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INTRODUCTION INTRODUCING OSTEOARTHRITIS About the disease GETTING A DIAGNOSIS The process of getting diagnosed COMMUNICATING WITH HEALTH PROFESSIONALS Who you will see, what you will do LOOKING AFTER YOUR JOINTS Useful ways of living with arthritis PRACTICALITIES Sources of help USEFUL ADDRESSES 3 4 10
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Osteoarthritis is a disease of the joints affecting almost everyone as they get older. Around eight out of 10 people over the age of 50 are affected. In its early stages, it can be very difficult to detect. Some people who have arthritis are not even aware that they have the disease, or only become aware of the problem when symptoms develop. Osteoarthritis also varies tremendously from person to person. Pain might be a problem for some, while others may find it difficult to move and use the joint. Osteoarthritis can begin at a young age, so it does not mean that you are over the hill – teenagers have sometimes been known to develop it. Osteoarthritis cannot be cured, but an early diagnosis can help slow its progression and a lot can be done to ease the symptoms. It is not a good idea to ignore sore joints, inflammation and other warning signs. Some people delay seeking treatment because they believe chronic aches and pains are simply signals that they are getting old, and that nothing can be done about them. In fact, there is a wide range of treatments to try once a diagnosis has been made and a lot that you can do to make day-to-day living easier for yourself.
What is OA?
Osteoarthritis is a condition that usually develops gradually, over several years. It affects a number of different joints, but is most commonly found in the fingers, knees, hips and spine. The precise cause of osteoarthritis is unknown, but it does appear more in females than males and often starts after the menopause, which can lead to it being seen as part of the ageing process. For some people, the changes are so subtle and develop over such a long period of time that they are hardly noticeable. But others may experience gradually worsening problems, with pain and restricted movement, particularly in large joints such as the hip or knee, being involved. You may still have to see the doctor from time to time to have your condition reassessed and your treatment plan discussed. We do not yet know the causes or the cure for osteoarthritis, but recent research is uncovering the mechanisms which lead to joint damage as well as factors that control the healing response. For example, we now know some of the chemicals which thin out the cartilage in osteoarthritis. Drugs are being tested that inhibit the actions of these chemicals. Doctors and research workers have changed their attitude a great deal in recent years. They now see real possibilities of understanding and controlling osteoarthritis in the future. They no longer see osteoarthritis as an inevitable part of ageing or a wear and tear disease, but more as a major challenge and an important problem which they can one day solve.
Healthy cartilage – the protective layer that covers the bone end in the joint – is very smooth, strong and flexible. It absorbs the stresses put on a joint, and protects the bones from damage. In osteoarthritis, this becomes pitted, brittle and thin, and, over time, can wear out completely. When the cartilage deteriorates, the bone underneath thickens and broadens out, spreading the weight that the cartilage has to support. As the cartilage becomes thinner, the bones of the joint rub 4
CAPSULE AND LIGAMENTS BONE SYNOVIAL FLUID SYNOVIAL MEMBRANE BONE CARTILAGE A normal joint THINNING CARTILAGE The early stages of osteoarthritis CARTILAGE THINS FURTHER THICKENED JOINT CAPSULE BONE THICKENS AND SPREADS OUT (OSTEOPHYTES) More advanced osteoarthritis together. the joint capsule becomes thicker and 5 . At the same time. inflammation and the gradual build-up of bony outgrowths (osteophytes). which make it look knobbly. causing pain.
Normal activity and exercise are good for the joints and do not cause osteoarthritis. it does not generally make you feel unwell. especially the hips. Carrying extra weight puts pressure on weight-bearing joints. like most conditions. Osteoarthritis is common in people with certain occupations such as physiotherapists (osteoarthritis of the thumbs). but it is probably due to bodily changes which come with old age. However. it is not unheard of. very hard repetitive activity may injure joints. such as the muscles becoming weaker. It is not known for sure why older people tend to develop it. Although it is uncommon before the age of 40. It also increases the chances of osteoarthritis worsening once it has developed. Causes Specific causes of osteoarthritis are hard to pin down and. and in professional footballers (osteoarthritis of the knee) if they have had cartilage surgery.the amount of synovial (lubricating) fluid can increase. often causing the joint to swell. especially in the knees and hands. knees and spine. Usually. Exercising too soon after an injury has had time to heal properly may also 6 . It may also become stiff and painful to move. several factors need to be present before osteoarthritis develops including the following. Gender Osteoarthritis is more common and often more severe in women. putting on weight and the body becoming less able to heal itself. Age People usually develop osteoarthritis from their late 40s through to old age and it is often undiagnosed. there are many factors that can increase the risk of developing it. Whilst the pain itself can be very unpleasant. Obesity The effects of obesity on osteoarthritis are well documented. Joint injury A major injury or operation on a joint may lead to osteoarthritis at that site later in life.
lead to osteoarthritis in that joint later on. Other types of joint disease Osteoarthritis is sometimes caused by injury and damage from a different kind of joint disease years before. It is not known which inherited genes lead to nodal osteoarthritis. ■ Who gets it? Osteoarthritis is usually not hereditary. In other common forms of osteoarthritis. There are many people who have had very similar lives. rather it is a term that doctors use to describe the type of damage that osteoarthritis causes in a joint. while the other has quite severe osteoarthritis. 7 . osteoarthritis. The standard explanation for osteoarthritis is that it is a result of wear and tear. but the following factors are associated with an increased risk of developing the condition: ● obesity – being overweight for several years can put strain on the joints ● stress on joints caused by occupation ● stress on joints caused by activity or ageing ● injury to the joint lining caused by a past fracture. one of whom will have virtually perfect joints. there must be an inbuilt susceptibility to. It is always best to check with your doctor. but it is believed that many genes are involved. or protection against. physiotherapist or nurse when it is safe to exercise after you have sustained an injury. There are some very rare forms of osteoarthritis that start at a young age and run in families and these are linked with single genes that affect collagen – an essential component of cartilage. Therefore. people with rheumatoid arthritis can develop osteoarthritis in the joints that were most affected by rheumatoid inflammation. ageing and joint injury. This particularly affects the hands of middle-aged women. Heredity There is one common form of osteoarthritis (nodal osteoarthritis) that runs strongly in families. This does not necessarily mean that you have done something to cause it. For example. heredity plays a small part compared to obesity.
there is no evidence that a particular arthritis diet will eliminate either the disease or the symptoms. It is also important to eat a balanced diet to nourish muscles. However. However. For example. The weather makes arthritis worse ‘I find that the climate affects my knee and spine. We know this is true because warmer regions in the world do not have lower incidences of arthritis than colder regions. auto-immune diseases. However. in all types of climate. Diet can cure arthritis Many people who have arthritis spend a lot of their time searching hopefully for a special arthritis diet. Which joints? Osteoarthritis is very variable and can affect different joints in different ways. This will reduce the risk of osteoarthritis. While researchers continue to investigate the link between arthritis and diet. but is most 8 . Genetic disorders. it is very important to keep your weight as close as possible to the ideal for your height and age. many people find that their joints are often sensitive to the weather and tend to feel worse when the atmospheric pressure is falling. just before it rains. they generally agree that excess weight compounds the problem. Osteoarthritis occurs all over the world.’ Meriel Blake Although there is no evidence to support this claim. the weather may temporarily affect symptoms. This helps to explain how some people with osteoarthritis can predict rain and why joint pain seems to be linked with the damp.Challenging the myths Osteoarthritis does have other causes – we just don’t know what they are yet. which are more painful when the weather turns bad.’ Mrs Lipman ‘The warm weather is definitely better for my joints. But we do know enough to correct some myths. but not the actual arthritis itself. cartilage and bone. Only older people get it It is true that the majority of people who have osteoarthritis are over 45. While some types of arthritis – gout for example – are directly affected by diet. sports injuries and other trauma can cause osteoarthritis at any age. even young people can develop arthritis.
