What an incredibly common word this is! Whilst “low back pain” seems to plague the younger to middle aged population, “arthritis” seems to replace back pain as the most prevalent condition we hear about, especially in the middle aged to older populations.
What is concerning is the number of relatively young people that we see with arthritic changes in their joints. We can see people in their 40’s or even 30’s with quite significant arthritic change on scans, and arthritis can even be an issue in young children.
The term arthritis is an umbrella term that actually covers a multitude of different conditions. Just as “low back pain” tells us nothing about the severity, type, cause, expected duration, disability, outcome etc, neither does the term “arthritis” tell us anything at all other than the fact someone may have an inflammatory condition of a joint. We need to delve a lot deeper than simply a diagnosis of arthritis to be able to effectively achieve optimal outcomes for anyone suffering this condition.
And the great news is that whereas once upon a time the diagnosis of arthritis used to go hand in hand with an expectation of chronic pain, loss of function, and often surgery, there is some fantastic evidence out at the moment that gives great hope in the management of arthritic conditions.
What is Arthritis?
As mentioned, arthritis is often referred to as a single disease but actually refers to more than 100 medical conditions that affect our musculoskeletal system. Arthritis is the major cause of disability and chronic pain in Australia, with 3.85million Australians affected at a cost to our economy of more than $23.9 billion each year. As the population ages, the number of people with arthritis is predicted to hit 7 million Australians by the year 2050.
And whilst there is a widely held belief that arthritis is simply a consequence of ageing, this in incorrect – 2.4 million of all people suffering from arthritis are of working age.
Of the almost 100 forms of arthritis, the most common forms are:
· Osteoarthritis
· Rheumatoid arthritis
· Gout
· Ankylosing spondylitis
· Juvenile arthritis
· Systemic lupus erythematosus (lupus)
· Scleroderma
…but osteoarthritis, rheumatoid arthritis and gout account for more than 95 per cent of cases in Australia.
Osteo-arthritis
When people use the term arthritis, it is osteo-arthritis (OA) that they are usually referring to. OA is more common than both high blood pressure and diabetes, and is the most common lifestyle disease in people over 65 years of age. In a healthy joint, articular cartilage lines the ends of bones where they meet at a joint, and functions to provide a smooth lubricated surface for movement, as well as absorbing shock and distributing weight bearing pressures. Every day we are breaking down articular cartilage, but a healthy joint has the capacity to restore or regenerate the damaged cartilage cells at the same rate they are broken down. For a variety of reasons (not just ageing) this restoration may not keep pace with the degradation, resulting in damage to the articular cartilage, an inflammatory process, and eventually (if left unchecked) changes to the underlying bone surface itself.
However, to be diagnosed with arthritis, you don’t actually have to be at the stage of showing ‘wear and tear” or degeneration on scans – in a nutshell, a better definition of arthritis is perhaps “joint failure”: a condition where the joint is unable to perform its usual daily requirements due to pain, cracking, giving way, joint stiffness or loss of range. The sooner we can intervene with joints in these early stages, the better the outcomes will be.
Other than ageing, the risk factors for developing OA include:
· Previous joint injury
· Joint overload (incorrect type, frequency, duration, or intensity of activity)
· Overweight or obesity
· Physical Inactivity
· Muscle Weakness
The great thing is all the above factors are modifiable (we can influence them), however there are some non-modifiable risk factors that we cannot influence – age, sex, and genetics! So it is critical we do as much as we can to address these modifiable risk factors as research suggests that early intervention can delay the onset of OA and may reduce the number of cases by about 500,000 within 15 years.
Giving hope to everyone with a bad scan result!
Take a look at the following Xrays: the one on the left is a “normal” knee X-Ray and the one on the right is a patient who presented recently with knee pain.
Even to the untrained eye, it is obvious the X-ray on the right has a lot more “wear and tear”, spurs, loose bodies, “bone on bone”, and uneven bone surfaces. What is amazing is this patient presented with pain that was not related to these changes at all, and reported having barely any knee pain over the years. What we take from this is a few things:
– Scans often aren’t that accurate in predicting whether pathology is the cause of pain.
– Sometimes decisions (eg surgery intervention) can be made by placing too much emphasis on what the scans look like, and not enough emphasis on what the patient actually feels.
– And importantly, we know a knee like this probably will get painful at some time if it is left unchecked, so by intervening as early as possible with the appropriate exercise program, we can avoid unnecessary pain and dysfunction!
Upcoming Seminar
SSPC will soon be conducting a free seminar for SSPC patients and interested friends/family, outlining all the latest research on arthritis, explaining which treatments are accepted (and effective) and which aren’t, and showing the new exercise program that is successfully taking on the arthritis problem with great results.
To pre-register your interest for this seminar (will be held in August, date to be confirmed) please email rob@sspc.com.au
Anthony Lance
SSPC Physiotherapist
References available on request
