT-free navigation, intraoperative surgical planning and handheld robotics to knee replacement surgery.

Supporting healthcare professionals

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A less invasive patient experience

Mr Matthew Bartlett BA FRCS(Orth) Consultant Orthopaedic Surgeon, London North West Hospitals NHS Trust Navigation systems have been in use since 2005, but the new robotics element will mean greater accuracy, less invasive surgery and should lead to less hospital time for patients.

“The ultimate goal is for people to forget they’ve had a knee replacement.”

Robotics are already making a tangible difference to total knee replacements, according to Consultant Orthopaedic Surgeon, Mr Matthew Bartlett.

He says, improving surgeons’ ability to perform more accurate and less invasive surgeries can improve patient outcomes in the long run.

“What we hope is that this will make total knee replacements more consistent and reproducible across the board,” he said. That could, in time, lead to the NHS being able to offer implants that feel far more like a normal knee. “The ultimate goal is for people to forget they’ve had a knee replacement. Hopefully, this technique will allow us to use implants with a greater functional range in the future.”

Increased accuracy to reduce recovery times placement is likely to have a hugely positive knock-on effect for patients and the NHS. “Patients actually get up and out a bit quicker, and the knee should feel normal a bit quicker,” he says.

“The robotic system will limit your cutting to just what you need to cut, and fine-tune it to a greater degree of accuracy. It is a huge leap forward.”

This new method could be presumed to be more expensive than the traditional forms of surgery.

In fact, Mr Jennings believes the practice will prove more costeffective for patients and the NHS in the long-term.

Previously, trays upon trays of

instruments would be wheeled in to surgery in order to fit all shapes and sizes of knee.

“We just don’t have to do that anymore. I can work out exactly what size I want to use, saving the costs of sterilising unrequired instruments.”

The improved accuracy of implant placement will further improve the longevity of implants, too. By ensuring they are placed correctly and in a balanced fashion, they’ll be less likely to wear.

“It definitely gives me a degree of precision we never previously had,” Mr Jennings said.

We are looking closely at our patients to show how the whole

package of the total knee replacement process can be improved.

From patient experience in the clinic and in-patient admission, to the post-surgery outcome, satisfaction and longevity.

“It’s early days, but the initial signs are incredibly positive.”

James Alder

Read more on healthawareness.co.uk

Increased accuracy is a key benefit of the new technique, with anecdotal evidence already pointing towards better patient outcomes. Mr Bartlett stressed that it is early days, but he expects the improved leg alignment that comes with using the technology to have a positive knock-on effect for recovery times and long-term mobility.

Use of the robotic hand piece also means a less invasive experience for patients, reducing swelling and stiffness. Traditional techniques would often cause substantial bleeding, leading to swelling after the operation. Mr Bartlett hopes this effect will be less prominent with the use of robotics.

Less radiation and less costly scans Other similarly accurate systems use a CT scan for planning, which exposes patients to substantial doses of radiation. Avoiding this also means fewer hospital appointments for the patient and a more cost-effective solution for the NHS. Time will prove how much patient outcomes can be improved by robotics, but Mr Bartlett says his patients are mobilising better in the short-term, which should lead to a brighter long-term outlook.

James Alder

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Arthritis: an ‘unseen disease’ that people often dismiss Claire King

Tailoring treatment to a patient’s individual needs Claire King Actress and Patron, National Rheumatoid Arthritis Society Ex-Emmerdale actress, Claire King, was shocked to be told she had a chronic disease in her late twenties. She insists, however, that it hasn’t held her back from living a full life.

Being diagnosed with rheumatoid arthritis isn’t what you might expect as a person in their late twenties. Actress, Claire King, was sporty and a keen horse rider, not for one second thinking that the pain starting to announce itself in her joints would stay with her for life.

“My joints swelled up, and my knees felt like someone had hit them with a mallet,” Claire says.