making sitting down. In more advanced cases. rising from a reclining or sitting position and walking difficult. in fact. The weight-bearing joints such as the knees. and grinding and swelling can often occur. Symptoms can vary and you may have bad patches of a few weeks or months followed by better periods. Sometimes you may feel the joint giving way because of weak muscles. hips. Pain can vary in severity and can be so mild that many people don’t even notice it. I had various rheumatic illnesses and OA is on both sides of my family too. You may find that the weather affects your joints. Arthritis in the elbow joint can make the elbow very difficult to straighten and bend.’ Veronica Jones ‘I had a car crash before I was diagnosed and they attributed the neck pain to whiplash when it was. or that it depends on how much physical activity you do. You can prevent this by doing muscle-strengthening exercises.commonly found in the knees. Early signs and symptoms Osteoarthritis tends to creep up on you and the early signs are so mild that they are often easy to miss. but the joint may not move as freely or as far as normal and may ‘creak’ or ‘crack’ when moved. hands and spine. Shoulder and elbow joints are also susceptible to arthritis although this is much rarer. there may be constant pain and everyday tasks may become difficult. writing and doing up buttons. ‘In my 30s I started getting vague pains in my legs and neck. with the pain tending to be worse while exercising the joint and at the end of the day. thumbs and wrists affects grip strength and the ability to perform everyday tasks such as opening jars. Some people may experience a grinding feeling in the shoulder and a reduced range of movement.’ Joyce Cox 9 . picking small things up. Stiffness after resting usually wears off after a minute or two. but I didn’t see a doctor about them. The main symptoms are stiff and painful joints. Osteoarthritis of the knee or hip may cause difficulties in going up and down the stairs. walking a long way or getting in or out of the car. I was diagnosed with OA at about the age of 45. Osteoarthritis in the fingers.’ Jan Slaney ‘As a child. You may find that the joints appear swollen due to the bony osteophytes or extra synovial fluid. arthritis. as mentioned earlier. ankles and hips are most frequently affected by osteoarthritis. or so severe that mobility and quality of life is affected. Elbows are very sensitive to injury so very mild arthritis here can lead to quite a significant loss of mobility. Pain from arthritis in the shoulder may also make it difficult to sleep.’ Joyce Cox ‘I slipped a disc in 1966 and I’m wondering whether this signalled the beginning of my OA.
you will be asked about any other medical conditions you may have and whether you are taking any medicines. and when and how the condition started. These will show such things as cartilage loss. If your arthritis is severe. nerves and aspects of your general health.GETTING A DIAGNOSIS It is usually not difficult to tell if somebody has osteoarthritis. after a time. Your GP will be able to assess whether you have osteoarthritis or whether your symptoms are due to another illness. It is more difficult to tell if the disease is causing the person's symptoms because pain in an area may not be due to osteoarthritis. He or she will feel for any bony swellings and creaking joints. how to overcome mobility problems. X-rays do not determine how much your arthritis will trouble 10 . excess fluid or instability in the joints. X-rays are the most useful test to confirm osteoarthritis and to see how much damage has occured. and how they have changed over time. Your history To diagnose osteoarthritis. you may be referred to a hospital specialist such as a rheumatologist or an orthopaedic surgeon. how to avoid joint strain and how to cope with pain. It is also important for the doctor to know how osteoarthritis affects your work and daily life. Finally. Physical examination Your doctor will examine your joints and may check muscles. giving a good description of pain. Make sure you tell your doctor exactly how you feel. your GP will begin by asking you to describe the symptoms. to a physiotherapist or occupational therapist who can give you special exercises to do and advice on how to relax. They will also see any restricted movement and will look for joint tenderness and any thinning muscle. stiffness and joint function. Testing for osteoarthritis There is no blood test for osteoarthritis although you may be given one to rule out other types of arthritis. bone damage and osteophytes. You may be referred.
You have got the job of taking charge of your arthritis. only you know how you feel. giving the impression 11 . As a result. some questions have no answer. This will help you understand and feel confident about any treatment you are given.’ Anne Howard ‘I was lucky – I had a good GP when my hip got really bad. nobody will think you are stupid. Ultimately.’ Jan Slaney ‘I did a lot of research before I went to my GP and found that it really helped me. Also. but if that is the case. Very little of any information you give your doctor will be unhelpful. to prompt me in case I forgot to ask anything. He knows I hate having to take drugs and so I always check with him when I want to try taking a supplement. Most doctors and health professionals are happy for you to do this if you explain that you feel it will help you. new developments or drug side effects. but it is important that you make the most of your consultations. they may not show early osteoarthritis damage. Going away with unanswered questions or worries may cause you greater concern. Don't be afraid of asking questions if something is not clear. Doctors are often rushed. The part you play in this is vital. learning how to manage it and adjusting to how it affects your life.you – an X-ray that shows severe changes does not necessarily mean that you will have a lot of pain or disability. COMMUNICATION WITH HEALTH PROFESSIONALS Your GP will be your main contact to do with matters concerning your treatment. Talking to him or her openly will ensure that you are given the correct treatment and one that is most effective for you. Of course. It may help you to write things down or to take a friend or relative with you. you need to know this.’ Mr Viv Williams Wear and tear The phrase ‘wear and tear’ is often used by GPs to describe osteoarthritis. the difficulties you face and the sort of help you need most. ‘Luckily my GP is very flexible and he keeps an eye on me. I have a general interest in that sort of thing anyway. Not all are sympathetic or easy to talk to. before much cartilage loss has taken place. I also took a friend to the surgery with me. it is important to develop a good relationship. Between us we sort it out. It might be about the treatment options available. You and your GP must work together to help you manage your arthritis by relieving your symptoms and helping you live as normal a life as possible. but many people feel that it trivialises the condition.
Appropriate exercise is actually very beneficial for osteoarthritis because it helps to strengthen the muscles that surround the joint. However. ● Don't be afraid to discuss the treatment options available or to take on more responsibility for your own needs. you can always ask for another appointment. This may be easier said than done. the same disease factors are involved. Ways to reduce stress on the joints include: ● sticking to your ideal weight. injuries to a joint increase the risk of developing osteoarthritis in that joint. It will give you confidence too. Some argue that wear and tear is actually inaccurate since younger people can get osteoarthritis too and their bones are not old at all. can reduce the severity and impact of osteoarthritis. If you hear the phrase wear and tear to describe your osteoarthritis. ● When you join a practice you can ask at reception if a GP is interested in a particular condition. keeping physically active and avoiding excessive stress on the joints as you get older. ● If you feel that you need more time with your doctor to bring up the points that are worrying you. for example. arthritis. ■ Tips on getting the most out of your GP appointment ● It is a good idea to make a list of about four questions to ask your GP before your appointment in case you become flustered or your mind goes blank. maintaining a normal weight for height and body structure. ● It is worth reminding your GP of any other conditions you have or medications and supplements you are taking. but losing excess weight 12 . However. Treatment versus prevention While it can be difficult to avoid. don't be afraid to use your joints.that they have been put on the scrap heap and that nothing can be done to help. You may even be able to book a double appointment. making the joint more stable and less painful. This usually occurs many years after the injury and it is not usually possible to prevent the condition occurring. Your local surgery will be able to tell you of its rules.
Rheumatoid arthritis can occur at any age from childhood onwards. ● A GP may prescribe a different non-steroidal antiinflammatory drug (if this is appropriate for you) or a stronger codeine-based painkiller. ● Massaging the muscles around the joints will help ease pain and help keep you supple. A therapist can advise you on the most appropriate one for you and how to use it properly. ■ Tips for managing your arthritis ● General exercise – keep moving. although the average age is the late 40s. The 13 . ● Should your condition deteriorate to the point where your mobility is severely affected. Make sure you follow the dosage instructions on the packet. knees and hips. What's the difference between osteo. such as paracetamol or ibuprofen (a non-steroidal anti-inflammatory drug). Many joints are involved and the synovium becomes inflamed. can ease pain. or an orthopaedic surgeon to discuss the possibility of joint replacement surgery. Combining regular exercise with healthy eating is often better than dieting alone ● pacing yourself.may be the most effective method of arthritis prevention. soft soles can act as shock absorbers for your feet. Instead of attending to the jobs that need doing all at once. you may be advised by your GP to see a rheumatologist for specialist advice on medical management. ● Mild to moderate disease can usually be managed successfully with simple over-the-counter painkillers. ● Sleeping on a good mattress. such as a pocket- sprung mattress. It also helps to reduce pain. ● Swimming in a heated pool can help.and rheumatoid arthritis? Osteoarthritis and rheumatoid arthritis are two very different diseases. damaging the tissues in the joint. and reduce jarring ● using a walking stick can reduce the weight and stress on a painful hip or knee joint. spread them throughout the day or week ● wearing shoes with thick. such as housework or mowing the lawn.
