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Arthritis

Arthritis refers to a group of conditions affecting the body’s joints, including the bone, muscle and surrounding soft tissues. The most common symptoms are joint pain, stiffness and reduced function, which can lead to disability and reduced quality of life. Arthritis is a common condition affecting 3.5 million Australians which is about 15 per cent of the population. Osteoarthritis (OA) and rheumatoid arthritis (RA) are the two most common types. Arthritis has no cure but its symptoms can be successfully managed with exercise, weight loss, lifestyle changes and appropriate medication. When symptoms become unmanageable joint replacement surgery can be considered.

How do I know if I have arthritis?

Arthritis can affect anyone, regardless of age, gender or nationality and is generally more common in women (18 per cent) than men (13 per cent). Osteoarthritis is most common in older people, affecting 48 per cent of people over 50 years old. RA affects only 2 per cent of the population, but is the second most common form of arthritis.

At an individual level, arthritis symptoms can greatly affect your quality of life causing disability, physical limitations and associated emotional and psychological distress. The burden on the Australian economy is significant with around $23.9 billion spent annually on arthritis care.

Common symptoms

Arthritis affects each person differently and symptoms vary depending on what type of arthritis a person has and it’s severity. The most common symptoms include joint pain and joint stiffness. Other joint symptoms can include redness, warmth, swelling and in later stages, catching, clunking or grinding in the joint. People may also feel generally fatigued or unwell because of their arthritis.

Where to seek help if you think you might have arthritis

There are many causes of joint pain so it’s important to see your GP, a musculoskeletal physiotherapist or an experienced physiotherapist for assessment and diagnosis. They can diagnose your arthritis by discussing past medical history, current symptoms and performing a physical examination of your joints. A physiotherapist will often refer you to a GP, as in some cases blood or other special tests may be required to rule out other conditions, particularly in the case of rheumatoid arthritis. X-rays may be used, although these are not necessary to make a diagnosis, as joint changes identified on x-ray are often not linked with pain or arthritis severity.

Evidence has shown that multiple types of care are most effective to manage arthritis such as tailored education, appropriate exercise therapy and medications.

Osteoarthritis (AO)

OA is the most common type affecting 56 per cent of Australian arthritis suffers. OA can develop at any age, although is more common in people over 45 years old. It involves changes to the whole joint including the cartilage (the smooth layer that covers the ends of a bone), the underlying bone, the ligaments and tendons, as well as the surrounding muscles. As OA progresses, the changes to the joint can cause pain and loss of movement. The joint can also change in appearance due to swelling and/or the bones on each side of the joint changing shape and sometimes they may move away from their normal position. 

Rheumatoid arthritis (RA)

RA is the second most common type of arthritis affecting 14 per cent of Australian arthritis sufferers. Unlike OA, RA affects the whole body and involves an autoimmune disease where the immune system produces an abnormal inflammatory response in many tissues, including arteries and joints. Common symptoms are episodes of joint swelling and pain, accompanied by morning stiffness and over time it can lead to disabling joint damage. A doctor, specifically a rheumatologist, will typically diagnose RA by taking a thorough history of symptoms, a physical examination and confirmatory blood test. RA can occur at any age.

Other types of arthritis include gout, ankylosing spondylitis, juvenile arthritis, systemic lupus erythematosus (lupus) and scleroderma.

What are the risks to my health if I have arthritis?

Research shows that arthritis sufferers are more likely to be inactive, overweight and have multiple health conditions. Three out of four Australians with arthritis have other chronic health conditions. In particular, 44 per cent of arthritis sufferers have cardiovascular disease, 32 per cent are obese, and 22 per cent are diagnosed with a mental health problem.

Experiencing other health conditions with arthritis is linked to poorer health outcomes, reduced quality of life and makes arthritis more complex and challenging to treat. Some forms of arthritis such as lupus can also affect other organs including the kidneys, heart, nervous system and skin, causing a variety of symptoms such as ulcers, visual disturbances and hair loss.

Some risk factors that are common to all chronic health conditions including arthritis are smoking, physical inactivity, poor nutrition and obesity. Maintaining overall health is therefore very important to reduce the risk of developing arthritis but also to prevent all chronic health conditions.

What can I do to prevent arthritis?

Why arthritis develops and how it can be prevented is not fully understood. The best way to prevent arthritis is to take steps to manage the known risk factors that contribute to it developing in the first place. These include inactivity, poor nutrition and obesity. Eating a balanced diet, participating in regular physical activity, maintaining a healthy stable weight and not smoking are all important. Maintaining a healthy lifestyle is the best way to reduce the impact of arthritis and prevent the symptoms from worsening.

Early diagnosis is also linked to better arthritis outcomes, ensuring treatment starts as soon as possible. This means symptoms are managed early, potentially reducing the impact on a person’s quality of life.