“You just think: ‘This is an old person’s disease, am I going to end up in a wheelchair?’ There was very little treatment available at the time. You just tend to think the worst.”

Immediately, Claire had to change her diet and lifestyle to help manage her arthritis. Specific foods and drinks had to go, and she still feels the loss of red wine! “It’s shameful,” she jokes.

As an actress, especially in the modern age, any changes in weight are often seized upon by the media. Steroids are a common treatment for the inflammation that comes with arthritis, and weight gain is a side-effect of steroids. It can be hard to avoid the scales going up when vigorous exercise is difficult, because of the arthritic pain.

Finding movements that your body can cope with is a big step towards managing arthritis and leading an active life, says Claire. “Yoga has been great for me,” she said. “Things like running or lifting weights though – it’s just too punishing on my joints.”

Claire still rides horses, but with less gusto than before her diagnosis. “I just don’t bounce like I used to!” She chuckles.

While she insists her pain hasn’t held her back, she works with organisations, such as NRAS (National Rheumatoid Arthritis Society), to challenge misconceptions about what is often an ‘unseen disease’.

When she appeared on Strictly Come Dancing’s fourth series in 2006, some felt Claire’s arthritis was an attempt to hoodwink the audience into a sympathy vote.

“It wasn’t at all. I was trying to push through the pain and do the best I could, it’s just that people don’t see your pain so it’s harder for them to sympathise.”

Both of Claire’s parents battle chronic diseases and Claire’s inner strength comes from seeing their determination. Her dad has MS (Multiple Sclerosis) and her mum has both osteoarthritis and rheumatoid arthritis.

“I look at that and think, ‘Look, I’m ok. I’m still working and enjoying life’. That’s half of it, being thankful what you do have and staying positive. It will never stop me from doing my job or having an active life.”

James Alder

Research into treatment for rheumatoid arthritis — including a new era of personalised therapies — could be the next major step forward for patients with the disease.

Ailsa Bosworth MBE, Founder and Chief Executive of the National Rheumatoid Arthritis Society, knows how devastating rheumatoid arthritis (RA) can be. She has lived with the condition for over 35 years and was first diagnosed when disease-modifying anti-rheumatic drugs (DMARD) — an important intervention for people with RA — were only given to those who had become extremely ill or disabled.

“My rheumatoid arthritis was very aggressive,” says Bosworth.

“But it was three years or more before I was finally given the disease-modifying drugs that, today, are routinely given immediately on diagnosis. As a result, my RA wasn’t controlled properly, and I sustained a lot of irreversible damage.”

I am soon to have my 20th RA-related operation Indeed, Bosworth has undergone extensive surgery to counter the effects of rheumatoid arthritis over the years, including replacement knees, hips, elbows, ankles and a partially fused neck. The disease is now affecting her vision, too; so, in July, she will have her 20th operation, this time to improve the sight in her left eye.

Despite the destructive toll RA has taken on her body, Bosworth is optimistic about the direction of future treatment. Currently, therapies may include painkillers, anti-inflammatories (steroids) or disease-modifying drugs.

“Because rheumatoid arthritis is a syndrome rather than a single disease, there isn’t a ‘one-size-fits-all’ treatment,” says Bosworth. “If disease-modifying drugs don’t work for an individual after a period of time — and they have a disease activity score (DAS) greater than 5.1, which is the criteria laid down by NICE (National Institute for Health and Care Excellence) — then they may be prescribed a biologic or biosimilar therapy.

and innovative therapies recently available in the UK include JAK inhibitors, which are small-molecule therapies that can be taken by mouth.

Ailsa Bosworth MBE Founder and Chief Executive, National Rheumatoid Arthritis Society

“Biologics have been a saviour.”