X-rays show that the bones can become thin and eroded. weight loss and tiredness. Side effects are unusual. Paracetamol. I felt as though I had to make a choice between sickness and pain. There is a difference in the pattern of stiffness – people with rheumatoid arthritis tend to be worse in the morning while people with osteoarthritis tend to be worse in the evening. rather than the bony spurs and calcification which indicate osteoarthritis. including pain relief gels. For a while. Treatment is also different. Treatment of osteoarthritis depends very much on GPs who are more than capable of treating your disease. but help relieve the pain and stiffness. Many pain relieving drugs. but don't assume that. tender and swollen with fluid (not with bone). often very stiff and are warm. Analgesics These are pain-relieving drugs.affected joints are painful. but they can make me feel funny – not quite myself.’ Veronica Jones There is a vast range of drugs to treat arthritis. can be bought over the counter without a prescription. The medication each person is prescribed and how often they take them differs depending on their disease type and on how they react to the drugs. although taking too great a dosage can cause liver damage. Some of the most commonly used drugs for osteoarthritis are listed below. Blood tests show widespread inflammation which affects the body generally. which is available over the counter. it does not mean that you are not being as well looked after. they are 14 . Just because you do not have to see a rheumatologist. and the best one to try first. They will see a range of health professionals such as rheumatologists and orthopaedic surgeons who will keep an eye on the progression of their disease and help them to find the right treatment for them. Treatment with drugs ‘When I had my knee replacement. the painkillers I was on made me physically sick.’ Joyce Cox ‘My tablets keep the pain under control. People with rheumatoid arthritis will need to take a mixture of drugs to help control their disease and reduce inflammation. such as paracetamol. just because they are easy to obtain. often causing anaemia. that do not affect the arthritis itself. is the simplest and safest painkiller. They come in varying strengths and the stronger ones are only available on prescription.
and the correct dose. Ask your doctor if you are eligible. if in doubt. but are more likely to cause side effects. if there is no inflammation. Never take more than the recommended dose and. your doctor may prescribe a course of non steroidal anti-inflammatory drugs (NSAIDs). parecoxib (Dynastat). is relatively effective and very safe. cocodamol and codydramol are available on prescription. as is often the case with osteoarthritis. such as constipation or dizziness. several times daily. the pepper plant) if used regularly. Capsaicin cream (made from capsicum. Your doctor will advise you which is the appropriate one to take. especially for knee and hand osteoarthritis. Cox-2 inhibitors are a new type of NSAID. these drugs may have no advantage over painkillers. making it more bearable. Non steroidal anti-inflammatory drugs (NSAIDs) If you have mild inflammation in your joints. talk to your pharmacist or doctor. people using other medicines known to increase the risk of gastrointestinal problems or those reqiuiring longterm use of NSAIDs at the maximum dose. but are more likely to cause side effects – especially indigestion and diarrhoea. etoricoxib (Arcoxia).’ Anne Howard ‘You have to watch out if you have other conditions too. These may be stronger than paracetamol. They tackle inflammation in a similar way. I can’t take anti-inflammatories for my OA now that I’m taking other drugs for my heart. but they alter the nature of the pain. Ibuprofen and diclofenac are commonly used NSAIDs but there are many others. ‘I find with painkillers that they don’t actually remove the pain completely. NSAIDs can help some people more than paracetamol. They include celecoxib (Celebrex). They contain paracetamol and a second codeine-like drug. rofecoxib (Vioxx) and valdecoxib (Bextra). Some anti-inflammatory drugs such as ibuprofen can be used as painkillers in low doses. This includes people aged 65 or over. but have been developed to be safer for the stomach – although they do have other side effects and Cox-2s still need to be considered carefully.harmless. Guidance from the National Institute for Clinical Excellence states that Cox-2s can only be prescribed to people who may be at a high risk of developing serious gastrointestinal problems.’ Jan Slaney 15 . However. Combined painkillers such as coproxamol. NSAID creams and gels can often help.
It is very difficult to predict the outcome in individual cases. Other people may experience a worsening in one or more joints (especially in the hip or knee). it does not necessarily mean that it will get worse. Most people can lead a full. Keeping healthy is part of this. osteoarthritis tends to reach a peak after a few years and then stays the same. Arthritis prevention and knowing how to take care of your own joints are the best ways to either avoid or control osteoarthritis. They can also advise on your work environment. to the way you lift. My OT managed to get me a walk-in shower room installed because I just couldn’t step into the bath. For many. cooking and cleaning. They may also be able to supply some of the more expensive items on temporary loan. For example. This probably means learning different ways of doing everyday jobs. common sense alterations to life. and adapting your life in a number of ways. you may have to give more thought to the clothes and shoes you wear. but you also need to avoid straining joints by doing things awkwardly or doing more than you are comfortably able. Inflamed or damaged joints need to be cared for and protected. protecting the joints from further injury and maintaining an ideal weight through a healthy diet will all benefit you. 16 . active life by properly managing the condition and making small. OTs are experts on what equipment is available to help you and where you can buy these items.’ Jan Slaney Occupational therapists (OTs) are the best people to get help from if you are having difficulty with day-to-day tasks like washing. dressing. but there are many things that can be done to help alleviate the symptoms and prevent the disease from progressing.LOOKING AFTER YOUR JOINTS Although there is no cure for osteoarthritis (at least. and it may become painful and disabling. An occupational therapist can help with all of this. Regular exercise. Occupational therapists ‘Remember that OTs can provide you with equipment right up to bathrooms and stair lifts. grip and carry things or to the way you arrange your home or place of work. not yet). So it is possible to take an active role in your life with osteoarthritis.
The wrong sort of exercise could put strain on your joints and damage them further. So. stronger joints – use larger joints to protect the fragile joints in your fingers and wrists by using larger ones. ● Don't grip things too tightly – with pens. The fact that I’m leading them with my new hip gives them all confidence too. satchel or rucksack instead.Your GP or hospital consultant can put you in touch with an occupational therapist. even though I know they’re good for me – I find them boring. ● Use less effort and shift rather then lift – slide heavy pans along a kitchen top. but it’s difficult. I actually got the rails in my bathroom. Everyone benefits from exercise. choose a fatter one.’ Meriel Blake ‘I try to do stretching and range of movement exercises every day. Exercise protects joints by keeping the muscles strong and keeping you mobile. This may be at your local hospital or they may visit you at home. However. but for people with arthritis. I’m piling on the weight because its almost impossible to do any aerobic exercise. use your shoulder or hip. and take frequent breaks when writing. use a trolley to move things over longer distances.’ Veronica Jones ‘I’m a “Walking for Health” leader. exercise is good for us. and reduces the risk of illness. You should ask for an assessment of your needs under the NHS and Community Care Act 1990. Exercise won't make your arthritis worse – as long as it is the right sort. ● Use larger.’ Anne Howard ‘I’m useless at doing my exercises. the high loo and the railing up the stairway through social services. then you can refer yourself by phoning your local social services department. If you are having trouble getting a referral to an OT.’ Meriel Blake Exercise and rest – a fine balance Exercise can be the furthest thing from people’s minds when they live with pain on a daily basis. ● Watch your posture – if you slouch. which is a scheme to encourage people to get out and about. ● Change positions often – shifting position or stretching every half an hour will help you dodge joint stiffness. But it is also good for pain and stress. Avoid handheld bags: use a shoulder strap. for example. Ask your GP whether it is ■ Change the way you move ● Spread the load – use both hands to lift and hold. 17 . for example. rather than pushing a door open with your hand and wrist. It can also help you lose any extra weight which puts strain on joints. It keeps us supple and flexible. but I have lost a bit of confidence because I don’t want to fall and damage it. the benefits of exercise are enormous. ’Make sure that you tell the OT what you want and what you’d find most helpful. fatigue and pain.’ Jan Slaney ‘I’m starting to ride my bike again after my hip replacement. the weight of your body falls forward putting added strain on muscles and joints. hold it as loosely as possible or expand the grip with padding. I know that it’s best not to be overweight with OA.
appropriate for you to be referred to a physiotherapist. As the muscles get used to doing more. gradually building up the repetitions. protect and support your joints. By developing strong muscles. This type of exercise burns off calories. joints become more stable and things such as walking and climbing stairs are easier. Strengthening Strengthening exercises are important for everyone. Range of movement Range of movement (ROM) exercises form the backbone of every exercise programme. This can lead to muscle wastage and weaker joints. Start slowly. especially people with arthritis. ROM exercises are done smoothly and gently so they can be done even when in pain. which includes these exercises. Everyone should do these as they help maintain flexibility. The type of exercises you do will depend on which joints are affected and how severe your condition is. Aerobic Aerobic just means exercise that raises your heart rate. Ask your GP or physiotherapist for examples of these exercises or call 020 7380 6540 for Arthritis Care's Fit for life booklet. they adapt and become stronger. 18 . then ease them a little further ● strengthening – these tighten and relax muscles around a joint to protect it ● aerobic – any exercise that raises your heart rate and gets you slightly out of breath. Always check with a doctor or physiotherapist before starting a regime. Many people become less active when they develop arthritis because of the pain and fear of causing damage. who will help you work out a programme combining different types of exercise: ● flexibility or range of movement – these exercises gently take your joints through their range of movement. and are important for good posture and strength. The exercises involve taking joints through their full range of movement and then easing them a little further. because they help to strengthen the muscles which move.
