Arthritis and osteoporosis are two of the commonest and most disabling diseases to afflict a person. Although once considered a disease of the elderly today younger patients in the prime of life are being diagnosed with either one or both these painful and debilitating conditions for which there is no cure. However, the good news is that the pain and disability can be reduced significantly with correct gentle exercises on the advice of an experienced therapist.
The Sunday observer spoke to Head of Rehabilitation Services MJF Charitable Foundation Dr Gopi Kitnasamy who draws from his wide experience as a Chartered Physiotherapist to enlighten those who are already afflicted and those who can prevent it with easy to do treatments
Following are excerpts.
Q. We recently observed World Arthritis Day and World Osteoporosis day. Can you tell out readers why two special days have been set aside for these two very common conditions and the significance of the themes each to especially Sri Lankans?
A. This was started to increase global awareness about these conditions amongst people. The primary objective is to educate people about Arthritis/Osteoporosis, and how one can prevent/manage it. It teaches people about different aspects, and types of Arthritis one can have in his/her lifetime.
Q. It has been said that it is the commonest cause for disability in the world and that 1 in 5 persons get arthritis at some time or other. Elaborate
A. People of all ages, sexes and races can and do have arthritis, and it is the leading cause of disability in the world. Arthritis affects a person’s overall function and mobility, which can result in activity and other limitations. The physical disability arising from pain which is the primary symptom of Arthritis and loss of functional capacity reduces quality of life and increases the risk of further morbidity. Apart from causing lifelong disability, it puts a severe economic burden on families when the main breadwinner is unable to go to work.
Q. How does it originate? In the joints? Bones? Skin?
A. Arthritis is derived from the Greek term “disease of the joints.” It is defined as an acute or chronic joint inflammation that often co-exists with pain and structural damage. Arthritis (arthro = joint, itis = inflammation) can involve almost any part of the body, most often affecting the hip, knee, spine or other weight-bearing joints, but also found in the fingers and other non-weight-bearing joints. Some forms of arthritis can also affect other parts of the body.
Q. Causes? Age? Gender? Excess weight? Injury? Explain why in each case
A. There is no single cause of all types of arthritis. The cause or causes vary according to the type or form of arthritis. Most types of arthritis are linked to a combination of factors, but some have no obvious cause and appear to be unpredictable in their emergence. The risk of developing most types of arthritis increases with age, most types of arthritis are more common in females, and 60 percent of all people with arthritis are female.
Gout is more common in males than females. Some people may be genetically more likely to develop certain arthritic conditions. Additional factors, such as previous injury, infection, smoking and physically demanding occupations, can interact with genes to further increase the risk of arthritis. Excess body weight can cause wear and tear in the weight bearing joints which can lead to Osteoarthritis.
Q. Can an injury to a joint that occurred several years ago, progress to arthritis later?
A. Arthritis can be caused by the wearing out of a joint that has had any kind of physical injury. The injury could be from sports, accident, fall or other physical trauma. Such injuries can damage the cartilage and/or the bone, changing the mechanics of the joint and making it wear out more quickly. The wearing-out process is accelerated by continued injury and excess body weight.
Q. Are genes a contributory factor? Can you inherit arthritis?
A. As I have mentioned before, some people may be genetically more likely to develop certain arthritic conditions. Some types of arthritis run in families, so you may be more likely to develop arthritis if your parents or siblings have the disorder. Your genes can make you more susceptible to environmental factors that may trigger arthritis.
Q. Gender wise and age wise who are more vulnerable to developing arthritis? Why?
A. Women have a significantly higher risk for developing arthritis, particularly osteoarthritis due to many reasons such as the unique function and motions of women’s joints, wider hips, which some experts believe affects the alignment of the knee and increased stress on the inner side of knee, more flexible joints and hypermobility, number of full-term childbirths and hormonal changes after menopause. The risk of Osteoarthritis increases with aging because of many reasons such as less water content in cartilage as we age, reducing its ability to cushion and absorb shock. Cartilage also goes through a degenerative process which is when arthritis can develop. Ligaments and other connective tissues become less elastic and flexible with age with limited movements.
Q. Occupation wise what categories of workers are most at risk?
A. Physically demanding occupations and occupations which involve heavy lifting, frequent and repeated kneeling or squatting, stair climbing, crawling, running, standing for long hours, bending and whole-body vibration, and repetitive movements are at risk of causing arthritis related conditions.
Q. Is Arthritis and osteoarthritis the same?
A. Osteoarthritis is the most common type of arthritis. It is also called Degenerative Arthritis. When the cushioning surface on the ends of bones (cartilage) gets worn out, the bone rubs against bone, causing pain, swelling and stiffness. The risk factors include excess body weight, family history, age and previous injury or overuse.
Q. Symptoms – what are the early symptoms of the onset of arthritis?
A. The signs and symptoms of arthritis that appear and how they appear may vary widely, depending on the type. You can develop symptoms gradually or suddenly. The early signs and symptoms are pain in one or many joints which may be on and off or constant, swelling - when the skin over the joint becomes red, swollen and feels warm, difficulty in moving a joint, stiffness which may be in the early morning or after sitting for long hours or persistent. However, when you see these early key signs, please consult a doctor.
