Osteoarthritis

a guide

CONTENTS
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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INTRODUCTION
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.

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INTRODUCING OA
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.

What happens?
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

inflammation and the gradual build-up of bony outgrowths (osteophytes). the joint capsule becomes thicker and 5 . which make it look knobbly. causing pain.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. At the same time.

several factors need to be present before osteoarthritis develops including the following. it is not unheard of. putting on weight and the body becoming less able to heal itself. However. Joint injury A major injury or operation on a joint may lead to osteoarthritis at that site later in life. very hard repetitive activity may injure joints. but it is probably due to bodily changes which come with old age. knees and spine. and in professional footballers (osteoarthritis of the knee) if they have had cartilage surgery. especially in the knees and hands. Gender Osteoarthritis is more common and often more severe in women. there are many factors that can increase the risk of developing it. Carrying extra weight puts pressure on weight-bearing joints. Age People usually develop osteoarthritis from their late 40s through to old age and it is often undiagnosed. It is not known for sure why older people tend to develop it.the amount of synovial (lubricating) fluid can increase. Usually. Exercising too soon after an injury has had time to heal properly may also 6 . Normal activity and exercise are good for the joints and do not cause osteoarthritis. especially the hips. Obesity The effects of obesity on osteoarthritis are well documented. like most conditions. often causing the joint to swell. Causes Specific causes of osteoarthritis are hard to pin down and. it does not generally make you feel unwell. Osteoarthritis is common in people with certain occupations such as physiotherapists (osteoarthritis of the thumbs). It also increases the chances of osteoarthritis worsening once it has developed. Although it is uncommon before the age of 40. such as the muscles becoming weaker. Whilst the pain itself can be very unpleasant. It may also become stiff and painful to move.

heredity plays a small part compared to obesity. or protection against. 7 . For example. there must be an inbuilt susceptibility to. The standard explanation for osteoarthritis is that it is a result of wear and tear. Therefore.lead to osteoarthritis in that joint later on. people with rheumatoid arthritis can develop osteoarthritis in the joints that were most affected by rheumatoid inflammation. osteoarthritis. Heredity There is one common form of osteoarthritis (nodal osteoarthritis) that runs strongly in families. 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. There are many people who have had very similar lives. ageing and joint injury. It is not known which inherited genes lead to nodal osteoarthritis. This does not necessarily mean that you have done something to cause it. rather it is a term that doctors use to describe the type of damage that osteoarthritis causes in a joint. 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. In other common forms of osteoarthritis. ■ Who gets it? Osteoarthritis is usually not hereditary. physiotherapist or nurse when it is safe to exercise after you have sustained an injury. It is always best to check with your doctor. This particularly affects the hands of middle-aged women. Other types of joint disease Osteoarthritis is sometimes caused by injury and damage from a different kind of joint disease years before. while the other has quite severe osteoarthritis. but it is believed that many genes are involved.

While some types of arthritis – gout for example – are directly affected by diet. We know this is true because warmer regions in the world do not have lower incidences of arthritis than colder regions. cartilage and bone. It is also important to eat a balanced diet to nourish muscles. While researchers continue to investigate the link between arthritis and diet. This will reduce the risk of osteoarthritis.’ Meriel Blake Although there is no evidence to support this claim. auto-immune diseases. but is most 8 . they generally agree that excess weight compounds the problem. But we do know enough to correct some myths. Genetic disorders.’ Mrs Lipman ‘The warm weather is definitely better for my joints. but not the actual arthritis itself. Osteoarthritis occurs all over the world. the weather may temporarily affect symptoms. Diet can cure arthritis Many people who have arthritis spend a lot of their time searching hopefully for a special arthritis diet. many people find that their joints are often sensitive to the weather and tend to feel worse when the atmospheric pressure is falling. Only older people get it It is true that the majority of people who have osteoarthritis are over 45. even young people can develop arthritis. just before it rains. This helps to explain how some people with osteoarthritis can predict rain and why joint pain seems to be linked with the damp. For example. The weather makes arthritis worse ‘I find that the climate affects my knee and spine. However.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. there is no evidence that a particular arthritis diet will eliminate either the disease or the symptoms. it is very important to keep your weight as close as possible to the ideal for your height and age. However. Which joints? Osteoarthritis is very variable and can affect different joints in different ways. in all types of climate. sports injuries and other trauma can cause osteoarthritis at any age. However.

Osteoarthritis of the knee or hip may cause difficulties in going up and down the stairs.’ Joyce Cox 9 . making sitting down. Some people may experience a grinding feeling in the shoulder and a reduced range of movement. hips. arthritis.commonly found in the knees. Arthritis in the elbow joint can make the elbow very difficult to straighten and bend. The weight-bearing joints such as the knees. as mentioned earlier.’ Joyce Cox ‘I slipped a disc in 1966 and I’m wondering whether this signalled the beginning of my OA. but the joint may not move as freely or as far as normal and may ‘creak’ or ‘crack’ when moved. I had various rheumatic illnesses and OA is on both sides of my family too. 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. The main symptoms are stiff and painful joints. hands and spine. writing and doing up buttons. or so severe that mobility and quality of life is affected. rising from a reclining or sitting position and walking difficult. I was diagnosed with OA at about the age of 45. ankles and hips are most frequently affected by osteoarthritis. ‘In my 30s I started getting vague pains in my legs and neck. but I didn’t see a doctor about them. Pain can vary in severity and can be so mild that many people don’t even notice it. Stiffness after resting usually wears off after a minute or two. Osteoarthritis in the fingers. and grinding and swelling can often occur. thumbs and wrists affects grip strength and the ability to perform everyday tasks such as opening jars. with the pain tending to be worse while exercising the joint and at the end of the day. Sometimes you may feel the joint giving way because of weak muscles.’ Veronica Jones ‘I had a car crash before I was diagnosed and they attributed the neck pain to whiplash when it was. in fact. walking a long way or getting in or out of the car. You may find that the joints appear swollen due to the bony osteophytes or extra synovial fluid. Shoulder and elbow joints are also susceptible to arthritis although this is much rarer. In more advanced cases. 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. or that it depends on how much physical activity you do. there may be constant pain and everyday tasks may become difficult.’ Jan Slaney ‘As a child. You may find that the weather affects your joints. picking small things up. You can prevent this by doing muscle-strengthening exercises. Symptoms can vary and you may have bad patches of a few weeks or months followed by better periods.

bone damage and osteophytes. X-rays are the most useful test to confirm osteoarthritis and to see how much damage has occured. you may be referred to a hospital specialist such as a rheumatologist or an orthopaedic surgeon. It is also important for the doctor to know how osteoarthritis affects your work and daily life. stiffness and joint function. He or she will feel for any bony swellings and creaking joints. Physical examination Your doctor will examine your joints and may check muscles. to a physiotherapist or occupational therapist who can give you special exercises to do and advice on how to relax. Your history To diagnose osteoarthritis. Your GP will be able to assess whether you have osteoarthritis or whether your symptoms are due to another illness. excess fluid or instability in the joints. They will also see any restricted movement and will look for joint tenderness and any thinning muscle. These will show such things as cartilage loss. and when and how the condition started. giving a good description of pain. after a time. X-rays do not determine how much your arthritis will trouble 10 . and how they have changed over time. how to overcome mobility problems. how to avoid joint strain and how to cope with pain. Finally. you will be asked about any other medical conditions you may have and whether you are taking any medicines. your GP will begin by asking you to describe the symptoms. 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. If your arthritis is severe. Make sure you tell your doctor exactly how you feel. You may be referred.GETTING A DIAGNOSIS It is usually not difficult to tell if somebody has osteoarthritis. Testing for osteoarthritis There is no blood test for osteoarthritis although you may be given one to rule out other types of arthritis. nerves and aspects of your general health.

