Bone and Joint Health - Q3 - Oct 2018

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Getting to the heart of the matter in rheumatoid arthritis 1% of the world live with rheumatoid arthritis, that’s 21 million people: 45,000 of those live in Ireland.

R

Sinead Harney

Consultant Rheumatologist Louise Murphy cANP, Davida Hehir CNS and Tommy Harty, Cork University Hospital

heumatoid arthritis (RA) is a chronic progressive autoimmune disease which affects the synovial joints predominantly of the hands and feet, in a symmetrical distribution. 1 Chronic inflammation results in progressive joint damage which results in arthralgia, joint deformity, decreased functional ability, prolonged disability and sometimes premature death. 2 It is estimated that RA affects 21 million people worldwide equating to a prevalence of 1% 3. There are about 3 million people living with RA in Europe and according to Arthritis Ireland 45,000 people suffer from the disease in this country.

RA is twice as common in women as men and the usual age of onset is between 35 and 50 years.

It was not until 1922 that RA was distinguished from gout and osteoarthritis, although it had featured in the paintings of artists in the seventeenth century.

Rheumatoid arthritis mainly affects the synovial joints, but many patients have extra-articular manifestations which can be serious. In particular, there is a substantial excess of infection and vascular disease; 50% of deaths in RA patients are attributable to cardiovascular disease resulting in heart failure, stroke and myocardial infarction 4 which can shorten life expectancy anything from three up to 18 years5.

Factors contributing to this increased risk include traditional cardiovascular (CV) risk factors such as age, gender, dyslipidaemia,

hypertension, smoking, obesity and diabetes mellitis (DM), which partially explain the excess CV risk.

Comorbidities in patients with chronic diseases including RA have been shown to be under-recognised and under-treated with wide variability existing between countries with respect to their prevalence, detection and compliance with recommendations for prevention and management 6. Guidelines published by the European League Against Rheumatism (EULAR) advise aggressive management of these traditional risk factors with tight RA disease management to try and combat cardiovascular disease for these patients7.

As our department is similar to others in Ireland, we are engaging with others in Galway and Sligo to examine RA and CV more closely. All of this work highlights a need for more targeted treatment of cardiovascular risk and has led us to consider establishing an ANP-led cardiac clinic here in Cork University Hospital to address this deficit. A cross sectional study performed recently in our unit showed that for the most part RA patients cardiovascular risk was grossly under treated hence the need for an ANP led clinic.

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World Arthritis Day – don’t delay, connect today If you are experiencing pains in or around your joints, don’t ignore them, hoping that they will go away. Instead, go to see a doctor and find out what’s causing your pain.

Brian Lynch

Arthritis accounts for

1 in 3 GP visits

Head of communications and advocacy, Arthritis Ireland

The theme of World Arthritis Day is summed up in the slogan ‘Don’t delay, connect today’. This is a really important message when it comes to arthritis, because too often people dismiss these “few aches and pains”, living in hope that they will pass.

W

e know, however, that early diagnosis of arthritis and access to care are key to better long-term outcomes. Autoimmune types of arthritis, such as Rheumatoid Arthritis (RA), can impact other organs (heart, eyes and lungs) if ignored or left undiagnosed. This can ultimately increase mortality.

Too few people are aware of these risks.

Let’s not forget either that arthritis is the biggest cause of disability in Ireland.

Arthritis can affect anyone There’s a general perception that arthritis is something that just older people get. However, the reality is very different: arthritis can affect people of any age – including children. Close to one million people have arthritis in Ireland; 165,000 of them under the age of 55. Juvenile

idiopathic arthritis is the most common inflammatory disorder of childhood and affects 1,200 children and young people under 16.

This autumn, Arthritis Ireland is organising a number of awareness campaigns around rheumatoid arthritis, psoriatic arthritis, gout, and pregnancy and arthritis.

The purposes of the campaigns are to increase awareness and understanding of these different disease types, and to provide information and support to those living with arthritis.

This latter point is especially important for people living with this invisible disease, as they can often feel misunderstood.

Misunderstood by friends and family Aoife McCoy (30) from Tyrellspass, Co. Westmeath said that people found it hard to understand that she was in pain all of the time.