the range of movement in your joints should increase and pain decrease. improves sleep. aerobic exercise must be done for a prolonged period (20-30 minutes) two to three times a week. Your doctor may possibly refer you for hydrotherapy. cycling and swimming. reduces depression and builds up stamina. You can improve muscle strength by pushing your arms and legs against the water. strengthens bones.speeds up the body's metabolism. To get any benefit. The warm water aids muscle relaxation and eases pain in joints. helps maintain a strong heart and helps muscles work more effectively. The best forms of aerobic exercise for people with arthritis are walking. ‘I tried hydrotherapy. and increase your energy and vitality. This involves exercising in a heated pool under the supervision of a physiotherapist. 14 Bedford Row. Hydrotherapy sessions may be held in your local hospital. WC1R 4ED. Begin any exercise by stretching to warm up. Check with a doctor before beginning any regime. help with good posture. Build gradually each day until you reach your goal. especially if you have moderate to severe arthritis. there will usually be a hoist. Because the water supports your weight. The first meeting will last about 45 minutes and 30 minutes thereafter. but found that it wasn’t effective enough at alleviating the pain for me. These exercises done correctly and consistently will provide some relief from the pain of arthritis. It allows people with arthritis to exercise their joints and muscles whilst being supported with warm water at body temperature. For more information on hydrotherapy. Tel: 020 7306 6666. It also helps control and reduce weight. You are at a good level if you start to sweat and can still carry on a conversation at the same time. contact the communications department at the Chartered Society of Physiotherapy. The good effects of it wore off pretty quickly. a heart condition or high blood pressure. Gentle exercise can be carried out in jacuzzis or heated swimming pools that 19 . Most hydrotherapy pools range in depth and if you cannot lower yourself into the water. London. making it easier to relax.’ Joyce Cox Warm water exercise Warm water exercise is popular with people who have osteoarthritis.
Studies on essential fatty acids (found in oily fish) show that they can ease joint pain and stiffness. Try to also cut down on sugary and fatty foods. Start slowly and make sure to avoid exercising in water that is too hot. A healthy diet Not eating certain foods doesn’t make any difference to my arthritis. pasta. relieves stiffness. pulses (such as beans and lentils). but too much may make them stiff. It is very important not to overdo things.The warm water soothes the joints. Certain foods may help. it makes sense to avoid it in future. ● Range of movement exercises should be done every day in every joint. as long as you don't miss out on essential nutrients.’ Jan Slaney ‘I try to steer clear of citrus fruits because they seem to add to my pain. I find that I am in less pain when I don’t eat these. and don't assume that 20 . Get advice if you are unsure. vegetables. Keeping active strengthens the muscles around the joints helping to prevent further degeneration.will usually be heated to around 34 degrees centigrade. ● Develop a moderate exercise programme – a strenuous programme may cause more pain and possibly accelerate damage. and also offers the resistance needed to keep muscles and joints in shape. and promotes better blood circulation. fish and white meat. Rest your joints – especially when they are inflamed or particularly painful. There is a lot of debate about whether what you eat affects arthritis. green peppers and potatoes from my diet. Resting painful joints will make them more comfortable. Some people claim that certain foods seem to make their inflammation or pain worse.’ Mrs Lipman Your body needs a range of nutrients. As with any exercise programme. Try to include more of these in your diet and consider taking a supplement. ● Regular exercise is one of the best ways to relieve the symptoms of osteoarthritis. balanced diet and include lots of fruit. so make sure you eat a healthy. Eating well will also help you lose any extra pounds which can put extra strain on your joints. The water enables gentle and lowimpact exercise.’ Joyce Cox ‘I have eliminated tomatoes. You need to strike a balance between rest and activity. consult your GP before you begin this type of exercise. If you notice this. It has definitely helped me. aubergines. and can work out which food is the trigger.
So far there is little evidence that dietary supplements improve arthritis or its symptoms. lobster or prawn shells.’ Meriel Blake Supplements People with arthritis take a huge range of supplements including herbal remedies. some people believe that it does help ease the pain and stiffness of their osteoarthritis.what works for someone else will work for you. although research in this area is complicated and much more needs to be done. Below are a few of the supplements most commonly taken by people with osteoarthritis. There is not much scientific evidence to support this at this stage. Read Arthritis Care's Food for Thought booklet for further information on diet and arthritis. While it does not cure arthritis.’ Mrs Lipman ‘I drink lots of semi-skimmed milk and take a homeopathic supplement to keep my bones strong and to encourage the bone to knit into my new hip replacement.’ Meriel Blake ‘Cod liver oil capsules seem to have been useless for me. and never begin a diet that involves stopping medication without discussing it with your doctor. talk it over with your doctor or dietician first. Beware of diets that claim to cure osteoarthritis. Taking supplements can be expensive. It is a natural substance extracted from crab. Some doctors believe that special diets are worth trying. Before you start taking supplements bear in mind the following: ● find out as much as you can about the supplement in which you are interested ● remember that supplements will not cure arthritis ● check with your doctor or pharmacist for interaction with prescription drugs ● tell your doctor if you are taking any supplements and report any side effects immediately ● keep a record of how you feel so you can see if they are having an effect ● buy brands from reputable manufacturers ● consider the cost. ‘Ginger in capsule form really seems to help my arthritis. though recent findings for omega-3 fatty acids and glucosamine are promising. If you are considering one. Call 020 7380 6540 for your copy. vitamins.’ Veronica Jones Glucosamine Glucosamine is popular with people who have osteoarthritis. It doesn't 21 . homeopathic medicines. minerals and dietary supplements. oranges and hard cheese all make the pain of my arthritis worse so I try not to eat them. ‘I’ve found that orange juice.
help everyone. can produce a modest improvement in joint pain and stiffness and have a good record of easing the symptoms of osteoarthritis. so if you haven't seen an improvement after two months. must be taken for at least three to six months. like cod liver oil. Glucosamine. often in capsule form. Studies still need to be carried out on the possible long-term toxicity of taking fish oils. it probably won't help you. which comes in capsule form. and is often taken alongside glucosamine. and they switch off another enzyme known to cause much of the pain and inflammation of arthritis. 22 . New Zealand green-lipped mussels Researchers have found that both stabilised mussel powder and a lipid extract may be effective in reducing pain. Chondroitin Chondroitin sulphate exists naturally in our bodies and is thought to give cartilage elasticity and to slow its breakdown. There do not seem to be any serious side effects. Care should be taken not to exceed safe levels of vitamin A and D when taking cod liver oil. Recent research has found that omega-3 fatty acids are effective because they reduce the activity of the enzymes responsible for cartilage damage. is often taken in combination with chondroitin. The long-term effects of this supplement are not known. Any benefit is lost when you stop taking it. There is no proof that it reverses cartilage loss. but some studies suggest that it helps stop joint degeneration. It could increase the chances of bleeding if you are taking any blood-thinning drugs. In supplement form it is derived from the trachea of cattle or sometimes shark cartilage. Fish oils Fish oils. A daily dose. It doesn't help everyone – if you have severe cartilage loss you probably won't get any benefit. but lesser ones include nausea and indigestion. Chondroitin is a slow-acting supplement so don't expect to see any improvement for at least two months. but minor ones include nausea and indigestion. There are no known major side effects. swelling and stiffness in both osteoarthritis and rheumatoid arthritis.
other studies have shown no benefit. ‘I managed to get on three 10week physiotherapy courses. complementary therapies do not offer a cure for arthritis. I undid all the good work.’ Anne Howard 23 . what works for one person may well not work for another. Some of them are thoroughly reputable and are regulated by statutory bodies. such as increased self-reliance. New Zealand green-lipped mussel extract commonly comes in capsule form. However. Complementary therapies Many people with arthritis have tried a range of complementary therapies in addition to the conventional drugs prescribed by their doctor. Complementary therapies can play an important role in encouraging positive changes in lifestyle and outlook. They can. Some complementary therapies are available on the NHS and some private health insurance companies will pay for treatment. a positive attitude. but nothing made a blind bit of difference to me.’ Anne Howard ‘I’ve tried everything for my arthritis. Lifestyle changes like these may help to stabilise or improve your arthritis.’ Jan Slaney ‘I had laser acupuncture done on my lower back. So. At the other end of the scale are therapies making highly dubious claims with little or no evidence to back them up. the majority of people who visit complementary therapists each year in the UK pay for their own treatment and they can be costly. some form of complementary medicine. I only had it done when the pain was really bad. About 30 per cent of the UK population has used. Like conventional medicine. This increases to nearly 60 per cent among people who have arthritis. Some of the complementary therapies that are beneficial for osteoarthritis are listed over the page. However. or is using. however. but I had to drive 15 miles there and back so by the time I got home. but at £25 a time. it was just too much money. help alleviate some of the symptoms such as pain and stiffness as well as dealing with some of the unwanted effects of taking drugs. Complementary therapies can generally be used alongside orthodox treatment. Some people find them helpful and others try them and choose not to continue. Practitioners of these therapies may advise people to stop using conventional medications and they should be regarded with extreme caution. although doctors may vary in their attitudes to them. The more concentrated versions are more likely to be effective. There are a multitude of different therapies.However. The hydrotherapy sessions were wonderful and I met lots of other people in a similar position. learning relaxation techniques and appropriate exercises.