It may help you to write things down or to take a friend or relative with you. I also took a friend to the surgery with me.’ Anne Howard ‘I was lucky – I had a good GP when my hip got really bad.’ Jan Slaney ‘I did a lot of research before I went to my GP and found that it really helped me. Very little of any information you give your doctor will be unhelpful. but it is important that you make the most of your consultations. Doctors are often rushed. Going away with unanswered questions or worries may cause you greater concern. but if that is the case. giving the impression 11 . but many people feel that it trivialises the condition. COMMUNICATION WITH HEALTH PROFESSIONALS Your GP will be your main contact to do with matters concerning your treatment. As a result. to prompt me in case I forgot to ask anything. Not all are sympathetic or easy to talk to. they may not show early osteoarthritis damage. This will help you understand and feel confident about any treatment you are given. before much cartilage loss has taken place. Most doctors and health professionals are happy for you to do this if you explain that you feel it will help you. nobody will think you are stupid.you – an X-ray that shows severe changes does not necessarily mean that you will have a lot of pain or disability. some questions have no answer. It might be about the treatment options available. Also. Ultimately. I have a general interest in that sort of thing anyway. 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. new developments or drug side effects. He knows I hate having to take drugs and so I always check with him when I want to try taking a supplement. The part you play in this is vital. Between us we sort it out. you need to know this. ‘Luckily my GP is very flexible and he keeps an eye on me. Of course. learning how to manage it and adjusting to how it affects your life. Don't be afraid of asking questions if something is not clear. it is important to develop a good relationship.’ Mr Viv Williams Wear and tear The phrase ‘wear and tear’ is often used by GPs to describe osteoarthritis. only you know how you feel. You have got the job of taking charge of your arthritis. Talking to him or her openly will ensure that you are given the correct treatment and one that is most effective for you. the difficulties you face and the sort of help you need most.

maintaining a normal weight for height and body structure. keeping physically active and avoiding excessive stress on the joints as you get older. injuries to a joint increase the risk of developing osteoarthritis in that joint. Ways to reduce stress on the joints include: ● sticking to your ideal weight. the same disease factors are involved. ● Don't be afraid to discuss the treatment options available or to take on more responsibility for your own needs. This usually occurs many years after the injury and it is not usually possible to prevent the condition occurring. If you hear the phrase wear and tear to describe your osteoarthritis. Treatment versus prevention While it can be difficult to avoid. However. but losing excess weight 12 . You may even be able to book a double appointment. don't be afraid to use your joints. This may be easier said than done. arthritis. ● It is worth reminding your GP of any other conditions you have or medications and supplements you are taking. ● When you join a practice you can ask at reception if a GP is interested in a particular condition. for example.that they have been put on the scrap heap and that nothing can be done to help. ■ 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. However. Some argue that wear and tear is actually inaccurate since younger people can get osteoarthritis too and their bones are not old at all. ● If you feel that you need more time with your doctor to bring up the points that are worrying you. making the joint more stable and less painful. Your local surgery will be able to tell you of its rules. It will give you confidence too. can reduce the severity and impact of osteoarthritis. Appropriate exercise is actually very beneficial for osteoarthritis because it helps to strengthen the muscles that surround the joint. you can always ask for another appointment.

and reduce jarring ● using a walking stick can reduce the weight and stress on a painful hip or knee joint. A therapist can advise you on the most appropriate one for you and how to use it properly. Many joints are involved and the synovium becomes inflamed. such as housework or mowing the lawn. ● Massaging the muscles around the joints will help ease pain and help keep you supple. although the average age is the late 40s. It also helps to reduce pain. ● Mild to moderate disease can usually be managed successfully with simple over-the-counter painkillers. ● Should your condition deteriorate to the point where your mobility is severely affected. you may be advised by your GP to see a rheumatologist for specialist advice on medical management. The 13 . knees and hips. or an orthopaedic surgeon to discuss the possibility of joint replacement surgery. such as paracetamol or ibuprofen (a non-steroidal anti-inflammatory drug).may be the most effective method of arthritis prevention. Instead of attending to the jobs that need doing all at once. ● A GP may prescribe a different non-steroidal antiinflammatory drug (if this is appropriate for you) or a stronger codeine-based painkiller. such as a pocket- sprung mattress. can ease pain. What's the difference between osteo. Combining regular exercise with healthy eating is often better than dieting alone ● pacing yourself. ● Sleeping on a good mattress. soft soles can act as shock absorbers for your feet. spread them throughout the day or week ● wearing shoes with thick. Rheumatoid arthritis can occur at any age from childhood onwards.and rheumatoid arthritis? Osteoarthritis and rheumatoid arthritis are two very different diseases. ● Swimming in a heated pool can help. ■ Tips for managing your arthritis ● General exercise – keep moving. Make sure you follow the dosage instructions on the packet. damaging the tissues in the joint.

Just because you do not have to see a rheumatologist. and the best one to try first. but don't assume that. People with rheumatoid arthritis will need to take a mixture of drugs to help control their disease and reduce inflammation.affected joints are painful. which is available over the counter. often very stiff and are warm. weight loss and tiredness. Side effects are unusual. but they can make me feel funny – not quite myself. just because they are easy to obtain. rather than the bony spurs and calcification which indicate osteoarthritis. such as paracetamol. Many pain relieving drugs. tender and swollen with fluid (not with bone). Some of the most commonly used drugs for osteoarthritis are listed below. Paracetamol. X-rays show that the bones can become thin and eroded. Treatment with drugs ‘When I had my knee replacement. although taking too great a dosage can cause liver damage. can be bought over the counter without a prescription. Analgesics These are pain-relieving drugs. For a while. often causing anaemia. they are 14 . 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. the painkillers I was on made me physically sick. Treatment of osteoarthritis depends very much on GPs who are more than capable of treating your disease. Blood tests show widespread inflammation which affects the body generally. 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. Treatment is also different.’ Veronica Jones There is a vast range of drugs to treat arthritis. 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. but help relieve the pain and stiffness. including pain relief gels. They come in varying strengths and the stronger ones are only available on prescription. it does not mean that you are not being as well looked after. that do not affect the arthritis itself. I felt as though I had to make a choice between sickness and pain.’ Joyce Cox ‘My tablets keep the pain under control. is the simplest and safest painkiller.