“They couldn’t understand how I was still tired after a full night’s sleep. As a young woman in my early 20s, I couldn’t go out with friends every weekend.

“We [people living with arthritis] become a list of symptoms, medication rituals and Epsom salt baths; that that’s all we are

anymore. We either are abandoned by friends and family who don’t understand and don’t want to say the wrong thing, or we hide ourselves away, not wanting to show our true selves,” she says.

Taking control of living with arthritis While there is no cure for arthritis, there are things that you can do to reduce the impact of the disease on your life. Healthy eating and exercise are central, while undertaking a self-management course has been proven to decrease pain, reduce reliance on health professionals and medication, and improve a person’s overall sense of well-being.

Ultimately, it comes back to being attentive to your body, to living healthily and to being a pro-active self-manager. Don’t delay, connect today – it’s a powerful message this World Arthritis Day. #ConnectToday.

Arthritis is the

biggest cause of disability

in Ireland

There are more than

100 types

different

of arthritis

See more at arthritisireland.ie

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Nearly 1 million people live with arthritis in Ireland

How to improve treatment of gout Gout is much more prevalent than many believe. One in 40 people in the UK live with the condition which is the most common form of inflammatory arthritis worldwide.

Dr Geraldine M McCarthy MD, FRCPI, Clinical Professor of Medicine, Consultant Rheumatologist

60%

165,000

people under the age of

55 have arthritis

There is

no cure for

arthritis SOURCE: ARTHRITIS IRELAND ICONS: FROM FLATICON; FREEPIK AND OCHA

of the adult population in Ireland is classified as either overweight or obese. Since being overweight or obese is a risk factor for gout, it is of little surprise that the prevalence of gout is so high in Ireland.

“Indeed, gout diagnoses are steadily increasing… particularly as the obesity epidemic progresses,” says Professor Geraldine McCarthy, Consultant Rheumatologist at the Mater Misericordiae University Hospital, Dublin.

“When the kidney is malfunctioning, it cannot remove uric acid from the body efficiently. This excess uric acid then accumulates in your joints as hard, needle-shaped crystals which inflame the lining of the joint (the synovium). The result is severe, painful swelling and redness of the joint”.

Breaking down the stigma and shame Professor McCarthy believes more needs to be done to address the stigma around this painful and increasingly-common condition.

“Unfortunately there is a stigma associated with gout. The stereotypical individual with gout is one who is greedy, consuming

too much alcohol, eating too much rich food and is overweight,” says Professor McCarthy.

“Some people become embarrassed to go to the doctor as they feel it will reflect badly on them. However, left untreated, gout can lead to joint and/or kidney damage, permanent disability and an increased risk of death by heart attack or stroke.”

Effective treatment of gout Appropriate medication and also lifestyle changes such as exercise, weight loss and cutting down on alcohol can reduce, or ultimately stop, recurrent gout attacks.

However, Professor McCarthy highlights the need to avoid common misconceptions about treatment for gout.

“It is incorrect that if you are receiving urate-lowering therapy (such as allopurinol or febuxostat) that you should stop the drug if you get an acute gout attack… even doctors get this one wrong sometimes,” she says.

“Also, when patients start urate-lowering therapy, they are initially at an increased risk of gout attacks. Therefore, to prevent these attacks early on in their treatment, we recommend them to take additional medication such

as colchicine consistently for three, six and sometimes nine months, depending on the amount of crystal deposition there is throughout the body,” says Professor McCarthy.

Potential for misdiagnosis Often, people who report persistent pain in the big toe, without swelling and redness and have high uric acid in the blood are diagnosed with gout, when these symptoms could actually be osteoarthritis and not gout.

The gold standard for diagnosis is to take a small sample of fluid from the affected joint and analyse it using a polarised-light microscope.

Although the process is ‘very easy’, according to Professor McCarthy, misdiagnoses can still occur.

Acute calcium pyrophosphate crystal arthritis or ‘pseudogout’ can cause similar attacks, but it’s calcium crystals that are deposited in the joint rather than urate crystals.

Professor McCarthy encourages patients to consult their doctor if they exhibit symptoms of gout. “If you don’t confirm what type of crystal it is, you can make the wrong diagnosis and then give the wrong treatment.”