Q. Are there different stages of its progress? What are they?
A. As we know, there are various types of arthritis and they follow different stages of progression. However, most types of arthritis follow a similar progression process. In the initial first stage, we can experience early signs/symptoms like pain, swelling and stiffness, the second stage can progress with the increase in the above symptoms to some difficulties in mobility/movement, the third stage can progress to weakness of muscles and decreased mobility and in the fourth stage, the symptoms can be severe and with extremely limited mobility or functioning of the joints.
Q. What are the most significant health impacts of arthritis?
A. Arthritis can have a profound impact on a person’s health, quality of life and wellbeing due to their symptoms, physical limitations, management of the condition and mental health issues which can result in job loss, increased financial burden/stress and can also limit their social participation. They are also at a high risk of developing cardiovascular diseases, diabetes, cholesterol and high blood pressure.
Q. How can you prevent developing arthritis?
A. Some causes of arthritis are beyond your control, like growing older, gender or having a family history of arthritis. You can take steps to reduce your risk of arthritis by keeping your joints healthy as you age.
Being active is the most important. Focus on low impact exercises like cycling, swimming or walking. Actively stretching your joints daily. Maintaining a healthy body weight. Avoiding injuries to the joints. Controlling your blood sugar and cholesterol levels. Stop smoking and excessive alcohol. Eating healthy foods like green vegetables, whole grains, nuts, fish and omega 3 rich foods.
Q. As a Physiotherapist, how do you treat persons with arthritis? What are the exercises you recommend? Are they custom-tailored for each patient?
A. Physiotherapists help to manage pain and overcome some of the challenges faced by persons with arthritis and to reduce limitations on mobility using various electrotherapy modalities, appropriate manual and exercise therapy and will guide on lifestyle modifications. Exercise is an integral part of any arthritis treatment program, as it helps to strengthen muscles and stabilize the joints, preventing further damage. Graded exercise starts slowly and increases in small steps.
This will help you to strengthen your muscles and joints and increase your fitness. Improving your general fitness and stamina will help you to increase your activity level without increasing your pain. Regular exercise will also stimulate production of your body’s own natural pain-relieving hormones (endorphins). It is very important that you pace yourself while doing these exercises. Overdoing things can increase your pain, but so can not doing enough.
Your Physiotherapist can advise you on increasing your activity level at a rate you can cope with and on finding the right balance between rest and activity. Focus on low impact exercises like cycling, walking, swimming. Exercising in water is an excellent option due to the decreased pressure placed on the joints. The exercises are prescribed by the Physiotherapist which are tailored to the patient’s condition and needs.
Q. World Osteoporosis Day also falls this month (October 20). Is there a link between Osteoporosis and arthritis? What is osteoporosis?
A. Osteoporosis (Osteo = bone, porosis = porous bone), which literally means porous bone, is a disease in which the density and quality of bone are reduced. The bones become porous and fragile, the skeleton weakens, and the risk of fractures greatly increases. Although osteoporosis and osteoarthritis are two very different medical conditions with little in common, the similarity of their names causes great confusion. These conditions develop differently, have different symptoms, are diagnosed differently, and are treated differently.
Q. Currently, osteoporosis is vastly underdiagnosed and undertreated. Worldwide, millions of people at high risk of broken bones (fractures) remain unaware of the underlying silent disease. Your comments?
A. Osteoporosis is known as a silent disease because it can progress undetected for many years without symptoms until a fracture occurs. The loss of bone occurs silently and progressively, often without symptoms until the first fracture occurs, most commonly at the wrist, spine or hip. Osteoporotic fractures negatively affect quality of life and often result in pain, loss of function and, in the worst cases, death. Osteoporosis can be diagnosed by a bone mineral density test, which is a safe and painless way to detect low bone density.
Q. It has also been said that Osteoporosis accounts for more days in the hospital than breast cancer, heart attack, diabetes and other diseases. 1 in 5 women with a spinal fracture will suffer another one within one year, and hip fracture, requiring long-term nursing care. How can this disturbing trend be prevented?
A. We can help prevent osteoporosis by leading a bone healthy lifestyle at all stages of life. In fact, it should begin in childhood, when a bone-healthy diet and plenty of exercise helps children achieve their highest possible peak bone mass. This is important because the more bone mass you have when you reach adulthood, the less likely you are to have weak and breakable bones at older age. Taking a healthy diet rich in calcium and protein, maintaining an ideal body weight, being active, exercising regularly and most importantly, avoiding smoking and excessive drinking can help you to maintain healthy bones and physical wellbeing.
Q. Have you any golden rules to keep both arthritis and osteoporosis at bay for our readers?
A. Making simple changes to your diet, taking enough exercise, being active and kicking bad lifestyle habits will not just help to reduce the risks of arthritis and osteoporosis, but will also benefit your general well-being.