parecoxib (Dynastat). these drugs may have no advantage over painkillers. Ask your doctor if you are eligible. rofecoxib (Vioxx) and valdecoxib (Bextra). 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. etoricoxib (Arcoxia). Combined painkillers such as coproxamol. cocodamol and codydramol are available on prescription. as is often the case with osteoarthritis.harmless. They tackle inflammation in a similar way. ‘I find with painkillers that they don’t actually remove the pain completely. is relatively effective and very safe. and the correct dose. 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. but they alter the nature of the pain. NSAIDs can help some people more than paracetamol. Non steroidal anti-inflammatory drugs (NSAIDs) If you have mild inflammation in your joints. They include celecoxib (Celebrex). Ibuprofen and diclofenac are commonly used NSAIDs but there are many others. They contain paracetamol and a second codeine-like drug. I can’t take anti-inflammatories for my OA now that I’m taking other drugs for my heart. especially for knee and hand osteoarthritis. if there is no inflammation. but are more likely to cause side effects – especially indigestion and diarrhoea. if in doubt. NSAID creams and gels can often help.’ Jan Slaney 15 . the pepper plant) if used regularly. Capsaicin cream (made from capsicum. 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. such as constipation or dizziness. Never take more than the recommended dose and. These may be stronger than paracetamol. Some anti-inflammatory drugs such as ibuprofen can be used as painkillers in low doses. Your doctor will advise you which is the appropriate one to take. This includes people aged 65 or over. several times daily. talk to your pharmacist or doctor. your doctor may prescribe a course of non steroidal anti-inflammatory drugs (NSAIDs). making it more bearable. Cox-2 inhibitors are a new type of NSAID.’ Anne Howard ‘You have to watch out if you have other conditions too. However.

you may have to give more thought to the clothes and shoes you wear. Keeping healthy is part of this. OTs are experts on what equipment is available to help you and where you can buy these items. common sense alterations to life. It is very difficult to predict the outcome in individual cases. Inflamed or damaged joints need to be cared for and protected. active life by properly managing the condition and making small. 16 . and it may become painful and disabling. Arthritis prevention and knowing how to take care of your own joints are the best ways to either avoid or control osteoarthritis. but you also need to avoid straining joints by doing things awkwardly or doing more than you are comfortably able. Occupational therapists ‘Remember that OTs can provide you with equipment right up to bathrooms and stair lifts. Other people may experience a worsening in one or more joints (especially in the hip or knee). dressing. not yet). They can also advise on your work environment. it does not necessarily mean that it will get worse. For example. They may also be able to supply some of the more expensive items on temporary loan. This probably means learning different ways of doing everyday jobs. grip and carry things or to the way you arrange your home or place of work. protecting the joints from further injury and maintaining an ideal weight through a healthy diet will all benefit you. Most people can lead a full. So it is possible to take an active role in your life with osteoarthritis. and adapting your life in a number of ways. osteoarthritis tends to reach a peak after a few years and then stays the same. to the way you lift.’ 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.LOOKING AFTER YOUR JOINTS Although there is no cure for osteoarthritis (at least. An occupational therapist can help with all of this. but there are many things that can be done to help alleviate the symptoms and prevent the disease from progressing. Regular exercise. 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.

’ Jan Slaney ‘I’m starting to ride my bike again after my hip replacement. 17 . ● Use larger. the benefits of exercise are enormous. I actually got the rails in my bathroom. and take frequent breaks when writing. Exercise won't make your arthritis worse – as long as it is the right sort. ● Change positions often – shifting position or stretching every half an hour will help you dodge joint stiffness. for example. Everyone benefits from exercise. However. choose a fatter one. This may be at your local hospital or they may visit you at home. It keeps us supple and flexible. hold it as loosely as possible or expand the grip with padding. satchel or rucksack instead. If you are having trouble getting a referral to an OT.Your GP or hospital consultant can put you in touch with an occupational therapist. and reduces the risk of illness. rather than pushing a door open with your hand and wrist. The wrong sort of exercise could put strain on your joints and damage them further. use your shoulder or hip. ● Use less effort and shift rather then lift – slide heavy pans along a kitchen top. which is a scheme to encourage people to get out and about. Ask your GP whether it is ■ Change the way you move ● Spread the load – use both hands to lift and hold. Exercise protects joints by keeping the muscles strong and keeping you mobile. fatigue and pain. but for people with arthritis. exercise is good for us.’ Veronica Jones ‘I’m a “Walking for Health” leader. I’m piling on the weight because its almost impossible to do any aerobic exercise. The fact that I’m leading them with my new hip gives them all confidence too.’ Meriel Blake ‘I try to do stretching and range of movement exercises every day. You should ask for an assessment of your needs under the NHS and Community Care Act 1990.’ Anne Howard ‘I’m useless at doing my exercises. but it’s difficult. Avoid handheld bags: use a shoulder strap. ’Make sure that you tell the OT what you want and what you’d find most helpful. So. ● Watch your posture – if you slouch.’ 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. I know that it’s best not to be overweight with OA. then you can refer yourself by phoning your local social services department. ● Don't grip things too tightly – with pens. use a trolley to move things over longer distances. stronger joints – use larger joints to protect the fragile joints in your fingers and wrists by using larger ones. the high loo and the railing up the stairway through social services. the weight of your body falls forward putting added strain on muscles and joints. for example. But it is also good for pain and stress. It can also help you lose any extra weight which puts strain on joints. but I have lost a bit of confidence because I don’t want to fall and damage it. even though I know they’re good for me – I find them boring.

18 . Start slowly. Everyone should do these as they help maintain flexibility. Ask your GP or physiotherapist for examples of these exercises or call 020 7380 6540 for Arthritis Care's Fit for life booklet. Aerobic Aerobic just means exercise that raises your heart rate. and are important for good posture and strength. This can lead to muscle wastage and weaker joints. because they help to strengthen the muscles which move. Always check with a doctor or physiotherapist before starting a regime. The type of exercises you do will depend on which joints are affected and how severe your condition is. gradually building up the repetitions. protect and support your joints. ROM exercises are done smoothly and gently so they can be done even when in pain. The exercises involve taking joints through their full range of movement and then easing them a little further. 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. they adapt and become stronger. joints become more stable and things such as walking and climbing stairs are easier. This type of exercise burns off calories.appropriate for you to be referred to a physiotherapist. By developing strong muscles. especially people with arthritis. 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. which includes these exercises. As the muscles get used to doing more. Many people become less active when they develop arthritis because of the pain and fear of causing damage. Strengthening Strengthening exercises are important for everyone. Range of movement Range of movement (ROM) exercises form the backbone of every exercise programme.

These exercises done correctly and consistently will provide some relief from the pain of arthritis. Build gradually each day until you reach your goal. The best forms of aerobic exercise for people with arthritis are walking. Your doctor may possibly refer you for hydrotherapy. reduces depression and builds up stamina. ‘I tried hydrotherapy. aerobic exercise must be done for a prolonged period (20-30 minutes) two to three times a week. For more information on hydrotherapy. London. especially if you have moderate to severe arthritis. The first meeting will last about 45 minutes and 30 minutes thereafter. It allows people with arthritis to exercise their joints and muscles whilst being supported with warm water at body temperature. You can improve muscle strength by pushing your arms and legs against the water. contact the communications department at the Chartered Society of Physiotherapy. improves sleep. a heart condition or high blood pressure. help with good posture. Because the water supports your weight. 14 Bedford Row.speeds up the body's metabolism. but found that it wasn’t effective enough at alleviating the pain for me. Hydrotherapy sessions may be held in your local hospital. The good effects of it wore off pretty quickly. WC1R 4ED. there will usually be a hoist. Most hydrotherapy pools range in depth and if you cannot lower yourself into the water. To get any benefit.’ Joyce Cox Warm water exercise Warm water exercise is popular with people who have osteoarthritis. the range of movement in your joints should increase and pain decrease. helps maintain a strong heart and helps muscles work more effectively. The warm water aids muscle relaxation and eases pain in joints. This involves exercising in a heated pool under the supervision of a physiotherapist. Gentle exercise can be carried out in jacuzzis or heated swimming pools that 19 . Tel: 020 7306 6666. You are at a good level if you start to sweat and can still carry on a conversation at the same time. cycling and swimming. strengthens bones. and increase your energy and vitality. Check with a doctor before beginning any regime. Begin any exercise by stretching to warm up. It also helps control and reduce weight. making it easier to relax.