London. This is not painful. legs. WA4 4QW. The theory is that health is determined by the flow of internal energy through the body. The first visit to an acupuncturist can take between 40 minutes and an hour. feet and hands.uk 24 . The acupuncturist will ask about your lifestyle and medical history. then examine you. 129 Camden Mews. 12 Marbury House. long standing complaints may need more. It aims to restore the natural balance of health by inserting fine needles into specific acupoints in the body. Email: email@example.com. Acupuncture needles will be inserted into chosen points on the arms. Some health insurance policies will cover the cost. between three and six sessions are required. It teaches pupils new ways of using the body to improve balance. sit and talk. Cheshire. Tel: 020 7284 3338.Acupuncture Acupuncture is a traditional Chinese medicine that has been practised for thousands of years. Some GPs will you refer you on the NHS. Warrington.org. Lessons last between 30 and 45 minutes and most people need between 15 and 30 lessons to become proficient. imbalances in the flow of energy can be corrected.uk Alexander technique ‘I’ve practised the Alexander technique for years and find that it really helps my posture and relieves pain’ Judith Morris The Alexander technique concentrates on how we use our bodies in everyday life and how this can adversely affect their functioning. co-ordination and awareness. By learning to stand and move correctly. thereby relieving pain. The British Medical Acupuncture Society. NW1 9AH. Alexander technique is generally taught oneto-one. By using needles at these special points. Generally. The Society of Teachers of the Alexander Technique. your complexion and your tongue and look at how you walk. Email: Admin@medical-acupuncture. but feels as though you are being lightly pinched. and you need regular practice to successfully change a lifetime of bad habits. Higher Whitley. people can ease stresses on their body and alleviate conditions that are exacerbated by poor posture. An initial consultation will cost around £40 with subsequent visits from £25. Tel: 01925 730727.
On your first visit. used in baths or a burner – but one of the most common methods is as part of an aromatherapy massage. chiropractors claim that by regularly adjusting them they can keep them healthy and mobile. Tel: 020 8251 7912 Chiropractic Chiropractic focuses on mechanical problems of the joints. For an inhalation. Pure essential oils can be bought at health food shops. A full body massage will last between one and two hours and cost about £30-£35 per hour. Essential oils can be used in many ways – vaporised. Oils which are particularly good for muscular and joint aches and pains are rosemary. the chiropractor will 25 .Aromatherapy Aromatherapy uses essential oils obtained from plants to promote health and well-being. Lean over the bowl with a towel over your head. While they cannot reverse the degeneration of joints with arthritis. for up to 10 minutes. chemists and by mail order. some relaxing. some as antibiotics. Chiropractors use their hands to adjust the joints of your spine and extremities where signs of restriction in movement are found. AOC. If you have any other health conditions. add two or three drops to water in the bowl of an oil burner and light the candle underneath. London SE25 6WF. especially the spine. reducing pain and helping to slow further degeneration. check if there are any oils you should avoid. inhaled. The Aromatherapy Organisations Council represents 12 associations and 6. P O Box 19834. marjoram and juniper. add six drops of oil to the water and lie back and relax for at least 10 minutes. camomile. For an aromatherapy bath. The oils then exert their effect both through the powerful aromas and by being absorbed through the skin. improving mobility and relieving pain. Each oil has its own range of properties – some are invigorating. add four drops of oil to a bowl of steaming water. To vaporise essential oils. some act as antiinflammatories. Aromatherapy massage combines the techniques of massage with the therapeutic properties of essential oils.000 practitioners.
’ Judith Morris Osteopathy Osteopathy focuses on the importance of the spine and peripheral joints for the proper functioning of all parts of the body. A full massage can last between 60 and 90 minute and costs around £30 per hour. Enclose an SAE. Before starting treatment. On a physical level. On a psychological level. infection or sometimes if osteoporosis is suspected. ‘I find massage really relaxing. The British Federation of Massage Practitioners. massage can loosen stiff muscles. Massage is poorly regulated and your GP may be able to recommend a therapist or your local sports centre or health club is likely to offer it. Blagrace House. An initial assessment will take longer (about 30 minutes) and cost more (£35) than follow-up appointments (10-20 minutes. increase the flow of blood and lymph and ease tension. I know it’s not going to make any difference to my arthritis. but being relaxed helps relieve the pain. Massage Massage is popular with many people with arthritis.probably take X-rays of your spine. Osteopaths manually adjust the alignment of the body and apply pressure to the soft tissues of the body. Preston. improve the tone of slack muscles. An initial assessment is similar to that carried 26 . contact: The British Chiropractic Association. Osteopathy was founded on the belief that disease is the result of a disturbance in the normal balance of the defence and repair mechanisms in the body. Tel: 01772 881 063. £20-£30). a good massage leaves you feeling relaxed and cared for. Tel: 0118 950 5950. 17 Blagrave Street. This corrects structural and mechanical faults and allows the body to heal itself. Reading RG1 1QB. Treatment should not be given where there is inflammation. a professional masseur will ask you about particular problem areas and general preference (a gentle touch or firmer pressure). Lancashire P1 1TS. 78 Medow Street. To find out more about the general register of chiropractics. They may also give advice on lifestyle changes and exercises to do at home. Some private practitioners will come to your home.
front or side. ● Tell your therapist about any drugs you are taking. Surgery is a big decision to make and is usually only 27 . but X-rays are rarely used. but remember that what works for someone else may not suit you. Follow-up appointments are usually around 20-30 minutes and cost approximately £20-£30. ● The Institute for Complementary Medicines (see page 38 for contact details) can also help you find a qualified therapist. what kind of training they have had and how long have they been practising.out by a chiropractor. Don't stop taking prescribed drugs without talking to your doctor first. An initial assessment may take up to an hour and cost £30. The number of treatments required will depend on the nature of your problem. Tel: 020 7357 6655. some therapies are available on the NHS. 176 Tower Bridge Road. talk to other people with osteoarthritis who have used the therapy you are thinking of trying. and your doctor about the therapy. The Balanced Approach. Osteopathy House. There is more information about complementary therapies in Arthritis Care's booklet. Ask if they have insurance in case something goes wrong. Ask them if they can recommend a therapist. For further information contact: The General Osteopath Council. Further examination is normally carried out in a variety of positions – lying on your back. improving mobility and reducing stiffness. Surgery While some people with arthritis will never need to have surgery. ■ Finding a good therapist ● Although most people pay for their own treatment. some people find it is very successful in relieving pain caused by arthritis. ● If possible. or sitting with your legs over one side of the couch and your back towards the osteopath. so it is worth asking your GP if he or she can recommend a therapist or a particular therapy. and how many sessions you will need to feel a benefit. ● Ask how much treatment will cost. London SE1 3LU. ● Ask if the therapist is a member of a professional body.
Doctors and research workers have changed their attitude a great deal in recent years. My recovery started straight away. including your orthopaedic surgeon. Surgery can be minor – to assess damage done or smooth joints and repair cartilage (also known as an arthroscopy) or it can be more intrusive – to replace or to fuse a joint. Recovery may take some time and a lot of effort on your part. but recent research is uncovering the mechanisms which lead to joint damage as well as factors that control the healing response. I chose to have a spinal block as I wanted to be awake. but more as a major challenge and an important problem which they can one day solve. I thought that if I could see what they were doing. The worst bit was waiting for it to be done. I still have a bit of pain. still many people who have to live with their osteoarthritis and the daily pain it can cause. Having surgery could bring about a dramatic improvement in your pain levels and quality of life.’ Meriel Blake ‘My knee replacement failed due to an infection setting in.’ Mr Viv Williams ‘I think a long stay in hospital does affect you. as I live alone. For a while I just couldn’t see a light at the end of the tunnel and I was a bit frightened of managing when I came out.’ Joyce Cox ‘Three months ago I broke my hip replacement when I fell over. They now see real possibilities of understanding and controlling osteoarthritis in the future. There is a risk the operation won't work. They no longer see osteoarthritis as an inevitable part of ageing or a wear and tear disease. You will find more information and advice in Arthritis Care’s Surgery booklet. For example. We do not yet know the causes or the cure for osteoarthritis. It does get better though. New developments In spite of great progress with artificial joints. or will lead to further physical complications.’ Mr Viv Williams considered after all other suitable treatment options have been explored and when the joint is badly damaged by arthritis. However. there are. They gave me an epidural when I had the operation and I had no pain at all. I could hardly leave the house before. but it doesn’t limit me like it used to.‘Having my hip replacement was the best decision I’ve ever made. I think I’ve just been unlucky and it certainly hasn’t put me off trying again. many people decide that the positive effects on their lifestyle will outweigh any risks. Surgery can also prevent joints deteriorating further and prevent disability. it would give me a sense of power and the confidence to get better. Call 020 7380 6540. unfortunately. we now know some of the chemicals which thin out the cartilage in osteoarthritis and drugs are being tested that inhibit the actions of these chemicals. The new one is far superior – it’s great. It is a good idea to weigh up the pros and cons of surgery with your healthcare team. You may still have to see the doctor from time to time to have your condition reassessed and your treatment plan discussed. 28 .