Without my treatment I’d be permanently in a wheelchair by now Biologics have to be delivered by injection or infusion drip due to the size of the molecule. They have revolutionised the field of rheumatology since they were first introduced in the UK at the end of the 1990s. “For people like me, who didn’t respond to disease-modifying drugs, biologics have been a saviour,” says Bosworth. “There’s no way I’d be able to do my job or work the hours I do without them. I’d be permanently in a wheelchair.”

Unfortunately, this type of medication is very expensive, which is why its prescription is restricted.

However, when an original biologic drug reaches the end of its patent, other manufacturers are allowed to make similar versions — known as ‘biosimilars’ — which have been shown to be similarly effective and safe as the original biologic but much less costly. “We now have a number of biosimilar drugs on the market and more are coming on stream in October,” says Bosworth.

“This is changing the market landscape for RA treatment.” Other new

The importance of personalised therapies Bosworth believes this is an interesting time for RA treatment research, both at home and internationally.

For example, she hopes that ongoing research into biomarkers — a biological molecule found in blood and other body fluids, or tissues — will enable individual RA patients to have their disease targeted with personalised therapies in the future.

“If a patient doesn’t receive treatment that works for them, it wastes time (as they would usually wait three months to see if the drug was starting to work) — which means they can continue to deteriorate and sustain damage,” she says. “So, we need to be able to quickly identify which drug will best suit each RA patient and then tailor treatment to the individual’s disease profile, just like we do in cancer treatment.”

Ultimately, Bosworth hopes that a cure will be found for rheumatoid arthritis, or, at least, a way to prevent it from really getting going.

“For example, an antibody test can identify people who haven’t yet developed RA symptoms but might be more likely to develop it at some point in their life due to family history. Trials are under way to see if biologics can stop the disease taking hold in these individuals who are in the pre-clinical stages of the disease.

There is also research going on into other target areas of the immune system. It’s an exciting time and gives me good reason to be positive about the future.”

Tony Greenway NRAS is ‘the voice’ of people affected by Rheumatoid Arthritis (RA) and the only UK charity devoted specifically to the condition.

Find out more at nras.org.uk, call 0800 298 7650 or email helpline@nras.org.uk

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Turmeric extract shown to reduce swelling and pain for this micro-artist SPONSORED

Clinical trials have confirmed curcumin’s benefits to arthritis patients, but Graham Short believes it’s helping him actively prevent the onset of the disease as well.

Graham Short is an unusual artist, with his methods even more unusual. To create his microscopic pieces, of which he typically only produces four each year, the 71 yearold must remain almost impossibly still at all times.

A 2016 project saw him engrave Jane Austen’s face onto four brand new five pound notes - a protest at the lack of women chosen to adorn them by the Bank of England.

His work does get even more miniscule than that however.

“I’ve engraved ‘Nothing is Impossible’ on the sharp edge of a razor blade. I love it, it’s really interesting work,” he said.

Having watched both his parents suffer with arthritis as they grew old, Short’s biggest fear in life is developing a disease that would force him to give up his two great passions.

Swimming, and micro-engraving.

Graham Short Micro-artist

“I’ve engraved ‘Nothing is Impossible’ on the sharp edge of a razor blade.”

A prolific swimmer, Short does what he can to put off the onset of arthritis.

His own personal research led to him starting to take daily doses of curcumin, a herbal supplement which originates from the turmeric plant.

Traditionally used in Chinese and Indian medicine, several clinical studies have shown curcumin to have anti-inflammatory properties as well as positive effects on the immune system.

These studies have shown that curcumin can ease swelling and joint pain for patients with both Rhuematoid Arthritis and Osteoarthritis (Source: Arthritis Foundation).

Short says the positive effects on both his swimming and his work since he started taking curcumin eighteen months ago were immediately noticeable.

“Just three months in I felt sharper mentally. I was less tired and my swimming felt more comfortable,” Short told me.

“My back does stiffen up sometimes, which makes me think ‘I’m getting the arthritis my mother had’, but the curcumin seems to reduce that inflammation and keep me moving.”