consult your GP before you begin this type of exercise. it makes sense to avoid it in future. If you notice this. relieves stiffness. Keeping active strengthens the muscles around the joints helping to prevent further degeneration.’ Mrs Lipman Your body needs a range of nutrients. Certain foods may help. Start slowly and make sure to avoid exercising in water that is too hot.’ Joyce Cox ‘I have eliminated tomatoes.will usually be heated to around 34 degrees centigrade. as long as you don't miss out on essential nutrients. but too much may make them stiff. ● Develop a moderate exercise programme – a strenuous programme may cause more pain and possibly accelerate damage. A healthy diet Not eating certain foods doesn’t make any difference to my arthritis. It has definitely helped me.’ Jan Slaney ‘I try to steer clear of citrus fruits because they seem to add to my pain. and don't assume that 20 . ● Range of movement exercises should be done every day in every joint. and promotes better blood circulation. and can work out which food is the trigger. Rest your joints – especially when they are inflamed or particularly painful. balanced diet and include lots of fruit. Some people claim that certain foods seem to make their inflammation or pain worse. Resting painful joints will make them more comfortable. Try to include more of these in your diet and consider taking a supplement. and also offers the resistance needed to keep muscles and joints in shape. aubergines. ● Regular exercise is one of the best ways to relieve the symptoms of osteoarthritis. Get advice if you are unsure. Eating well will also help you lose any extra pounds which can put extra strain on your joints. You need to strike a balance between rest and activity. The water enables gentle and lowimpact exercise. I find that I am in less pain when I don’t eat these. It is very important not to overdo things. pasta.The warm water soothes the joints. fish and white meat. There is a lot of debate about whether what you eat affects arthritis. As with any exercise programme. Try to also cut down on sugary and fatty foods. Studies on essential fatty acids (found in oily fish) show that they can ease joint pain and stiffness. vegetables. so make sure you eat a healthy. pulses (such as beans and lentils). green peppers and potatoes from my diet.

lobster or prawn shells.’ 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. Call 020 7380 6540 for your copy. minerals and dietary supplements. and never begin a diet that involves stopping medication without discussing it with your doctor.’ Veronica Jones Glucosamine Glucosamine is popular with people who have osteoarthritis. ‘I’ve found that orange juice. though recent findings for omega-3 fatty acids and glucosamine are promising. vitamins. It is a natural substance extracted from crab. 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. talk it over with your doctor or dietician first.’ Meriel Blake Supplements People with arthritis take a huge range of supplements including herbal remedies. If you are considering one. There is not much scientific evidence to support this at this stage. So far there is little evidence that dietary supplements improve arthritis or its symptoms. homeopathic medicines. Some doctors believe that special diets are worth trying. It doesn't 21 .’ Meriel Blake ‘Cod liver oil capsules seem to have been useless for me. Taking supplements can be expensive. ‘Ginger in capsule form really seems to help my arthritis. oranges and hard cheese all make the pain of my arthritis worse so I try not to eat them. Below are a few of the supplements most commonly taken by people with osteoarthritis. although research in this area is complicated and much more needs to be done. While it does not cure arthritis. Read Arthritis Care's Food for Thought booklet for further information on diet and arthritis.what works for someone else will work for you. some people believe that it does help ease the pain and stiffness of their osteoarthritis. Beware of diets that claim to cure osteoarthritis.

but minor ones include nausea and indigestion. New Zealand green-lipped mussels Researchers have found that both stabilised mussel powder and a lipid extract may be effective in reducing pain. It doesn't help everyone – if you have severe cartilage loss you probably won't get any benefit. There do not seem to be any serious side effects. is often taken in combination with chondroitin. it probably won't help you. must be taken for at least three to six months. swelling and stiffness in both osteoarthritis and rheumatoid arthritis. It could increase the chances of bleeding if you are taking any blood-thinning drugs. A daily dose. often in capsule form. 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. Glucosamine. Studies still need to be carried out on the possible long-term toxicity of taking fish oils. There is no proof that it reverses cartilage loss. Chondroitin Chondroitin sulphate exists naturally in our bodies and is thought to give cartilage elasticity and to slow its breakdown. so if you haven't seen an improvement after two months.help everyone. but some studies suggest that it helps stop joint degeneration. can produce a modest improvement in joint pain and stiffness and have a good record of easing the symptoms of osteoarthritis. Care should be taken not to exceed safe levels of vitamin A and D when taking cod liver oil. which comes in capsule form. Any benefit is lost when you stop taking it. like cod liver oil. 22 . In supplement form it is derived from the trachea of cattle or sometimes shark cartilage. and they switch off another enzyme known to cause much of the pain and inflammation of arthritis. The long-term effects of this supplement are not known. There are no known major side effects. and is often taken alongside glucosamine. Recent research has found that omega-3 fatty acids are effective because they reduce the activity of the enzymes responsible for cartilage damage. Fish oils Fish oils.

There are a multitude of different therapies. Some complementary therapies are available on the NHS and some private health insurance companies will pay for treatment. but I had to drive 15 miles there and back so by the time I got home.’ Anne Howard 23 . At the other end of the scale are therapies making highly dubious claims with little or no evidence to back them up. Like conventional medicine. ‘I managed to get on three 10week physiotherapy courses. I only had it done when the pain was really bad. However. other studies have shown no benefit. Some people find them helpful and others try them and choose not to continue. About 30 per cent of the UK population has used. Lifestyle changes like these may help to stabilise or improve your arthritis. what works for one person may well not work for another. Complementary therapies can play an important role in encouraging positive changes in lifestyle and outlook.However. such as increased self-reliance. or is using. So. This increases to nearly 60 per cent among people who have arthritis. The more concentrated versions are more likely to be effective. The hydrotherapy sessions were wonderful and I met lots of other people in a similar position. Some of the complementary therapies that are beneficial for osteoarthritis are listed over the page. a positive attitude. some form of complementary medicine. New Zealand green-lipped mussel extract commonly comes in capsule form.’ Jan Slaney ‘I had laser acupuncture done on my lower back. but at £25 a time. although doctors may vary in their attitudes to them. Complementary therapies Many people with arthritis have tried a range of complementary therapies in addition to the conventional drugs prescribed by their doctor. They can. Practitioners of these therapies may advise people to stop using conventional medications and they should be regarded with extreme caution. complementary therapies do not offer a cure for arthritis. learning relaxation techniques and appropriate exercises. Some of them are thoroughly reputable and are regulated by statutory bodies. Complementary therapies can generally be used alongside orthodox treatment. however. I undid all the good work. the majority of people who visit complementary therapists each year in the UK pay for their own treatment and they can be costly. it was just too much money. but nothing made a blind bit of difference to me. help alleviate some of the symptoms such as pain and stiffness as well as dealing with some of the unwanted effects of taking drugs.’ Anne Howard ‘I’ve tried everything for my arthritis. However.

