Health
| When joints protest |
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| Written by Roz Lewis, 2009 | |
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Shoulders, knees and hips can all wear out or cause problems - to the young as well as the old. Roz Lewis looks at what can go wrong and what you can you do to keep joints healthy. We have 240 joints in our body, all providing the essential range of movements that enable us to participate in daily life. It's not much fun when they start to act up, causing us to suffer from aches and pains in knees, hips, feet and hands, and shoulders. What is a joint?A joint is the location at which two or more bones make contact. They are designed to allow movement and to provide mechanical support to the body. There are three types of joint:
Trouble brewingJoints go wrong due a combination of factors - injury, old age, inflammatory disease, general wear and tear, and in some instances as a reaction to medication (a report the October 2008 Annals of the Rheumatic Disease said that there was a higher risk of women who take HRT developing joint problems that lead to replacement surgery).So what can you do if you are a 'jointy' person, someone who seems to be predisposed to joint problems, and how do you know when you need medical intervention for worn-out joints? Going to your doctor is the first step. "People often come with pain, stiffness or fatigue from joint problems," says Dr Carol Cooper, a GP from West London and spokesperson for Arthritis Care. "Anyone can develop joint problems but certain factors predispose us to getting problems. Obese people, because they are carrying excess weight, will get more joint problems, and the elderly, as their joints suffer more accumulative wear and tear." To some extent, joint problems are genetic; if your parents had bunions or trouble with hips or knees, it can mean that you are more likely to suffer, too. The most common forms of disease affecting joints are osteoarthritis, where cartilage, the tough connective tissue in between joints, is worn away, causing pain and inflammation of the tissues; and rheumatoid arthritis, an inflammatory illness where the body literally attacks its own joints, organs and skin. In people with rheumatoid arthritis, antibodies are formed against the synovium (the tissue that surrounds each joint). This causes inflammation in and around affected joints. Over time, the inflammation can damage the joint, the cartilage and parts of the bone near to the joint. Most people will suffer from some form of arthritis in their lives. Other joint conditions include gout, which involves the depositing of uric acids in the joint, usually of the big toe, and ankylosing spondylitis, a condition that affects the spine, causing vertebrae to fuse and that often occurs in young men. What will your GP offer you?Dr Rod Hughes, Consultant Rheumatologist at St Peter's Hospital, Chertsey, Surrey, and spokesperson for the British Society of Rheumatology, says: "GP response is normally to take a history and examine the patient - most GPs have little or no training or background in musculo-skeletal medicine or surgery, so they often struggle making the diagnosis.They may then suggest either an X-ray (to detect damage) or a blood test (to detect inflammation), or both. They may then consider referral to a physiotherapist and may use either simple painkillers such as paracetamol or a paracetamol and codeine combination or anti-inflammatories (widely used) such as ibuprofen or stronger (such as diclofenac or naproxen by prescription). A patient may then be offered either a referral to an orthopaedic surgeon or a rheumatologist. "If the referral goes to a surgeon then there is a high chance of operation," says Dr Rod Hughes. "Surgeons also routinely use imaging with MRI scans even if they are sure about what is going on. Rheumatologists normally start with X-rays, then can use either ultrasound or MRI to further assess the joint. In cases of obvious joint or ligament/cartilage damage, which is unlikely to repair with time, then surgery may be planned. Joint replacement surgery is used for osteoarthritis that has become severe, usually knee, hip and less commonly shoulder." Joint replacementsDuring 2006-07 there were 89,254 hip replacement operations performed in the UK. Knee and shoulder replacement operations are also regularly carried out.Techniques are advancing all the time, with some surgeons offering resurfacing of joints rather than total replacements, so the whole process is usually guaranteed to make patient's lives much, much easier. Self-help"There's no evidence to suggest that diet affects joint health/pain," says Dr Carol Cooper. "Some people anecdotally say that cutting out red meat or dairy produce from their diets helps with problems such as gout. Taking fish oil supplements, which contain prostaglandins, a natural anti-inflammatory, is a good idea."A small study has shown that taking regular doses of glucosamine can help prevent knee problems needing surgical intervention, so I would recommend patients take 1,500mg per day for a month, to see if that has a positive effect. There's no evidence that glucosamine can help all joint problems, however," says Dr Cooper. Making sure you have enough calcium in your diet is essential too, as calcium helps build bones - women over 45 should aim to have 700mg daily. Good sources of calcium are dairy produce (cheese, milk), tofu and spinach. Staying active"Keep active," says Dr Cooper. "Exercise is good for keeping joints going. And keeping the weight off will also help prevent you from developing serious joint problems.Getting referred for physiotherapy is another option - in some areas, you can self-refer to an NHS physio, otherwise ask your GP to set you up with some sessions. Physiotherapy can help with surgical after-care too. If you are overweight you may also be able to get on an Exercise Referral Scheme from your GP, qualifying you for cheap gym or swimming membership. Useful information
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