How can physiotherapy help with arthritis?

Physiotherapy plays an important role in self-management of arthritis. As there is no cure, the aim of treatment is to manage pain, keep joints mobile and help people stay active and healthy by developing safe, personalised exercise programs. They can also help by providing joint protection advice.

Exercise

Physical activity and exercise is the best treatment regardless of how severe arthritis is. Some people successfully manage their arthritis with exercise alone, avoiding the need for surgery. Exercise is also vital for preventing or managing other chronic health conditions.

Below are some different types of exercise a physiotherapist can prescribe:

Strengthening exercise involves using weights, resistance bands, or body weight to increase muscle strength. Stronger muscles help support and protect joints making it easier to stay mobile and active.

Flexibility exercise involves stretches and gently moving the joint to reduce stiffness.

Aerobic exercise is any exercise that increases your heart rate and maintains general fitness and heart health.

Hydrotherapy is strengthening, aerobic and flexibility exercises completed in a pool, which is often heated. It can be beneficial because water supports the weight of your body, reducing the impact on your joints. Water can also provide greater resistance, further strengthening your muscles.

How can I start exercising?

When starting regular exercise it can be hard to know what to do, what level to start at and how to stay motivated. Fitness levels and symptoms vary from person to person so it’s important to be guided by your physiotherapist to make sure the exercise is tailored to you. It is essential to start slow and increase gradually as fitness and strength improves. To see the benefits, exercise must be completed regularly and incorporated it into your daily routine.

Exercise and pain

Many people avoid using their painful joints for fear of making their arthritis worse, but this will not happen. When we don’t move joints they become stiffer and the muscles less supportive. Over time, without regular exercise your joints can become more painful. As many people with arthritis experience joint pain constantly, exercising when in pain is unavoidable but with regular exercise pain can reduce over time. As a guide, tolerable pain before or during exercise is common, expected and most often harmless. Pain that is un-tolerable or beyond a person’s normal level indicates exercise should be reduced.

Joint protection advice and pain relieving strategies

A physiotherapist will provide advice on techniques to reduce pain like using hot or cold packs, selecting appropriate footwear or using a walking stick or hand splint. They can also provide guidance on how to pace activities to limit pain flares and recommend ways to do things without causing strain to the joints.

How effective is exercise-based physiotherapy for treating arthritis?

Guidelines recommend exercise for all people with arthritis, irrespective of arthritis type, pain or severity. However, if you suffer from an acute flare of gout, other methods such as medication and ice are recommended. Evidence shows regular exercise is one of the most effective non-surgical treatments for all types of arthritis as it reduces pain, improves function and keeps joints moving. As well as improving symptoms, exercise is vital for weight management and general health, both very important to lessen the impact of arthritis.

For osteoarthritis of the knee, hip and hand there is considerable evidence showing strengthening exercises and physical activity reduces joint pain, stiffness and improves overall long term function to the same extent that medication can, but without the side effects of pain killers and anti-inflammatory drugs.

For rheumatoid arthritis, evidence shows moderate to high intensity exercise (both aerobic and muscle strengthening) improves muscle strength and general fitness in the short term, and that these benefits can be maintained with longer-term exercise.

To see long-term exercise benefits research highlights that exercise must involve a regular routine and long-term commitment.

What can I do at home?

Physical activity recommendations 

People with arthritis should be including regular physical activity into their day. This can include regular walking, cycling, dancing, swimming, water aerobics as well as incidental activity such as gardening, housework, taking the stairs or walking to the shops.

Guidelines recommend all Australians, including those with arthritis, should do at least 30 minutes of moderate intensity physical activity on most days. This means activity that is ‘somewhat hard’ and makes a person ‘puff’ but still be able to talk. The 30 minutes can be broken into smaller sessions if needed, of 10 minutes or more. A daily step count of at least 10 000 is recommended to achieve health benefits.

There are some simple and safe exercises that are useful for people with arthritis. Speaking with your physiotherapist is best when starting an exercise program to ensure it is appropriate for you. As a general rule, exercise might cause some discomfort, but not persist afterwards in a way that reduces your ability to perform your day-to-day activities.

Keep these general guidelines in mind and stay safe when exercising at home:

  • if standing to exercise, have a chair or bench close for support and balance
  • move carefully and at a medium speed when exercising. Avoid sudden, jerky movement
  • make sure footwear is appropriate for exercise. Choose shoes that are comfortable, supportive and won’t rub or give blisters.
  • tolerable and temporary discomfort is okay. Pain after exercising should subside to usual levels by the next day with no substantial increase in swelling or pain following exercise.

Pain that feels intolerable is not acceptable. It’s not okay to have severe pain after exercise and indicates your physiotherapist should modify your exercises.