An initial consultation will cost around £40 with subsequent visits from £25. Tel: 020 7284 3338. Alexander technique is generally taught oneto-one. Cheshire. The British Medical Acupuncture Society. Email: Admin@medical-acupuncture. The acupuncturist will ask about your lifestyle and medical history. Email: stat@stat. Higher Whitley. NW1 9AH. long standing complaints may need more. co-ordination and awareness. 129 Camden Mews.uk 24 . people can ease stresses on their body and alleviate conditions that are exacerbated by poor posture.org. feet and hands. your complexion and your tongue and look at how you walk. but feels as though you are being lightly pinched. By learning to stand and move correctly. sit and talk.Acupuncture Acupuncture is a traditional Chinese medicine that has been practised for thousands of years. Warrington. and you need regular practice to successfully change a lifetime of bad habits. Tel: 01925 730727. 12 Marbury House.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. Generally. London. legs. Acupuncture needles will be inserted into chosen points on the arms. By using needles at these special points. between three and six sessions are required. This is not painful. The Society of Teachers of the Alexander Technique. thereby relieving pain. Lessons last between 30 and 45 minutes and most people need between 15 and 30 lessons to become proficient.org. The first visit to an acupuncturist can take between 40 minutes and an hour. then examine you. imbalances in the flow of energy can be corrected. WA4 4QW. The theory is that health is determined by the flow of internal energy through the body. It aims to restore the natural balance of health by inserting fine needles into specific acupoints in the body. Some health insurance policies will cover the cost. Some GPs will you refer you on the NHS. It teaches pupils new ways of using the body to improve balance.

camomile. Aromatherapy massage combines the techniques of massage with the therapeutic properties of essential oils. especially the spine. some act as antiinflammatories. improving mobility and relieving pain. chiropractors claim that by regularly adjusting them they can keep them healthy and mobile. chemists and by mail order. Lean over the bowl with a towel over your head. used in baths or a burner – but one of the most common methods is as part of an aromatherapy massage. add six drops of oil to the water and lie back and relax for at least 10 minutes. Tel: 020 8251 7912 Chiropractic Chiropractic focuses on mechanical problems of the joints. The Aromatherapy Organisations Council represents 12 associations and 6. for up to 10 minutes. Pure essential oils can be bought at health food shops. AOC. While they cannot reverse the degeneration of joints with arthritis. For an aromatherapy bath. If you have any other health conditions.000 practitioners. Chiropractors use their hands to adjust the joints of your spine and extremities where signs of restriction in movement are found. Oils which are particularly good for muscular and joint aches and pains are rosemary. P O Box 19834. The oils then exert their effect both through the powerful aromas and by being absorbed through the skin. add four drops of oil to a bowl of steaming water. Essential oils can be used in many ways – vaporised. check if there are any oils you should avoid. the chiropractor will 25 . A full body massage will last between one and two hours and cost about £30-£35 per hour. To vaporise essential oils. some as antibiotics.Aromatherapy Aromatherapy uses essential oils obtained from plants to promote health and well-being. Each oil has its own range of properties – some are invigorating. some relaxing. inhaled. On your first visit. add two or three drops to water in the bowl of an oil burner and light the candle underneath. marjoram and juniper. For an inhalation. London SE25 6WF. reducing pain and helping to slow further degeneration.

Tel: 0118 950 5950. Reading RG1 1QB. 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. ‘I find massage really relaxing. increase the flow of blood and lymph and ease tension. Blagrace House. contact: The British Chiropractic Association. infection or sometimes if osteoporosis is suspected. Before starting treatment. a good massage leaves you feeling relaxed and cared for.probably take X-rays of your spine. The British Federation of Massage Practitioners. 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. I know it’s not going to make any difference to my arthritis. Lancashire P1 1TS. They may also give advice on lifestyle changes and exercises to do at home. Preston. Some private practitioners will come to your home. 78 Medow Street. On a physical level. a professional masseur will ask you about particular problem areas and general preference (a gentle touch or firmer pressure). Treatment should not be given where there is inflammation. This corrects structural and mechanical faults and allows the body to heal itself. £20-£30). massage can loosen stiff muscles. Enclose an SAE. Massage Massage is popular with many people with arthritis.’ Judith Morris Osteopathy Osteopathy focuses on the importance of the spine and peripheral joints for the proper functioning of all parts of the body. An initial assessment will take longer (about 30 minutes) and cost more (£35) than follow-up appointments (10-20 minutes. Tel: 01772 881 063. but being relaxed helps relieve the pain. improve the tone of slack muscles. Osteopaths manually adjust the alignment of the body and apply pressure to the soft tissues of the body. On a psychological level. An initial assessment is similar to that carried 26 . A full massage can last between 60 and 90 minute and costs around £30 per hour. To find out more about the general register of chiropractics. 17 Blagrave Street.

● Ask how much treatment will cost. talk to other people with osteoarthritis who have used the therapy you are thinking of trying. front or side. An initial assessment may take up to an hour and cost £30. improving mobility and reducing stiffness. Osteopathy House. The Balanced Approach. 176 Tower Bridge Road. ● If possible. ■ Finding a good therapist ● Although most people pay for their own treatment. ● The Institute for Complementary Medicines (see page 38 for contact details) can also help you find a qualified therapist.out by a chiropractor. but X-rays are rarely used. or sitting with your legs over one side of the couch and your back towards the osteopath. ● Tell your therapist about any drugs you are taking. and how many sessions you will need to feel a benefit. Ask them if they can recommend a therapist. Surgery While some people with arthritis will never need to have surgery. ● Ask if the therapist is a member of a professional body. Don't stop taking prescribed drugs without talking to your doctor first. but remember that what works for someone else may not suit you. Further examination is normally carried out in a variety of positions – lying on your back. and your doctor about the therapy. what kind of training they have had and how long have they been practising. some therapies are available on the NHS. Tel: 020 7357 6655. some people find it is very successful in relieving pain caused by arthritis. Ask if they have insurance in case something goes wrong. Surgery is a big decision to make and is usually only 27 . London SE1 3LU. so it is worth asking your GP if he or she can recommend a therapist or a particular therapy. The number of treatments required will depend on the nature of your problem. There is more information about complementary therapies in Arthritis Care's booklet. For further information contact: The General Osteopath Council. Follow-up appointments are usually around 20-30 minutes and cost approximately £20-£30.

‘Having my hip replacement was the best decision I’ve ever made. 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. They no longer see osteoarthritis as an inevitable part of ageing or a wear and tear disease. Recovery may take some time and a lot of effort on your part. unfortunately. including your orthopaedic surgeon. but it doesn’t limit me like it used to. It is a good idea to weigh up the pros and cons of surgery with your healthcare team. I chose to have a spinal block as I wanted to be awake. They now see real possibilities of understanding and controlling osteoarthritis in the future. I thought that if I could see what they were doing. The new one is far superior – it’s great. It does get better though. New developments In spite of great progress with artificial joints. The worst bit was waiting for it to be done. There is a risk the operation won't work. or will lead to further physical complications. there are.’ Meriel Blake ‘My knee replacement failed due to an infection setting in. Having surgery could bring about a dramatic improvement in your pain levels and quality of life. as I live alone. but recent research is uncovering the mechanisms which lead to joint damage as well as factors that control the healing response. You will find more information and advice in Arthritis Care’s Surgery booklet. We do not yet know the causes or the cure for osteoarthritis. My recovery started straight away.’ Mr Viv Williams considered after all other suitable treatment options have been explored and when the joint is badly damaged by arthritis. I could hardly leave the house before. You may still have to see the doctor from time to time to have your condition reassessed and your treatment plan discussed. 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. Surgery can also prevent joints deteriorating further and prevent disability. it would give me a sense of power and the confidence to get better.’ Joyce Cox ‘Three months ago I broke my hip replacement when I fell over. They gave me an epidural when I had the operation and I had no pain at all. 28 . 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.’ Mr Viv Williams ‘I think a long stay in hospital does affect you. Call 020 7380 6540. For example. still many people who have to live with their osteoarthritis and the daily pain it can cause. many people decide that the positive effects on their lifestyle will outweigh any risks. However. Doctors and research workers have changed their attitude a great deal in recent years. I still have a bit of pain. I think I’ve just been unlucky and it certainly hasn’t put me off trying again. but more as a major challenge and an important problem which they can one day solve.