Having left school at 15 to work in the Birmingham engraving trade, Short started his own business in the mid 1970s.

Soon, however, as personal stationary engraving became increasingly less popular and Graham was forced to think outside of the box.

“It was about 15 years ago that I started doing the miniature engraving work, and I can’t believe how it’s taken off,” he said.

“I’m selling in art galleries all around the world, it’s a completely new life for me.”

Working from midnight until 5AM to avoid vibrations from passing traffic, Graham goes to great physical lengths to create his work.

The need to remain completely

still sees him have regular botox injections in to his eyelids to ensure there is no distraction from eye muscles and nerves while working.

On top of that, a cocktail of drugs including potassium, magnesium and beta-blockers helps Short reduce his heartbeat to 20 beats per minute.

“I work in between heartbeats you see, using a stethoscope taped to my chest,” short explained.

“I can only make three to four cuts a night, so staying still is vital.

The curcumin hasn’t just helped my body, I feel sharper and more able to concentrate on what I’m doing.”

Still swimming competitively, Short broke the 1,500 metres freestyle record for his age group at the European Championships last year.

“There’s even an age group for 100 year-olds,” he said.

“There aren’t many of them, obviously. If you want to do really well, you have to try and outlive the others!”

The tangible difference to his swimming is down to taking curcumin regularly according to Short.

He said the improvements in his lap times have impressed his friends more than the difference the supplement has made to his work.

“I’ve recommended it to all my swimming friends. I saw my parents struggle with arthritis, and I can’t have any of that,” Short said.

“I’m doing all I can to prevent it.”

James Alder

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Mental health is a core component of holistic arthritis treatment Jack March Rheumatology Clinical Lead, Chews Health; Chartered Society of Physiotherapists

Having arthritis shouldn’t mean you can’t do what you love.

Physiotherapists are working to dispel negative attitudes towards a condition that should no longer prevent an active lifestyle.

The role of physiotherapy in the treatment of arthritis is far more wide-reaching than you might think. A truly holistic approach, which incorporates both a patient’s physical and mental health, is vital in terms of helping individuals manage their arthritis and general wellbeing.

Jack March, Rheumatology Clinical Lead at Chews Health, says physiotherapists first look to establish what an individual has lost the ability to physically do due to their arthritis. They can then build an exercise plan that will enable them to get back to doing what they love most.

“The biggest impact of physiotherapy is increasing the function of the joint,” he says. “Simply reducing pain isn’t necessarily the most helpful measure to work from. The focus should be on how we can empower individuals to return to their preferred activity, whether that be vigorous exercise or gardening.”

Positive messages help people to cope Historic clinical advice was often centred around negative rhetoric, suggesting that arthritis was caused by ‘wear and tear’ or that a joint would only have a certain amount of mileage. This is something Mr March feels has changed, with a more positive outlook now being encouraged.

“Piling negativity on to people is unhelpful in the long run. We look to educate people on how to manage and monitor their arthritis.”

Global assessments promoting better understanding The initial assessment session focuses on the individual’s needs, establishing the range of motion of the joint as well as the strength of the surrounding muscles.

Gaining a handle of the general conditioning of an individual is also vital, according to March. “Someone might have excellent muscular conditioning in their legs, but have poor cardiovascular health, meaning they’re not getting enough oxygen to those muscles. By understanding these factors, we can then work towards giving them an exercise plan that’s tailored towards their individual goals.”

Mental and physical health are closely connected in the healing process Understanding an individual’s mental health has come more sharply into focus too, as people with poorer mental health have been proven to report pain more acutely.

Indeed, March believes assessments should go well beyond simply helping individuals increase joint function.

“We need a picture of their general health, with diet and sleep patterns being just as important as joint function.”

Patients need to be able to enjoy their exercise plan When motivating individuals to exercise regularly, enjoyment is really important. There’s little mileage in prescribing gym work to someone who’s never set foot in a gym.