It’s the same with the fridge. The organisations listed on pages 38 and 39 of this booklet also have a wealth of practical advice and experience to share. But there are many ways you can set things up at home to make sure that it is as streamlined and stress-free as possible. In the kitchen. such as chairs. At home Most homes aren’t designed for people with arthritis. and the latches and knobs on doors. ‘I’m very conscious of the heights of furniture. It’s far easier than trying to balance a tray. There are lots of handy gadgets and useful adaptations that can help around the home. I made sure that the fridge was at the top and the freezer at the bottom because I use the fridge more. or knives and peelers with padded handles ● a stool to sit on while you are preparing food. health and social services board in Northern Ireland) may be able to help with equipment or adaptations to your home. You are entitled to have your needs assessed – usually by an occupational therapist – to see whether you are eligible for help.’ Anne Howard Help with costs Your local social services department (social work department in Scotland. You may also have to wait a long time for an assessment or equipment.’ Anne Howard ‘I find a tea trolley is great for moving things around. or a trolley for moving heavy items across the room ● devices for turning taps more easily ● evening up your worktops. but there are plenty of sources of help.’ Meriel Blake ‘I find that ceramic hobs are far easier to keep clean and I only use the top oven to avoid bending down. 29 . It means that I don’t get something home and am then unable to use it. so they are at the right height for you and you can slide things around. or raising the oven and fridge.’ Anne Howard ‘When it’s really cold. When I need something new. mugs or a kettle ● equipment with easy-to-use buttons and switches ● an electric tin opener. Eligibility varies throughout the UK and you may have to contribute towards the cost. cupboards and gadgets. I find that wearing thermal shorts under my trousers really helps to keep my hip joint warm. for instance.’ Jan Slaney ‘Use a small travel kettle rather than a large one if your wrists are weak. contact social services so they can move you up the waiting list. If your needs change. Men’s thermal boxer shorts are best because they are bigger and go almost down to my knees. Some equipment may also be available on the NHS. I make a list before I go of criteria that must be met. they might include: ● rearranging cupboards and drawers so the things you use the most are nearby ● lightweight pans.’ Jan Slaney ‘Reaching things high up and low down is difficult so I now arrange my things so that they are within easy reach. Local home improvement agencies and voluntary organisations also offer help or funding for equipment and adaptations.PRACTICALITIES Living with osteoarthritis may not be easy. a cap gripper.
or getting a handyperson in for bigger tasks. and try them out before buy them. ● High street stores like chemists.’ Anne Howard Gadgets. and maybe able to lend you some to try out. products or services. what about getting someone else to help? Friends and family may be able to lend a hand. You could also think about paying a cleaner. advice and the chance to try out a range of products. tools and aids can add up. electricity and phone companies often offer disabled people help with advice. or to give you support with personal tasks. supermarkets and hardware shops often sell labour-saving devices and daily living equipment. the assessment must also take their needs into account. get as much information as you can. such as cleaning and shopping.’ Jan Slaney ‘At my local supermarket there’s a service that provides electric carts if you find it hard to get around the store – I find it invaluable. Ask yourself: will this solve the problem or create new ones? ● Your occupational therapist can help you find the right equipment or adaptations. the Disabled Living Foundation (call 0870 603 9177) holds the most comprehensive database on equipment. contact your local social services department. ● Arthritis Care’s helplines team can also help with suggestions (see back page). ● Local disablement information and advice lines (DIALs – see page 38) can give you information about services and suppliers who loan or sell equipment near you. but social services may be able to arrange for care workers to visit you for domestic care. Local 30 . If you are thinking of buying your own. or look in the Yellow Pages under Disability. If you have a specific carer. I used to have to drape myself across a trolley. The cost of purchasing ‘Don’t let your pride get in the way of using equipment that may really help you in the end. ● Many national and local disability organisations – such as disabled living centres – offer information. ● Gas.■ Care assessment You have the right to an assessment of your care needs at home – again. As well as being a Disabled Living Centre. See page 38 for more details. then go for it. Help varies a lot from area to area. If a wheelchair or electric buggy makes life easier for you. Other people If you find you are doing a lot of work around the home.
but had to give up in the end. Depending on how your arthritis affects you. There’s lots more information about home life in Arthritis Care’s booklet. ‘After I gave up work I went back to university and got a degree in behavioural sciences. I fought and fought. I just thought: I can’t do this anymore. and help people understand what osteoarthritis means for you. Reaching Independence. Contact your local Jobcentre for more information. An occupational therapist can help you figure out what you need to do to make working life easier. using computer equipment correctly. handling application forms and interviews. citizens advice bureau or library if they know of a local volunteers’ organisation which can help. This could be by providing things such as a support worker. relaxing. I just couldn’t cope with getting in and out of the car. Work and education Your arthritis may not significantly affect your work at all – other than time off for doctor’s appointments or surgery – but hiding it and struggling on if you have difficulties could make your arthritis worse. Smarter ways of working will help protect your joints and conserve energy. honest and clear about your needs.’ Jan Slaney 31 .organisations may be able to put you in touch with volunteers to help you with jobs around the house. but I had to give it up due to my OA and fibromyalgia. and work-related expenses. Access to Work advisers offer in-depth information on the Access to Work programme– a Government scheme that helps disabled people and their employers overcome work-related obstacles.’ Anne Howard ‘I had to give up working in a charity shop. or being based at home some of the time if that fits in with your job. There is also financial and practical help on offer if you want support finding work. Ask your local council. They can include: ● organising your work – rearranging work area. such as car adaptations or taxi fares. The best policy is to be positive. pacing yourself and varying tasks ● flexibility – perhaps working a shorter day or different hours.’ Mr Viv Williams ‘I was an occupational therapist and the manager of a residential care home. It really kept me occupied. or making the move from benefits to work. equipment or adaptations to your workplace. taking regular breaks. I can now only drive about a 20 mile radius. Contact the organisations listed on page 38 for more details. as can a disability employment adviser. Disability employment advisers are based at your local Jobcentre and offer support and advice to disabled people and employers.
contact Skill (see page 39). training. service provision throughout the UK can be patchy. promotion and dismissal and only if you fit the definition. you may be eligible for a disabled students’ allowance. You don’t have to be a full-time student to get it. ● You can apply for a blue badge. Some people do have to stop working altogether – this is never an easy decision and it’s important to get professional advice about your rights and options. further education and voluntary work may all open new doors. which means that you will be allowed to park in a designated parking space closer to your destination.’ Judith Morris Getting around is very important. Transport ‘I find trains very hard to get on and off. The Disability Discrimination Act (DDA) says that companies with more than 15 employees must take reasonable measures to ensure they don’t discriminate against disabled people. moving your workspace to the ground floor. your life can become very restricted. The allowance is intended to cover any extra costs or expenses students have because of a disability. For more information. If you are going into higher education (post18). However. These can include changing the working environment. and voluntary and commercial organisations to allow you to maintain your mobility. It is important to discuss options before deciding to give up work. Information for people with arthritis looking for – or already in – work can be found in Arthritis Care’s booklet Working Horizons.the time may come when you need to consider changing jobs. The DDA also covers recruitment. And there are often so many steps at stations. The badge belongs to the disabled person who qualifies for it (who may or may not be a car driver) and can be used in any vehicle they are 32 . But you will only be protected by the DDA if your employer knows about your arthritis. If it becomes difficult for you to use public transport or drive a car. There are some transport schemes and services run by local authorities. Remember that giving up work doesn’t mean that you are giving up your life: retraining. or retraining you and reallocating your duties.