I make a list before I go of criteria that must be met. The organisations listed on pages 38 and 39 of this booklet also have a wealth of practical advice and experience to share.’ Anne Howard ‘When it’s really cold. At home Most homes aren’t designed for people with arthritis. 29 . It’s far easier than trying to balance a tray.’ Jan Slaney ‘Use a small travel kettle rather than a large one if your wrists are weak. a cap gripper.’ Anne Howard Help with costs Your local social services department (social work department in Scotland. cupboards and gadgets.’ Anne Howard ‘I find a tea trolley is great for moving things around. It means that I don’t get something home and am then unable to use it. 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. and the latches and knobs on doors. I made sure that the fridge was at the top and the freezer at the bottom because I use the fridge more. or a trolley for moving heavy items across the room ● devices for turning taps more easily ● evening up your worktops. Men’s thermal boxer shorts are best because they are bigger and go almost down to my knees. they might include: ● rearranging cupboards and drawers so the things you use the most are nearby ● lightweight pans. health and social services board in Northern Ireland) may be able to help with equipment or adaptations to your home.PRACTICALITIES Living with osteoarthritis may not be easy. mugs or a kettle ● equipment with easy-to-use buttons and switches ● an electric tin opener. Some equipment may also be available on the NHS. When I need something new.’ Meriel Blake ‘I find that ceramic hobs are far easier to keep clean and I only use the top oven to avoid bending down. You are entitled to have your needs assessed – usually by an occupational therapist – to see whether you are eligible for help. so they are at the right height for you and you can slide things around. for instance. There are lots of handy gadgets and useful adaptations that can help around the home. or knives and peelers with padded handles ● a stool to sit on while you are preparing food. If your needs change. ‘I’m very conscious of the heights of furniture.’ Jan Slaney ‘Reaching things high up and low down is difficult so I now arrange my things so that they are within easy reach. Eligibility varies throughout the UK and you may have to contribute towards the cost. Local home improvement agencies and voluntary organisations also offer help or funding for equipment and adaptations. It’s the same with the fridge. such as chairs. You may also have to wait a long time for an assessment or equipment. In the kitchen. contact social services so they can move you up the waiting list. I find that wearing thermal shorts under my trousers really helps to keep my hip joint warm. or raising the oven and fridge. but there are plenty of sources of help.

tools and aids can add up. See page 38 for more details. Help varies a lot from area to area.’ 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. the assessment must also take their needs into account. contact your local social services department. or getting a handyperson in for bigger tasks. and try them out before buy them. ● Gas. Ask yourself: will this solve the problem or create new ones? ● Your occupational therapist can help you find the right equipment or adaptations.’ Anne Howard Gadgets. If you have a specific carer. Other people If you find you are doing a lot of work around the home. the Disabled Living Foundation (call 0870 603 9177) holds the most comprehensive database on equipment. You could also think about paying a cleaner. ● Many national and local disability organisations – such as disabled living centres – offer information. get as much information as you can. supermarkets and hardware shops often sell labour-saving devices and daily living equipment. Local 30 . ● High street stores like chemists. advice and the chance to try out a range of products. As well as being a Disabled Living Centre. If a wheelchair or electric buggy makes life easier for you. I used to have to drape myself across a trolley. what about getting someone else to help? Friends and family may be able to lend a hand. The cost of purchasing ‘Don’t let your pride get in the way of using equipment that may really help you in the end. or to give you support with personal tasks.■ Care assessment You have the right to an assessment of your care needs at home – again. electricity and phone companies often offer disabled people help with advice. or look in the Yellow Pages under Disability. products or services. such as cleaning and shopping. ● 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. If you are thinking of buying your own. but social services may be able to arrange for care workers to visit you for domestic care. ● Arthritis Care’s helplines team can also help with suggestions (see back page). then go for it. and maybe able to lend you some to try out.

and help people understand what osteoarthritis means for you.’ Jan Slaney 31 . honest and clear about your needs. or making the move from benefits to work.organisations may be able to put you in touch with volunteers to help you with jobs around the house. It really kept me occupied. The best policy is to be positive.’ Mr Viv Williams ‘I was an occupational therapist and the manager of a residential care home. There is also financial and practical help on offer if you want support finding work. but I had to give it up due to my OA and fibromyalgia.’ Anne Howard ‘I had to give up working in a charity shop. equipment or adaptations to your workplace. Reaching Independence. relaxing. Depending on how your arthritis affects you. Contact the organisations listed on page 38 for more details. but had to give up in the end. There’s lots more information about home life in Arthritis Care’s booklet. Smarter ways of working will help protect your joints and conserve energy. using computer equipment correctly. such as car adaptations or taxi fares. This could be by providing things such as a support worker. pacing yourself and varying tasks ● flexibility – perhaps working a shorter day or different hours. Ask your local council. ‘After I gave up work I went back to university and got a degree in behavioural sciences. They can include: ● organising your work – rearranging work area. I just thought: I can’t do this anymore. citizens advice bureau or library if they know of a local volunteers’ organisation which can help. Disability employment advisers are based at your local Jobcentre and offer support and advice to disabled people and employers. An occupational therapist can help you figure out what you need to do to make working life easier. I just couldn’t cope with getting in and out of the car. I fought and fought. handling application forms and interviews. 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. and work-related expenses. Contact your local Jobcentre for more information. taking regular breaks. 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. I can now only drive about a 20 mile radius. or being based at home some of the time if that fits in with your job. as can a disability employment adviser.

moving your workspace to the ground floor. you may be eligible for a disabled students’ allowance. which means that you will be allowed to park in a designated parking space closer to your destination. It is important to discuss options before deciding to give up work. If it becomes difficult for you to use public transport or drive a car. 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 . or retraining you and reallocating your duties. If you are going into higher education (post18). There are some transport schemes and services run by local authorities. training. For more information. Remember that giving up work doesn’t mean that you are giving up your life: retraining. ● You can apply for a blue badge. contact Skill (see page 39). You don’t have to be a full-time student to get it. These can include changing the working environment. promotion and dismissal and only if you fit the definition.’ Judith Morris Getting around is very important. And there are often so many steps at stations. further education and voluntary work may all open new doors. Information for people with arthritis looking for – or already in – work can be found in Arthritis Care’s booklet Working Horizons. But you will only be protected by the DDA if your employer knows about your arthritis. Transport ‘I find trains very hard to get on and off. The allowance is intended to cover any extra costs or expenses students have because of a disability. and voluntary and commercial organisations to allow you to maintain your mobility.the time may come when you need to consider changing jobs. However. 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. service provision throughout the UK can be patchy. The DDA also covers recruitment. 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. your life can become very restricted.

