Arthritis: What to do about it

While it is true that arthritis is a common problem and many forms of it cannot be cured, much can be done to reduce pain, improve patients' mobility and preserve their independence, Carmel Mallia, consultant rheumatologist at St Luke's Hospital, says.

That is the fundamental message on World Arthritis Day, which is being observed in Malta for the first time today and is attempting to dispel myths that surround the chronic condition, namely that arthritis is irreversible and that nothing can be done about it.

In fact, over the past years, significant advances have been made in its treatment, Prof. Mallia points out.

Arthritis is one of the major forms of disability in the world, including Malta. It affects millions throughout - 25 per cent of adults across Europe - and many thousands here.

And its impact is expected to worsen over the next 20 to 30 years, mostly due to an ageing population, as well as changes in lifestyle, such as increased obesity and lack of physical activity.

Despite the enormous impact worldwide, arthritis has not received the attention it deserves by the medical profession, policy makers, or the media, Prof. Mallia maintains. The reason, according to him, is the perception that it is a less serious condition and, unlike heart disease, AIDS and cancer, does not kill, but is simply an inevitable consequence of ageing.

"It is generally believed that nothing can really be done about arthritis and that one has to learn to live with it, accepting the pain as the price to pay for living a long life," Prof. Mallia says.

But while it is true that there are no cures for most chronic forms of arthritis, improvement in pain and loss of function is possible in almost every patient as a result of developments, including new drugs and treatments, exercise programmes and joint surgery, which can have "spectacular" results.

These effective drugs for rheumatoid arthritis, known as biological agents, were discovered only about six years ago and have been available in Malta for about five. "Excellent" drugs, they help most sufferers of rheumatoid arthritis where other medications have failed. But just over 50 patients are receiving them at the moment for financial reasons: a year's treatment costs over Lm4,000 - and treatment has to be continued indefinitely. They are, therefore, limited to patients with severe disease.

Nevertheless, Prof. Mallia believes that "the future of patients with arthritis is full of possibilities - many of which were only dreams as recently as 25 years ago".

As regards its incidence, a recent survey, carried out by the Department of Health Information, indicated that arthritis was the most common cause of chronic morbidity and reported that one in three interviewees complained of joint and/or back pain.

In fact, disease or injury resulting in arthritis affects almost every individual, irrespective of age or gender, at one time or other in their lifetime. It also affects children, but becomes more common in the elderly, and is more prevalent in females as opposed to males. Some conditions are minor and transient, but many cause lifelong disability, Prof. Mallia explains.

"While the word arthritis is used as though it were a single disease, it is actually an umbrella term that includes almost 200 conditions - including osteoarthritis, rheumatoid and juvenile arthritis, gout, osteoporosis, lupus and Paget's disease of bone, a common condition in Malta."

The common feature of these 200 conditions is that they affect the system of the body concerned with movement - bones, muscles, tendons, ligaments and, specifically, joints.

Arthritis is also considered to be a major drain on the country's economy, Prof. Mallia notes, pointing out that the magnitude of the problem can be seen, for example, in the vast number of patients, mostly elderly, with bone fractures due to low bone density at the hospital's emergency department, the number of joint replacements being carried out and the need for more such operations, resulting in long waiting lists.

Apart from expenses due to medical care, arthritis also causes significant indirect expenses in sick leave, lost production, lost wages and early retirement, Prof. Mallia adds.

Patients attending the Rheumatology Clinic at St Luke's Hospital total over 2,000 and have access to a helpline. The service is currently limited to them, but it may be possible to extend it in future if logistical problems are overcome, Prof. Mallia augurs.

Local support groups exist for patients with lupus, osteoporosis and fibromyalgia, and one for those suffering from rheumatoid arthritis will be set up shortly. In collaboration with the Health Department, the aim is to further improve the services for arthritis patients in Malta, especially in the areas of education and prevention of arthritis.

This year, the theme of World Arthritis Day, which ushers in Bone and Joint Decade action week, is Take Action - as a means of encouraging exercise in arthritis patients. Conscious of the present and future burden of arthritis throughout the world, the United Nations and the World Health Organisation had set up the Bone and Joint Decade, which spans the years 2000 to 2010.

On the occasion of Bone and Joint Decade action week, various activities have been organised by the Rheumatology Division at St Luke's Hospital and endorsed by the Health Department. They are aimed at increasing awareness of arthritis both among the population, including arthritis patients, as well as healthcare professionals.

A symposium, Fighting Arthritis Together, is being held today for healthcare personnel from various categories, as well as patients.

What causes arthritis?

Most cases of arthritis are probably caused by several factors acting together, and lifestyle may be particularly important. For example, patients with physically demanding jobs may be at a greater risk of developing arthritis in certain joints, and overweight people are more likely to develop osteoarthritis, particularly of the knee joints. Some forms of arthritis, such as rheumatoid arthritis and lupus, result from over-activity of the body's immune system.

People who smoke and drink too much are at a higher risk of developing low bone density and osteoporosis. Some types of arthritis could be triggered by a mild infection, while hereditary factors may contribute to the cause of others, but they are not passed directly from one generation to another.

Many arthritis sufferers claim that changes in weather affect the level of pain, but there is no evidence of that.

The relation between diet and arthritis

¤ The most important single link between diet and arthritis is certainly weight, which puts an extra burden on the weight-bearing joints, increasing the risk of osteoarthritis. Eating a healthy, well-balanced diet would, therefore, be beneficial.

¤ Supplements of calcium and vitamin D in the diet are important to prevent the development of osteoporosis, especially in women.

¤ Certain fatty acids found in oily fish and oils produced from them can be of help in patients with some forms of arthritis.

Advice

The Guide to the Prevention and Treatment of Arthritis for the Healthcare Practitioner and the Policy Maker, published by the Bone and Joint Decade in 2005, suggests:

¤ a well-balanced diet;

¤ keeping an ideal weight;

¤ physical activity to maintain physical fitness;

¤ avoiding smoking and abuse of alcohol;

¤ health promotion at the workplace and related to sports activities to avoid overuse and damage to joints;

¤ and greater public awareness of the problems that relate to arthritis.

Facts & figures

¤ One of every five Europeans is on long-term treatment for arthritis.

¤ One of every three women over 50 runs the risk of developing a fracture related to osteoporosis.

¤ Half of those suffering from arthritis think that nothing can be done to help them!