If you prefer to drive then just a few minor adjustments – such as a padded steering wheel. carried my case and asked someone else to help me on to my connecting train when it came. contact an accredited driving assessment centre. and any other schemes run by voluntary or commercial organisations. ● Tripscope (see page 39) runs a free information service and can help you plan local.gov. available from any train station. extra side-mirrors or a wide-angled mirror – may make driving easier. An automatic gearbox and power steering can be essential for many people with osteoarthritis as they reduce strain on joints and muscles. again the Motability scheme can help. ● For more ideas. national and international travel. library or local newspaper may also be able to tell you about what’s on offer locally.uk ● Some local authorities (in the phone book) produce guides to accessible bus.’ Meriel Blake 33 . Public transport isn’t all bad. You don’t even have to stand at the actual bus stop – they stop and pick you up just if they see you. Get their details from the National Railway Enquiries Line on 08457 484950 or the Rail Travel for Disabled Passengers booklet. help you plan and book your journey and arrange any assistance you need. For further details visit the Department for Transport website at www. If you prefer to get around by wheelchair or scooter. See page 39 for details. and some run their own transport schemes. If you need a specially adapted car. you can order two free leaflets from the Department of Transport which are a guide to transport for disabled people: Get Wheelchair-Wise and Wheels within Wheels. Don't forget to tell the Driver ‘Buses are great where I live. If you get the higher rate of the mobility component of the disability living allowance.’ Judith Morris ‘People have been generally very kind to me when using public transport. Ask the Mobility Advice and Information Service (MAVIS) for a list of centres. a headrest. you may be able to use it to hire or buy a car through the Motability scheme (see page 39). ● Your local disability organisation (in the phone book). ● Most international airports produce their own disability access guides. ● Individual railway operating companies can give you information.dft.’ Meriel Blake ‘I can’t use public transport – it’s too far from my house and buses don’t come often enough. train and minicab services in their area. A nice train conductor helped me off the train at Manchester once.travelling in. The booklet also tells you how to get a disabled person’s railcard. I have to rely on my car.
Contact your local council or social services for more details. My car has everything I need – fully adjustable seats and electric windows. but what a fight that was. It took two and a half years to thrash it out. your local council may run a scheme making you exempt from paying for public transport. it is worth getting expert help and advice from: ● a social worker or welfare rights officer at your social services department (social work department in Scotland. DLA and AA Whether you are working or not. Benefits ‘I am eligible for the DLA low rate care component and the higher rate mobility component.’ Anne Howard ‘The DLA has helped me.’ Anne Howard ‘I’m lucky because I worked in the welfare department of the NHS so I knew how to fill out the benefit forms. Don’t be put off if your claim is initially unsuccessful. you can claim disability living allowance (DLA) if you are under 65 and need help getting around or with personal care (such as washing and dressing). it’s my responsibility. if anything goes wrong with it. . so it is worth applying for them if you think you are eligible. However.Vehicle Licensing Authority (DVLA) and your insurance company if your arthritis affects your ability to drive.’ Joyce Cox ‘I didn’t want to use the Motability scheme because I didn’t want to be locked into a three-year contract. If you are disabled or over 60. but reapplied and was awarded it without quibbling. which aims to advise disabled people of their benefit entitlements and assists them in making a claim. health and social services board in Northern Ireland) ● your citizens advice bureau or other advice centre ● your local social security office or Jobcentre Plus office (under Jobcentre Plus or social security in the phone book) ● Benefit Enquiry Line – an information line run by the government. It is worth reapplying as many people go on to qualify on further attempts. before you start. Benefits for Beginners. They also mean you may qualify for other benefits or help. like running a car. The mobility component of the DLA allows me to be able to run a car – it’s a great asset and has opened up my life. You may be eligible for free or discounted travel too. If you are 65 or over you may be entitled to attendance allowance (AA) for help with personal care. are tax free and are paid in full on top of other income and all other benefits you get. I was turned down to begin with. Call 0800 882200 ● Arthritis Care's booklet. Claiming benefits can be complicated and time consuming so. It has allowed me to do and have the things which I would have had to give up. DLA and AA are not means tested.’ Anne Howard 34 You may be entitled to state benefits to help with the extra costs of having arthritis or if you are unable to work.
but it can provide answers to any questions about benefits. but income from savings will be taken into account. Keep a diary over a couple of weeks. Incapacity benefit If you can no longer work because of osteoarthritis or other health problems. Carers can apply for benefits too but should check first before claiming carer’s allowance that their claim will not affect the benefits of the person they care for. thank goodness. you may be able to claim incapacity benefit. listing any things you have trouble doing and the time it takes you to do them. there is no upper limit on the amount of savings you can have. there are several other benefits you can apply for such as income support.’ Jan Slaney Working tax credit and child tax credit If either you or your partner work 16 hours a week or more and you have a disability. The Benefits Enquiry Line (BEL) is a free telephone information service. Reflect the bad days as well as those when you can manage. Child tax credit (CTC) is also available if you are responsible for children. Other benefits If you are on a low income. It cannot deal with claims. Unlike disabled person’s tax credit which WTC replaced. pension credit (if you are over 60). Tel: 0800 882200 (or. then fight. you are asked to explain how your condition affects you.When you apply for DLA or AA. If you get turned down. in Northern Ireland. whether you are in work or out of work even if your income is quite high. Any occupational pension or health insurance you receive may reduce the amount of incapacity benefit you are paid. 35 . You usually need to have paid a certain amount of national insurance contributions to get it. I had to fight for DLA and got it in the end. See Arthritis Care's Benefits for Beginners for more details on other benefits. working tax credit (WTC) can top up earnings if you are on a low income. 0800 220674). housing benefit and council tax benefit. so you don't underestimate how much help you need. ‘The Benefits for Beginners booklet is absolutely excellent for benefit information. Benefits for Beginners guides you through the forms and helps you think out things to mention.
grip and mobility. and there are ways to overcome the loss of strength. The best thing is to be positive. Don't be surprised if you feel frustrated one day and perhaps angry the next. both physically and emotionally and encourage them to ask questions If you are feeling stiff or having trouble moving . Talk to your partner about how you feel. Your relationships Sharing information about your condition with family and friends can really help them to understand what you’re going through. The more you know about your condition. just how does arthritis feel? Depending on how advanced your arthritis is. You may not be the type of person who expresses their emotions freely. But when it comes to emotions. the more powerful you feel. Talking and listening is key. Nothing is more annoying than when someone says: “But you look so well”.’ Joyce Cox ‘When you want to go out socialising you end up making a deal with yourself and accept that you might feel a bit off colour the next day. Remember though. Some people become stronger and more determined as a result of having to adapt their lives to fit in with their arthritis – everyone is different.’ Meriel Blake ‘I had a gruelling time after my knee replacement. Our Emotions.Your emotions ‘Since my hip replacement I do still have the odd black day. Not all people experience the same symptoms. helpful. I was quite down. feeling positive one week and negative the next. that it is perfectly natural to feel out of sorts sometimes. Explain how your arthritis affects you and be as clear as you can about how you are feeling. The operation was such a challenge and I was on a high for quite a long time.’ Veronica Jones ‘I decided to have my hip replacements one at a time rather then both together as it knocks you a bit for six. but not know how. Some people find that their lives do not change that much and that they can more or less carry on as normal. but it is good to let your emotions out.’ Veronica Jones ‘I think that self-management is a wonderful thing. You may find Arthritis Care’s booklet. Your own reactions to arthritis will differ from time to time. level of pain or the same feelings. You may be worried about letting them down or about depending on them too much. I did get a bit depressed when I was recovering because of the weakness and painkillers. Bottling them up can make things worse. there comes a time when you realise that you are making progress.’ Anne Howard ‘The invisibility of the pain of osteoarthritis is most frustrating for me. stiffness and inflammation relieved. I thought I could do anything.’ Mr Viv Williams 36 Everyone's experience of arthritis is different. Your relationship may come under a bit of strain too. Well informed friends and family members will be in a much better position to help you should the need arise. However. but of course I couldn’t and this frustrated me. we know that pain is high up on the list as well as fatigue and a whole host of other physical symptoms. Our Feelings. So. things get a bit more complicated. Pain can usually be controlled. People you are close to may really want to help.
