Aching bones

An estimated 25 per cent of European adults are affected by the pain caused by arthritis, an illness that is commonly associated with age. Indeed, as our 40s give way to our 50s arthritis is blamed for most aches and pains.

Consultant physician and rheumatologist Franco Camilleri heads the rheumatology unit at St Luke's Hospital. He warns patients against assuming that they suffer from arthritis and advocates seeking medical advice.

"Many patients come to the rheumatology unit suffering from chronic generalised musculoskeletal pain which is most often unrelated to arthritis. The rheumatologist considers several factors including laboratory tests, detailed history and clinical evaluation before determining that the pain is indeed caused by arthritis," said Dr Camilleri.

Arthritis and rheumatism are actually blanket terms that encompass around 200 different medical conditions involving the musculoskeletal system (the joints, bones, muscles, tendons, ligaments etc). Osteoarthritis and rheumatoid arthritis are the two most common conditions.

Dr Camilleri explained the difference between the two:

"Osteoarthritis is the most common form of joint disease. It is a degenerative arthritis which becomes more prevalent in the elderly. Around 40 per cent of those aged over 70 suffer from osteoarthritis of the knee. Our high incidence of childhood obesity coupled with an aging population foretells a substantial increase in the number of future sufferers of this condition.

"Rheumatoid arthritis is a chronic inflammation of the lining of the joints and in some cases also affects the lungs and the heart which can be life threatening.

"Affecting 0.5 per cent of the population, rheumatoid arthritis usually begins between the ages of 35 to 45. Having said this, the condition can also start in childhood although this is less common.

"The loss of mobility caused by musculoskeletal conditions will obviously have a major impact on the patients themselves and society at large because of their frequency, chronicity and eventual disability."

All is not doom and gloom however and Dr Camilleri is quick to expand on the treatment available to patients locally.

"Our unit employs a multi-disciplinary approach to treating arthritis. Besides the rheumatologists our team includes physiotherapists, occupational therapists, rheumatology nurses and a chiropodist; all of whom have specialised roles in caring for our patients.

"The main priority for all patients with arthritis is pain relief and functional improvement. Seeking a rheumatologist's advice as early as possible is crucial to decide on the best course of treatment.

"The physiotherapist will aid the patient's rehabilitation while occupational therapists advise patients about environmental alterations at home and at work as well as the use of available aids.

"Arthritis also affects the feet and our chiropodist treats this area; often wearing more supportive footwear and a comfortable inner sole (an orthotic) will alleviate some of the discomfort.

"The rheumatology speciality nurses are responsible for administering the prescribed treatment. They also run educational programmes about arthritis which patients find extremely beneficial.

A number of more serious cases can benefit from corrective surgery or joint replacement and when surgery is the appropriate treatment we refer our patients to an orthopaedic surgeon.

"Over the years there have been some exciting developments in the medication available to slow the progress of inflammatory arthritis such as rheumatoid arthritis. Most of these medications are available locally and are being successfully used to treat our patients here."

For the last two years, patients who attend the rheumatology unit have had access to a specialised helpline service. The helpline is manned by the rheumatology nurse who will endeavour to return people's calls as soon as possible with the necessary advice.

Dr Camilleri has the following tips for anybody with painful joints or bones:

• Seek medical advice as early as possible; this enables the early detection and diagnosis of arthritis if this is your problem.
• Once you have been diagnosed with arthritis, stick to your treatment as prescribed by the rheumatologist. Non-adherence to management plans is the most common cause of treatment failure.
• Self-management is a key component of the treatment so you should attend any available educational programmes.
• Exercise regularly - weight bearing exercises such as walking are especially beneficial to strengthen the muscles. Periods of inactivity are likely to lead to further bouts of stiffness and pain. The exercise will improve your fitness while strengthening the muscles around the involved joints.
• Avoid smoking and alcohol abuse.

And on that note Dr Camilleri returns to the rheumatology unit to tackle the ever growing number of patients waiting for the team's attention.