For further details visit the Department for Transport website at www. help you plan and book your journey and arrange any assistance you need. available from any train station. 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. a headrest. train and minicab services in their area. carried my case and asked someone else to help me on to my connecting train when it came. ● Most international airports produce their own disability access guides. You don’t even have to stand at the actual bus stop – they stop and pick you up just if they see you. library or local newspaper may also be able to tell you about what’s on offer locally. national and international travel.’ Meriel Blake 33 . See page 39 for details. and some run their own transport schemes. Get their details from the National Railway Enquiries Line on 08457 484950 or the Rail Travel for Disabled Passengers booklet. If you prefer to get around by wheelchair or scooter.dft.’ Judith Morris ‘People have been generally very kind to me when using public transport. and any other schemes run by voluntary or commercial organisations. The booklet also tells you how to get a disabled person’s railcard. Ask the Mobility Advice and Information Service (MAVIS) for a list of centres. again the Motability scheme can help.uk ● Some local authorities (in the phone book) produce guides to accessible bus.gov. If you need a specially adapted car. Public transport isn’t all bad. ● Individual railway operating companies can give you information. extra side-mirrors or a wide-angled mirror – may make driving easier. Don't forget to tell the Driver ‘Buses are great where I live.’ Meriel Blake ‘I can’t use public transport – it’s too far from my house and buses don’t come often enough. contact an accredited driving assessment centre. ● For more ideas. ● Your local disability organisation (in the phone book). you may be able to use it to hire or buy a car through the Motability scheme (see page 39). I have to rely on my car. An automatic gearbox and power steering can be essential for many people with osteoarthritis as they reduce strain on joints and muscles.travelling in. If you get the higher rate of the mobility component of the disability living allowance. If you prefer to drive then just a few minor adjustments – such as a padded steering wheel. ● Tripscope (see page 39) runs a free information service and can help you plan local. A nice train conductor helped me off the train at Manchester once.

However. are tax free and are paid in full on top of other income and all other benefits you get. DLA and AA are not means tested. your local council may run a scheme making you exempt from paying for public transport. but reapplied and was awarded it without quibbling. 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. Call 0800 882200 ● Arthritis Care's booklet.’ Joyce Cox ‘I didn’t want to use the Motability scheme because I didn’t want to be locked into a three-year contract. My car has everything I need – fully adjustable seats and electric windows. DLA and AA Whether you are working or not. before you start. Claiming benefits can be complicated and time consuming so.’ 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. If you are disabled or over 60. which aims to advise disabled people of their benefit entitlements and assists them in making a claim. Benefits for Beginners. if anything goes wrong with it. It has allowed me to do and have the things which I would have had to give up. but what a fight that was. It took two and a half years to thrash it out. 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. . They also mean you may qualify for other benefits or help. like running a car.’ 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. 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). so it is worth applying for them if you think you are eligible. it’s my responsibility. You may be eligible for free or discounted travel too.’ Anne Howard ‘The DLA has helped me. 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. I was turned down to begin with. Don’t be put off if your claim is initially unsuccessful. Benefits ‘I am eligible for the DLA low rate care component and the higher rate mobility component. It is worth reapplying as many people go on to qualify on further attempts.Vehicle Licensing Authority (DVLA) and your insurance company if your arthritis affects your ability to drive. If you are 65 or over you may be entitled to attendance allowance (AA) for help with personal care. Contact your local council or social services for more details.

Reflect the bad days as well as those when you can manage. Keep a diary over a couple of weeks. Any occupational pension or health insurance you receive may reduce the amount of incapacity benefit you are paid. you may be able to claim incapacity benefit. I had to fight for DLA and got it in the end. there are several other benefits you can apply for such as income support. Benefits for Beginners guides you through the forms and helps you think out things to mention. in Northern Ireland. 35 . ‘The Benefits for Beginners booklet is absolutely excellent for benefit information. whether you are in work or out of work even if your income is quite high. working tax credit (WTC) can top up earnings if you are on a low income. Child tax credit (CTC) is also available if you are responsible for children.’ 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. See Arthritis Care's Benefits for Beginners for more details on other benefits. You usually need to have paid a certain amount of national insurance contributions to get it. there is no upper limit on the amount of savings you can have. Other benefits If you are on a low income. 0800 220674). 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. The Benefits Enquiry Line (BEL) is a free telephone information service. Unlike disabled person’s tax credit which WTC replaced. you are asked to explain how your condition affects you. but it can provide answers to any questions about benefits. thank goodness.When you apply for DLA or AA. listing any things you have trouble doing and the time it takes you to do them. so you don't underestimate how much help you need. Tel: 0800 882200 (or. then fight. It cannot deal with claims. Incapacity benefit If you can no longer work because of osteoarthritis or other health problems. If you get turned down. but income from savings will be taken into account. pension credit (if you are over 60). housing benefit and council tax benefit.

and there are ways to overcome the loss of strength. However. I thought I could do anything. You may not be the type of person who expresses their emotions freely. Nothing is more annoying than when someone says: “But you look so well”. but it is good to let your emotions out. You may find Arthritis Care’s booklet. Don't be surprised if you feel frustrated one day and perhaps angry the next. The best thing is to be positive.Your emotions ‘Since my hip replacement I do still have the odd black day. Not all people experience the same symptoms. Bottling them up can make things worse. The operation was such a challenge and I was on a high for quite a long time. but not know how. Talk to your partner about how you feel. we know that pain is high up on the list as well as fatigue and a whole host of other physical symptoms.’ Veronica Jones ‘I think that self-management is a wonderful thing. things get a bit more complicated. Well informed friends and family members will be in a much better position to help you should the need arise.’ Mr Viv Williams 36 Everyone's experience of arthritis is different.’ Anne Howard ‘The invisibility of the pain of osteoarthritis is most frustrating for me. Some people find that their lives do not change that much and that they can more or less carry on as normal. grip and mobility. stiffness and inflammation relieved. Your relationship may come under a bit of strain too. the more powerful you feel. 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. Our Feelings. Your relationships Sharing information about your condition with family and friends can really help them to understand what you’re going through. but of course I couldn’t and this frustrated me. The more you know about your condition. just how does arthritis feel? Depending on how advanced your arthritis is. But when it comes to emotions. level of pain or the same feelings. feeling positive one week and negative the next. People you are close to may really want to help. So. Our Emotions.’ 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. 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. Talking and listening is key. Pain can usually be controlled.’ Meriel Blake ‘I had a gruelling time after my knee replacement.’ 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. both physically and emotionally and encourage them to ask questions If you are feeling stiff or having trouble moving . Your own reactions to arthritis will differ from time to time. there comes a time when you realise that you are making progress. I was quite down. Remember though. 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. helpful.