it certainly hasn’t got me. I am like a bear with a sore head and my poor partner is the one who has to pick me up and put me back together again. ● Talk to somebody who understands how you are feeling. This could be someone close to you or someone else with arthritis. You could even try persuading your partner to give you a gentle foot or back massage. rather than the things you can’t.’ Pennie Cumming Living well From time to time. ● Include exercise in your day. Our Relationships. uncertainty. how to get the most from your health professionals. frustration. ‘When I feel achy and stiff I get bad tempered and depressed. Anger. ● Find out as much as you can about your arthritis. It will make you feel less worried about the future. helpful. and keeping active. I often stubbornly keep going when common sense tells me I should stop and rest my joints. A warm bath or shower beforehand will help to loosen your joints.’ Jan Slaney ‘I had to give up gardening – I used to have an allotment. There will be times when you are just too tired or painful to get close to your other half. ● Get out and about – keeping up with friends may become tricky if you are having problems with your osteoarthritis.around. Several things may help. I still grow tomatoes and have very good neighbours who help to pick them for me.Challenging Arthritis. ● Try to build a good relationship with your health professional. However. help you to keep flexible and boost your mood. For more on what Arthritis Care offers. There are ways round things – it’s a lot to do with your own attitude. but there are alternatives. it is hard to be spontaneous. your arthritis will get on top of you. and even a hug can be difficult if you are in pain. depression and fear are all very understandable and very common. ● Accept your limitations. It will build your strength. focuses on what you can do for yourself. Despite this. You may find Arthritis Care’s booklet. It is a great chance to meet with others in the same position. see the back page. handling pain. you will feel more positive and it will make it easier to approach them if you have a problem.’ Pennie Cumming ‘Friends mean well. I’ve been really hurt by what people have said. relaxing. Try different positions. Our popular course. If you like and trust them. though. but try to make space for your social life. Don’t be embarrassed to raise the issue with your healthcare team. The first time I used a wheelchair at the mall. Our Sexuality. 37 . supporting your body with pillows and cushions to make love-making more comfortable. and remind yourself about what you can do and enjoy. My daughter has been excellent. fatigue and depression. but they’re not necessarily tactful. Focus on the here and now.’ Mr Viv Williams ‘I love DIY and gardening and when I have a job to do I just have to finish it and get it right. we had a real laugh together – it took away the embarrassment. I will just go out and do it again because even if I’ve got OA.
30pm.uk Funds medical research into arthritis and produces information. Haddington East Lothian EH41 4YD Tel: 01620 822572 Information and helpline. 9am to 1pm.uk National campaigning organisation which also publishes a wide range of information on general disability issues.org.org. Chesterfield Derbyshire S41 7TD Tel: 01246 558033 www.disabilityalliance. College of Occupational Therapists 106-114 Borough High Street Southwark. Pain Concern PO Box 13256.org. Can put you in touch with qualified practitioners locally.org.ricability.nhsdirect.radar.uk Details on local practitioners.org.ncil. Daily life Disabled Living Centres Council Redbank House. 38 . Complementary therapies Institute for Complementary Medicine PO Box 194 .uk Researches and publishes guides on services and equipment.org.csp.uk Details of your nearest disability advice and information service.USEFUL ADDRESSES General arc (Arthritis Research Campaign) Copeman House St Mary’s Court St Mary’s Gate. Manchester M8 8QA Tel: 0161 834 1044 www. Ricability 30 Angel Gate City Road London EC1V 2PT Tel: 020 7427 2460 www. Benefit Enquiry Line for disabled people Tel: 0800 882200 Mon – Fri. local NHS facilities and waiting lists.org Information about chronic pain and pain clinics.nhs.cot.icmedicine.org. 4 St Chad’s Street.uk Advice and information on equipment. Send large sae and state the therapy.org.org Provides a welfare rights service and information on benefits. 8. Money and benefits Disability Alliance Universal House 88-94 Wentworth Street London E1 7SA Tel: 020 7247 8776 (voice and minicom) Rights advice line: 020 7247 8763. Sat.uk Details on local practitioners. National Centre for Independent Living 250 Kennington Lane London SE1 5RD Tel: 020 7587 1663 www.uk Information about health. Tel: 020 7357 6480 www. London SE1 1LB.dlf.co.dlcc. DIAL UK St Catherine’s Tickhill Road Doncaster DN4 8QN Tel: 01302 310123 www.arc.Tavern Quay London SE16 7QZ Tel: 020 7237 5165 www.painsociety. Mon and Wed 2-4pm www.org.dialuk.uk Umbrella body. Health services NHS Direct Tel: 0845 4647 www.uk Provides information on disabled living centres (demonstration and resource centres for disabled people) around the UK.uk Promotes personal assistance and other aspects of independent living. Disabled Living Foundation 380-384 Harrow Road London W9 2HU Tel: 020 7289 6111 Helpline: 0845 130 9177 www.30am to 6. Chartered Society of Physiotherapists 14 Bedford Row London WC1R 4ED Tel: 020 7306 6666 www. Pain management Pain Society 21 Portland Place London W1B 1PY Tel: 020 7631 8870 www. RADAR 12 City Forum 250 City Road London EC1V 8AF Tel: 020 7250 3222 www.
89-93 Fonthill Road London N4 3JH Tel: 0870 241 0450 www.uk/ mavis/mavadv. Rights and discrimination Disability Rights Commission DRC Helpline Freepost MID 02164 Stratford-upon-Avon CV37 9BR Tel: 08457 622 633 www.uk Support for people with disabilities to use computer technology. higher and continuing education. 118 Great Minister House.uk Provides cars and powered wheelchairs through the Motability scheme. 89-93 Fonthill Road London N4 3JH Helpline: 0800 018 4730 www. Other British Association for Counselling and Psychotherapy BACP House 35-37 Albert Street Rugby.org.skill. Harlow Essex CM20 2ET Tel: 01279 635666 www. Department for Transport Mobility and Inclusion Unit. Work and education Skill: National Bureau for Students with Disabilities Chapter House 18-20 Crucifix Lane London SE1 3JW Voice/text: 020 7450 0620 Information line: 0800 328 5050 www. Mobility Advice and Information Service (MAVIS) Macadam Avenue. Crowthorne Berks RG45 6XD Tel: 01344 661000 www. training and employment for young people and adults with disabilities.abilitynet.nos.org. National Osteoporosis Society Camerton.disabledparentsnetwork . Station Approach. information and assessments. Warwick Warwickshire CV34 5WS Helpline: 0800 269545 www.org.mobilityunit. Pregnancy and parenting Disabled Parents Network Unit F9.org.org.uk Details of local counsellors.Getting around Motability Goodman House.co.dft.motability. Disability Pregnancy and Parenthood International Unit F9. Bath BA3 3YB Tel: 01761 471771 Medical helpline: 0845 450 0230 www.uk AbilityNet PO Box 94.bacp. Warwickshire CV21 2SG Tel: 01788 550899 Information line: 0870 443 5252 www.htm Driving training. Old Wokingham Road.uk Information and advice for disabled parents.org Works to eliminate discrimination against disabled people. 39 .uk Tripscope The Vassall Centre.drc-gb.org. Gill Avenue Bristol BS16 2QQ Tel: 08457 585641 www.uk Arranges travel for people with disabilities.dppi.co.uk Information about further.gov.tripscope. 76 Marsham Street London SW1P 4DR Tel: 020 7944 8300 Order your Get Wheelchairwise and Wheels within Wheels leaflets from here.
a helpline service for young people with arthritis by telephone. London NW1 2HD Tel: 020 7380 6500. Production: Chris Hogg. It has over 500 branches and groups. Phone 020 7380 6540 to find your nearest one.uk ● offers The Source. Email: Helplines@arthritiscare. 1st Edition. Registered Charity No. It aims to empower people to take control of their arthritis.uk ● offers a range of self-management and personal development training courses for people with arthritis of all ages to enable people to be in control of their arthritis ● runs four hotels in the UK ● produces a range of helpful publications including a bi-monthly magazine. Arthritis News ● campaigns for greater awareness of the needs of all people with arthritis ● has a local office in Wales. letter and email.. and 70.uk Written by Sarah Rastrick.arthritiscare. It is also available 10am-4pm charged at the national rate. Scotland and Northern Ireland. November 2003 ACR124 ISBN 1 903419 31 X .org.org. their lives and their organisation.org. Published by Arthritis Care. Design: Jon Heal. Tel: 020 7380 6555. Edited by Kate Llewelyn. Freephone: 0808 808 2000 weekdays 10am2pm.Arthritis Care is the largest UK-wide voluntary organisation working with and for all people with arthritis. ARTHRITIS CARE: ● provides a helplines service by telephone and letter. and four regional offices in England.000 supporters. Arthritis Care 18 Stephenson Way. weekdays 12 noon-4pm on a freephone helpline (0808 800 4050). Printed by Manor Creative. Thanks to members of Arthritis Care’s readers’ panel and Arthritis Care’s medical advisory group for their guidance in producing this booklet. 206563. Fax: 020 7380 6505 www. Email: thesource@arthritiscare.
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