Instead, the approach is tailored to the individual and their desire to achieve their own personal goals. “Swimming is a really popular exercise, with people often having enjoyed it at school but not kept it up,” March says. “It can increase weight bearing in the joint, and the muscular strength around it, without the impact of running or lifting heavy weights.”

Following a programme of exercise should mean that no exercise type – including running or weight lifting – is off the table for most arthritis patients. Managing expectations and educating individuals on how to build their strength up is a key role for physiotherapists.

“Venus Williams has an inflammatory condition, which she manages.

Having arthritis doesn’t mean people can’t be active anymore, but individuals do need to be mindful of their own bodies.”

James Alder

“Rheumatoid arthritis is not a condition people understand” Phil Davies is a young, family man who enjoys being active — so a diagnosis of rheumatoid arthritis was devastating. He reveals how he and his family have coped with his condition.

When Phil Davies was diagnosed with rheumatoid arthritis in his mid-twenties, it was a scary time.

“I didn’t know anything about the condition,” he says. “I was pleased to find out what the problem was and to get a treatment plan, but I was heartbroken to discover there was no cure because I’d always been active. I was worried about the impact it would have on the rest of my life.”

Phil, now 31, was continually visiting A&E with excruciating shoulder pain. “But I’d always be told there was nothing wrong with me. It was only when my GP finally referred me to a rheumatology department that the diagnosis was given.”

Dealing with flare-ups Rheumatoid arthritis, an autoimmune disease that causes painful, swollen joints and stiffness, can affect any part of the body. “Thankfully, I’m more or less OK on a day-to-day basis,” says Phil. “But I do get flare ups once a month on average. I’ve had them in my jaw, shoulders, knees, hips, toes... even my collar bone.

I’ll notice a pain that gets progressively worse, then go to bed, get two or three hours’ sleep and wake up in agony, not being able to move a particular joint.” He can only take painkillers and wait for things to improve.

Phil Davies Ambassador, Arthritis Research UK

“I physically couldn’t pick up my children” Phil’s condition has also affected his family life. He and his wife have two children, aged five and two; and in the early days of his diagnosis Phil couldn’t pick them up, feed them or change their nappies. He was told to give up all contact sports and take up swimming or cycling instead. He became miserable; so, against medical advice, he started playing football — and loved it.

“I have always been told there was nothing wrong with me.”

Social stigma makes it difficult to share His rheumatologist has since given Phil the green light to play football — but he hasn’t told his teammates about his condition. “I don’t want the coach leaving me on the bench,” he admits. Because arthritis has badly affected his feet, Phil has an issue finding boots that fit. “I’d love to know if any top tier footballers have the same problem,” he says.

My employer is supportive It helps that Phil, who works in the heavy chemicals industry, has a supportive employer. “When I saw my job advertised four-and-a-half years ago, I nearly didn’t apply for it,” he says. “I was worried I’d fail the medical. But I was on established medication and my health was relatively stable, so I did apply — and I got it. I told my manager: ‘If I have to go to the doctor’s once a month, this is why.’

The company’s support has made a huge difference to me, because I don’t like taking time off work for illness.”

Understanding the condition If he’s ever feeling sorry for himself, Phil’s wife tends to snap him out of it. “That approach works well for me,” he says. He does agree it can be frustrating when people say to him: ‘You have arthritis?

Oh, my nan has that.’

“It’s not a condition people understand,” says Phil. “So, I have to make a decision to nod politely and explain to them that, actually, rheumatoid arthritis is not the same as osteoarthritis. People just don’t know about it.”

Tony Greenway

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Two-thirds of arthritis patients report depression when pain is at its worst The mental health challenges of living with persistent pain require resilience and specialist help.

Empowering individuals to take ownership of their own condition helps them stay positive.

A

rthritis is a growing problem in the UK. Arthritis patients have only a finite amount of time with their GP or specialist every year, so they often manage their own condition a lot of the time.