Alex Van Den Broek

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Movement and exercise are good for our bones, joints and muscles Dr Caitriona Cunningham

HEALTHY

Chartered Physiotherapist

Chartered physiotherapist , Dr Caitriona Cunningham, shares advice on how exercise and movement can benefit bones, joints and muscles.

1. Movement and exercise are good for maintaining bone and joint health.

This means sitting less, doing more general, everyday physical activity and participating in structured exercise programmes and sports.

Most fractures are preventable and won’t show warning

2. Adults should aim to get at least 150 minutes of moderate intensity exercise per week (e.g. very brisk walking, light cycling).

3. There’s always an exercise to suit-you just need to find the right type for you.

Walking programmes suit a lot of people who just need to get started and want to integrate exercise into a busy life on an ongoing basis.

4. Maintaining a healthy weight by combining a physically active lifestyle with a healthy diet will help prevent the overloading of joints, which can lead to joint pain and arthritis.

5. As we age, we lose bone and muscle mass. It is recommended that adults train each major muscle group for two or three days each week using a variety of exercises and equipment. Impact exercises (e.g. skipping, marching, running, jumping) are also recommended to prevent, and slow down loss of bone.

6. At work and in your home, consider ways that you can reduce the risk of joint and muscle problems. Move regularly and think before you lift - get assistance, or use lifting and moving equipment for heavier tasks. Consider how you can best arrange your work set up e.g. your desk, chair and computer.

7. If you have specific health issues, or a painful muscle or joint problem, you may benefit from the guidance of a physiotherapist to get you on the right exercise track.

8. Being active, taking exercise and maintaining a healthy weight are good for managing chronic joint and muscle pain and some muscle soreness is to be expected when starting a new type of exercise.

9. Obviously, if you have an acute bone or joint injury it may require a health professional consultation, combined with a defined period of taking it easy but it will be important to get moving again to achieve recovery.

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UNHEALTHY KNEE JOINT

KNEE JOINT

Professor Moira O’Brien Founder and President, Irish Osteoporosis Society

Osteoporosis is a disease that affects the insides of a person’s bones. It occurs when a person loses more bone, than their body produces.

W

ith osteoporosis, bones become brittle and break very easily, which are called fragility fractures. A person can look perfectly fine on the outside but have significant bone loss. There are no signs or symptoms prior to a person breaking a bone. Everyone should check to see if they have risk factors for bone loss, as only 15% of people have been diagnosed, which leaves 280,000 people undiagnosed.

Osteoporosis is preventable in the majority of people, therefore most fractures are also preventable. People assume that breaking a bone is not serious. The reality is, that 20% of people aged 60+ who break their hip, will die within six-to-12 months, from the secondary effects of a fracture @MediaplanetIE

and 50% will lose their independence.

90% of fractured hips are due to osteoporosis.

Many people confuse osteoporosis with arthritis. Osteoporosis affects the bones; arthritis affects the joints.

Everyone should be getting the recommended daily amounts of calcium, vitamin D and protein, not only for their bone health but for their overall health. Appropriate weight bearing exercise is essential to help build strong bones. Anyone with bone loss, should be assessed by a health professional who can interpret their DXA scan report.

It is not recommended that those with bone loss should be doing regular sit ups, yoga, trampolining, or twisting their spine. Swimming and bike riding are not weight bearing activities.

It is essential that the causes of bone loss are investigated and addressed, not assumed, as there are approximately around 200 causes. This is to ensure a person @MediaplanetUK

will improve on a chosen treatment and not continue to lose bone.

The treatment a person receives should be based on their age, their medical history, the results from a DXA scan of their spine and hips, if the person has broken a bone/s, the causes of their bone loss and the area/s affected.

One in four men and one in two women aged 50, will break a bone from osteoporosis in their lifetime, but it affects all age groups. Senior citizens are the highest risk group, as many are on medications or have conditions which cause bone loss.

Staggeringly, more women die from osteoporosis, than the combined deaths of cancer of the ovaries, uterus and cervix. More men die from osteoporosis, than get prostate cancer.

See more at irishosteoporosis.ie Please Recycle

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