If you like and trust them. Try different positions. ● Talk to somebody who understands how you are feeling. ● Get out and about – keeping up with friends may become tricky if you are having problems with your osteoarthritis. handling pain. 37 . There will be times when you are just too tired or painful to get close to your other half. Despite this. There are ways round things – it’s a lot to do with your own attitude. ‘When I feel achy and stiff I get bad tempered and depressed. frustration. you will feel more positive and it will make it easier to approach them if you have a problem. depression and fear are all very understandable and very common. supporting your body with pillows and cushions to make love-making more comfortable. and remind yourself about what you can do and enjoy. ● Include exercise in your day. and even a hug can be difficult if you are in pain. focuses on what you can do for yourself. Several things may help. and keeping active.’ 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. helpful. help you to keep flexible and boost your mood. fatigue and depression. ● Accept your limitations. ● Find out as much as you can about your arthritis. it is hard to be spontaneous. see the back page. Our Relationships. You could even try persuading your partner to give you a gentle foot or back massage. but there are alternatives.’ Pennie Cumming ‘Friends mean well. Anger. Focus on the here and now. Don’t be embarrassed to raise the issue with your healthcare team. A warm bath or shower beforehand will help to loosen your joints. I will just go out and do it again because even if I’ve got OA. Our popular course. I often stubbornly keep going when common sense tells me I should stop and rest my joints. The first time I used a wheelchair at the mall. relaxing. we had a real laugh together – it took away the embarrassment. your arthritis will get on top of you. rather than the things you can’t. ● Try to build a good relationship with your health professional. However. it certainly hasn’t got me. My daughter has been excellent. 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.’ Pennie Cumming Living well From time to time. uncertainty. I still grow tomatoes and have very good neighbours who help to pick them for me. how to get the most from your health professionals. Our Sexuality. It is a great chance to meet with others in the same position. though.Challenging Arthritis. but they’re not necessarily tactful. but try to make space for your social life. I’ve been really hurt by what people have said. It will build your strength. You may find Arthritis Care’s booklet.around.’ Jan Slaney ‘I had to give up gardening – I used to have an allotment. It will make you feel less worried about the future. For more on what Arthritis Care offers. This could be someone close to you or someone else with arthritis.

uk Funds medical research into arthritis and produces information. Health services NHS Direct Tel: 0845 4647 www. Pain management Pain Society 21 Portland Place London W1B 1PY Tel: 020 7631 8870 www. Tel: 020 7357 6480 www. Chesterfield Derbyshire S41 7TD Tel: 01246 558033 www. Sat. London SE1 1LB.uk Provides information on disabled living centres (demonstration and resource centres for disabled people) around the UK.nhs.radar.org.uk Researches and publishes guides on services and equipment.org Information about chronic pain and pain clinics. 9am to 1pm.uk Umbrella body.arc.org. Benefit Enquiry Line for disabled people Tel: 0800 882200 Mon – Fri.org. RADAR 12 City Forum 250 City Road London EC1V 8AF Tel: 020 7250 3222 www.uk Information about health.30am to 6.cot.dlf.uk Advice and information on equipment.disabilityalliance.org Provides a welfare rights service and information on benefits. local NHS facilities and waiting lists. Mon and Wed 2-4pm www.org. Pain Concern PO Box 13256.dialuk. Send large sae and state the therapy. Manchester M8 8QA Tel: 0161 834 1044 www. 38 .csp.uk Details on local practitioners. National Centre for Independent Living 250 Kennington Lane London SE1 5RD Tel: 020 7587 1663 www.org. 4 St Chad’s Street. College of Occupational Therapists 106-114 Borough High Street Southwark.icmedicine.org. Can put you in touch with qualified practitioners locally. 8.nhsdirect.ncil. 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.uk Details on local practitioners.USEFUL ADDRESSES General arc (Arthritis Research Campaign) Copeman House St Mary’s Court St Mary’s Gate.org.org.uk Details of your nearest disability advice and information service. Disabled Living Foundation 380-384 Harrow Road London W9 2HU Tel: 020 7289 6111 Helpline: 0845 130 9177 www. Complementary therapies Institute for Complementary Medicine PO Box 194 .dlcc. Daily life Disabled Living Centres Council Redbank House. Chartered Society of Physiotherapists 14 Bedford Row London WC1R 4ED Tel: 020 7306 6666 www.co.Tavern Quay London SE16 7QZ Tel: 020 7237 5165 www.uk Promotes personal assistance and other aspects of independent living.painsociety. DIAL UK St Catherine’s Tickhill Road Doncaster DN4 8QN Tel: 01302 310123 www.30pm. Haddington East Lothian EH41 4YD Tel: 01620 822572 Information and helpline. Ricability 30 Angel Gate City Road London EC1V 2PT Tel: 020 7427 2460 www.ricability.org.uk National campaigning organisation which also publishes a wide range of information on general disability issues.

training and employment for young people and adults with disabilities.co. Bath BA3 3YB Tel: 01761 471771 Medical helpline: 0845 450 0230 www.dppi.org.mobilityunit.uk Support for people with disabilities to use computer technology.gov. 39 .dft. Rights and discrimination Disability Rights Commission DRC Helpline Freepost MID 02164 Stratford-upon-Avon CV37 9BR Tel: 08457 622 633 www. Crowthorne Berks RG45 6XD Tel: 01344 661000 www.uk Provides cars and powered wheelchairs through the Motability scheme. Pregnancy and parenting Disabled Parents Network Unit F9.tripscope.org Works to eliminate discrimination against disabled people. Department for Transport Mobility and Inclusion Unit.abilitynet.nos. 118 Great Minister House. Disability Pregnancy and Parenthood International Unit F9. Harlow Essex CM20 2ET Tel: 01279 635666 www.org.uk Arranges travel for people with disabilities. 76 Marsham Street London SW1P 4DR Tel: 020 7944 8300 Order your Get Wheelchairwise and Wheels within Wheels leaflets from here. National Osteoporosis Society Camerton.htm Driving training.org. 89-93 Fonthill Road London N4 3JH Helpline: 0800 018 4730 www.co.uk Information about further. information and assessments. Gill Avenue Bristol BS16 2QQ Tel: 08457 585641 www.drc-gb.disabledparentsnetwork . Station Approach. Mobility Advice and Information Service (MAVIS) Macadam Avenue.org. 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. 89-93 Fonthill Road London N4 3JH Tel: 0870 241 0450 www.bacp.skill.uk Details of local counsellors.uk Information and advice for disabled parents.org. Warwick Warwickshire CV34 5WS Helpline: 0800 269545 www.uk Tripscope The Vassall Centre. Warwickshire CV21 2SG Tel: 01788 550899 Information line: 0870 443 5252 www. Old Wokingham Road. higher and continuing education.uk AbilityNet PO Box 94. Other British Association for Counselling and Psychotherapy BACP House 35-37 Albert Street Rugby.motability.uk/ mavis/mavadv.org.Getting around Motability Goodman House.

weekdays 12 noon-4pm on a freephone helpline (0808 800 4050).arthritiscare. It aims to empower people to take control of their arthritis. Email: thesource@arthritiscare. and 70.Arthritis Care is the largest UK-wide voluntary organisation working with and for all people with arthritis. Design: Jon Heal. Edited by Kate Llewelyn. Registered Charity No.000 supporters.org. It is also available 10am-4pm charged at the national rate. Email: Helplines@arthritiscare. Scotland and Northern Ireland. Arthritis News ● campaigns for greater awareness of the needs of all people with arthritis ● has a local office in Wales. ARTHRITIS CARE: ● provides a helplines service by telephone and letter. Fax: 020 7380 6505 www. Published by Arthritis Care. a helpline service for young people with arthritis by telephone.org. 1st Edition. letter and email.. Phone 020 7380 6540 to find your nearest one. It has over 500 branches and groups.org.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. and four regional offices in England.uk ● offers The Source. November 2003 ACR124 ISBN 1 903419 31 X . 206563. their lives and their organisation. Thanks to members of Arthritis Care’s readers’ panel and Arthritis Care’s medical advisory group for their guidance in producing this booklet. Tel: 020 7380 6555. London NW1 2HD Tel: 020 7380 6500. Production: Chris Hogg.uk Written by Sarah Rastrick. Freephone: 0808 808 2000 weekdays 10am2pm. Arthritis Care 18 Stephenson Way. Printed by Manor Creative.

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