Of the 65 million people in the UK, over 10 million live with arthritis.

That figure is expected to rise to 17 million by 2030. Shantel Irwin, CEO of arthritis charity, Arthritis Action, says empowering individuals to better manage their own condition can help tackle a growing problem.

“What’s really promising is that healthcare practitioners are starting to talk about self-management with patients,” she said.

Increasing importance of self-management “Yes, they still focus on treatment, but they’re also factoring in ways patients can help themselves, recommending charities such as ours to assist in that.”

The focus, Irwin said, is on giving

the individual the confidence, skills and tools to help them ‘live their best lives’.

With over 200 types of arthritis, diagnosing the disease can be difficult for GPs.

There is a link between physical and mental health Shantel Irwin CEO, Arthritis Action

“People are four times more likely to have depression if they have persistent long-term pain.”

Keep moving

They often look worse than they actually feel!

Exercise cannot damage joints, but inactivity can weaken muscles, increasing the pain and instability.

Arthritis isn't caused by too much work or sport, so keep the activity up!

Giving people the tools to cope on their own is key To combat that, clinicians are focusing on giving the individual the confidence to take control of

Tips for People with Arthritis

Don't worry about your X-rays

It’s not your fault

Understanding of the disease can be lacking, which often leads to people hiding their arthritis from friends and colleagues because they’re scared of what those people might think.

The disease can also be isolating for people in terms of getting out to work or to GP appointments, but also in terms of feeling like they are a burden on their family.

All of this can make dealing with the mental side of the disease a real challenge.

“People are four times more likely to have depression if they have persistent long-term pain,” Irwin says.

“Two-thirds of people with arthritis have reported having depression at some point when their pain is at its worst.”

Top 10

Don’t panic There is a lot you can do to help yourself. Pains usually come and go; sometimes they disappear entirely!

Arthritis dramatically increases levels of anxiety, with people naturally more worried about their financial and physical situation changing.

Our physical and mental health are intrinsically linked, which is why having arthritis can be challenging for both our physical and mental health.

“It’s so natural for us to look after our physical health, but there is such a strong link between our physical and mental health. Living in pain can really affect people’s mood and outlook on life,” Irwin says.

Finding out that you have arthritis can be daunting, but there are ways to manage. Treatments have improved dramatically. Unfortunately, though, there is still no cure.

The isolating effects of an invisible disease

Use the stairs rather than the lift Knee pain often improves once you get going.

Relax On a bad day, try meditating.

Calming the mind can help reduce pain.

their condition through supported self-management.

“There’s no ‘one size fits all’ model,” Irwin says.

Helping someone continue to do the things they love benefits their ability to deal with the mental health problems associated with arthritis.

“We try to give people a choice and let them decide what works for them. Some prefer meditation or distraction techniques, whereas some simply want to relax,” Irwin says.

Self-management and wellbeing events are a lifeline for people looking to build confidence, while helping them cope with persistent pain.

Irwin concluded by encouraging people with arthritis to get to know their bodies and avoid being passive towards their treatment.

“Individuals know their bodies best. By being part of conversations with their GP, they take more ownership of their condition.”

James Alder Find out more on healthawareness.co.uk

Dr Wendy Holden Medical Advisor, Arthritis Action

Keep to a healthy weight Every extra pound of weight means an extra 5 pounds passing through the knees, hips and feet. Losing weight can reduce joint pain as much as prescription painkillers.

Improve your balance

Sleep tight

Tai Chi may be as effective as physiotherapy for knee osteoarthritis

A good night's sleep can reduce pain and anxiety.

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Innovations in treatment means better care for patients t SPONSORED

Innovation in minimally invasive techniques mean patients are able to have a faster recovery period.

Arthritis is becoming increasingly common as people live longer, are becoming heavier and are indulging in more and more sports resulting in sports related damage to their joints and they also have a higher demand and greater expectation of outcomes from their doctors. Arthritis historically was a disease of the elderly but we are seeing younger and younger patients for the aforementioned reasons.

Arthritis is particularly disabling with severe pain, impaired mobility, stiffness and often mechanical symptoms of the joint locking or giving way.

Minimally invasive techniques

Minimally invasive surgery/arthroscopic surgery has made enormous leaps forward in recent years because of improved technology available to orthopaedic surgeons.

The holy grail of orthopaedic surgery has always been to be able to repair or regenerate lost diseased or damaged cartilage in joints.

Increasingly, this is becoming achievable in that more and more torn cartilages (menisci) in the knee are repairable. The Arthroscopy Association of North America estimates that up to 30% of meniscal tears should be repairable. This allows the surgeon, with minimally invasive surgery, to stitch or repair a torn cartilage in the knee rather than having to remove it. The result for the patient is that they will ultimately have a much more normally functioning knee, with significantly reduced risk of developing arthritis later on. Orthopaedic surgeons are also using arthroscopic/minimally invasive techniques to stimulate the repair of joint surfaces, (articular cartilage) using a range of techniques

Simon Moyes Consultant Orthopaedic Surgeon, Wellington Hospital

including making tiny holes in the underlying bone to stimulate the repair process, using cartilage grafting techniques either from the patient themselves or from a donor.

Additionally there are techniques available now whereby cells can be harvested from a patient’s cartilage, grown in a lab and then later transplanted back into the patients damaged joint.

It should be noted that all of these procedures are performed as day cases, are less painful and offer a faster recovery period.

Cellular based therapies

“Up to 30% of meniscal tears should be repairable.”

Other therapies are also growing in popularity using cells, either harvested from bone marrow or from fat and utilised to try and help stimulate a repair process in the damaged joint. Such techniques are becoming more and more widely available and practiced.

Surgeons from the UK Biological Knee Society are working hard to develop and expand these techniques. The ultimate goal is to be able to perfectly regenerate articular cartilage and therefore

repair a damaged joint with the use of either simply needles or arthroscopic surgery.

The use of cell based therapies is obviously, and correctly, highly regulated in this country, Europe and North America but in some instances when looking at other countries one can get a glimpse into the future. The Kuala Lumpa Sports Medicine Clinic, for example, is already offering patients a service where their stem cells can be harvested, expanded and utilised for surgery within a relatively short period and then banked for future usage. This I believe, will ultimately be available more close to home in the future. The development of such cellular based therapies or ortho biologics, as they are termed, in my opinion, is the future of orthopaedic and regenerative surgery. The development of the cell based regenerative techniques will significantly reduce the need in the future for more major surgery such as joint replacement.

Read more on simonmoyes.com

“My advice? Go along to a class and give it a try!”

s.co.uk

Exercise classes may be of benefit to anyone with arthritis. We talk to Miriam Smith, who has recently started attending a class which, she believes, could be improving her flexibility.

M

iriam Smith was diagnosed with arthritis in her knees around 16 years ago, when she was 60. At first, she tried to shrug it off and simply get on with life. Over time, however, she couldn’t ignore it any more.

“The first time I noticed I had a problem was when I went to a party and danced all night — and the next morning I could hardly move,” remembers Miriam.

“Then stairs became an issue: I’d have to come down one foot at a time.” Walking down slopes was also painful.

No pattern to symptoms Miriam doesn’t want knee replacement surgery so is looking for

other ways to improve her condition. She tried medication such as paracetamol, cortisone injections and acupuncture. “You name it, I have done it.”

Frustratingly, there doesn’t seem to be a pattern to her symptoms, so it’s a difficult condition to predict. Sometimes Miriam finds that going out for a walk with the dog will ease the pain; at other times, it exacerbates it.

Physiotherapy eases the condition “I used to love line dancing,” she says, “but that’s an activity where you have to twist your knees — and that became too painful, so I had to stop.”

Around 10 years ago, Miriam began visiting a chiropractor

Miriam Smith Supporter, Age UK, Oxfordshire

“It’s making me more flexible.”

who eventually referred her to a physiotherapist. “The exercises the physio gives me doesn’t make the condition better, but it does ease the symptoms slightly,” says Miriam. “She’ll massage my knees and apply heat and cold to them.”

demonstrates exercises to loosen up the neck, shoulders, arms, core and legs; and also how to keep your balance, because as you get older that can begin to be a problem.”

Benefits of an exercise class

The classes have also been a boost to Miriam’s social life, too. My advice to anyone thinking about doing an exercise class is to go along and give it a try.”

Then around six weeks ago, a friend told Miriam about Age UK Oxfordshire’s hour-long strength and balance exercise classes at her local village hall.

The classes are run every week by Level 4 Postural Stability Instructors, and are attended by men and women of all abilities.

“It’s still early days, but I think the classes have been beneficial,” she says. “It’s making me more flexible. The instructor

The classes are a good way to meet others

Tony Greenway

Find out more from the UK’s largest charity working with older people at ageuk.co.uk

16 HEALTHAWARENESS.CO.UK

AN INDEPENDENT SUPPLEMENT BY MEDIAPLANET

Arthritis is one of the biggest public health issues facing the UK, yet it is not talked about. We are revealing the true impact arthritis is having on society because, directly or indirectly, arthritis affects everyone.

Arthritis: The Nation’s Joint Problem THE SCALE OF THE PROBLEM

WORKING DAYS LOST TO THE TWO MOST COMMON FORMS OF ARTHRITIS

ONE-IN-FIVE BY 2050 ARTHRITIS RELATED CONDITIONS ARE THE

OF DISABILITY IN THE UK #1CAUSE 88% describe it as a debilitating and liferestricting condition YET PEOPLE DON’T TAKE IT SERIOUSLY

www.arthritisresearchuk.org/jointproblem

FAMILIES ARE LOSING OUT

THE NHS IS LOSING OUT

76% are not able to join family walks, play with their children/ grandchildren or keeping in touch with friends, due to their arthritis

25.1 million

There are over 10 million adults affected by arthritis in the UK today One-in-six people currently have osteoarthritis or rheumatoid arthritis – two of the most common forms of arthritis – and this is predicted to rise to

For more about the impact of arthritis, please visit

Liam O’Toole, CEO Arthritis Research UK

THE UK ECONOMY IS LOSING OUT

MILLION AFFECTED IN THE UK

MEDIAPLANET

ONE IN FIVE PEOPLE (20%) CONSULT A GP ABOUT A MUSCULOSKELETAL PROBLEM EACH YEAR

53% of people with arthritis think they are a nuisance to loved ones, rising to 81% among those with the most severe forms of arthritis

£2.58bn £10.2bn cost to the NHS this year cost to the UK economy

For two of the largest conditions– osteoarthritis and rheumatoid arthritis – 25.13m working days will be lost in 2017 at a cost of £2.58bn to the UK economy And for these two conditions alone, the cost of lost working days is set to rise to £3.43bn BY 2030

77% of those who have arthritis say society doesn’t understand what it’s like to live with the condition

A quarter (25%) of people with arthritis are leaving work, or taking retirement earlier than they would otherwise

58% of population don’t see arthritis as a major health condition or have never thought about it before

29% feel unable to attend social arrangements with friends

Treating the two most common forms of arthritis – osteoarthritis and rheumatoid arthritis – will cost the NHS and wider healthcare system £10.2bn this year. Cumulatively, the healthcare cost will reach

58% feel unable to take part in their favourite hobbies such as gardening or playing sports

£118.6bn over the next decade

104,695

Knee replacements carried out in 2015

98,211

Hip replacements carried out in 2015

Stats from: York Health Economics Consortium 2017, ESRO, 2016 and Norstat August 2017

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