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OSTEOARTHRITIS OF THE KNEE

An Information Booklet

OSTEOARTHRITIS OF THE KNEE

CONTENTS
2 Introduction 2 What is osteoarthritis? 3 How does osteoarthritis of the knee develop? 6 What causes osteoarthritis of the knee? 7 Does osteoarthritis of the knee vary for different people? 8 How can I tell if I have osteoarthritis of the knee? 8 How do doctors diagnose osteoarthritis of the knee? 9 What are the prospects if I have osteoarthritis of the knee? 10 How can osteoarthritis of the knee be treated? 12 What can I do to help myself? 18 Are there any likely complications with osteoarthritis of the knee? 19 Questions and answers 22 Glossary 23 Useful addresses
© Arthritis Research Campaign 2004. All rights reserved. Published June 2004 Useful addresses checked/updated: October 2007

Introduction
This booklet aims to help people who have osteoarthritis of the knee, and their families and friends. We first explain how osteoarthritis of the knee develops, how you can recognize the symptoms, and how doctors diagnose and treat it. We then offer hints and advice on living with it more easily, including answers to common questions. Near the end of the booklet you will find addresses of organizations that can offer further help, including information on how to contact the Arthritis Research Campaign (arc). There is also a brief glossary of medical words (like cartilage). We have put these in italics when they are first used in the booklet.

How does osteoarthritis of the knee develop?
To understand how osteoarthritis develops you need to know how a normal joint works. A joint is where two bones meet. Most of our joints are designed to allow the bones to move in certain directions. The knee is the largest joint in the body, and also one of the most complicated because it has many important jobs to do. It must be strong enough to take our weight and must lock into position so we can stand upright. But it has to act as a hinge, too, so we can walk. It must also withstand extreme stresses, twists and turns, such as when we run or play sports. The knee joint is where the thigh bone (femur) and shin bone (tibia) meet. The end of each bone is covered with cartilage which has a very smooth, slippery surface. The cartilage allows the ends of the bones to move against each other almost without friction. The knee joint has two extra pieces of cartilage (called meniscal cartilages or menisci) which help to distribute the load evenly within the knee. A normal knee joint is shown in Figure 1.
Thigh bone (femur) Capsule Synovium Meniscus Thigh muscle Tendon Knee cap (patella) Cartilage Shin bone (tibia) Tendon

What is osteoarthritis?
Osteoarthritis is a disease which affects the joints in the body. The surface of the joint is damaged and the surrounding bone grows thicker. ‘Osteo’ means bone and ‘arthritis’ means joint damage and swelling (inflammation). When joints are swollen and damaged they can be painful. They can also be difficult to move. Some other words are used to describe osteoarthritis, including ‘osteoarthrosis’, ‘arthrosis’ and ‘degenerative joint disease’. Osteoarthritis of the knee is a very common form of osteoarthritis. Other joints which are often affected include joints in the hands, the spine, the hip joint and the big toe joint (see arc booklet ‘Osteoarthritis’).

Figure 1. A normal knee joint (side view)

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The joint is surrounded by a membrane (the synovium) which produces a small amount of thick fluid (synovial fluid). This fluid helps to nourish the cartilage and keep it slippery. The synovium has a tough outer layer called the capsule which helps hold the joint in place. The knee cap (patella) is another important part of the knee joint. The underneath of the patella is also covered with cartilage. The patella is attached to the thigh muscles by a very large tendon. The patella is fixed to the bone just below the knee joint at the front of the tibia. The tendons are strong connecting tissues which attach the muscles to the bones on either side of the joint. They also help to keep the joint in place. When a muscle contracts it shortens, and this pulls on the tendon attached to the bone and makes the joint move. Figure 2 shows how the muscles are attached to the bones above and below the joint. The knee joint is held in place by four large ligaments. These are thick, strong bands which run within or just outside the joint capsule. Together with the capsule, the ligaments prevent the bones moving in the wrong directions or dislocating. The thigh muscles (quadriceps) also help to hold the knee joint in place.
Muscle Thigh bone (femur) Knee cap (patella) Tendon Muscle Shin bone (tibia)

When a joint develops osteoarthritis, the cartilage gradually roughens and becomes thin. This happens over the main surface of the knee joint or at the cartilage underneath the patella. The surrounding bone reacts by growing thicker. The bone at the edge of the joint grows outwards (this forms osteophytes or bony spurs) (see Figure 3). This bone growth can affect both the femur and the tibia, as well as the patella. The synovium swells slightly and may produce extra fluid, which then makes the joint swell. This extra fluid causes what some people call ‘water on the knee’. The capsule and ligaments slowly thicken and shrink, as if they were trying to push the joint back into shape. The muscles that move the joint gradually weaken and become thin or wasted. This can make the knee joint unstable so that it ‘gives way’ when you put weight on it. When we look at an osteoarthritic joint under a microscope, we see that the joint is trying to repair itself. All the tissues are more active than usual. New tissues, such as the bony spurs (osteophytes), are produced to try to repair the damage. In some types of osteoarthritis, especially in the small finger joints, the repair is successful.
Wasted muscle

Roughened back of patella Damaged cartilage Lipping of bone (osteophyte or ‘spur’)

Figure 2. How the muscles are attached to the bones

Figure 3. A knee joint with osteoarthritis

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This explains why many people have osteoarthritis but experience very few problems. Unfortunately, in osteoarthritis of the knee the repair does not usually work. Osteoarthritis may then seriously affect the joint, making it painful and difficult to move. Osteoarthritis is a slow process that develops over many years. In most cases there are only small changes which affect only part of the joint. Sometimes, though, osteoarthritis can be more severe and extensive. In severe osteoarthritis the cartilage can become so thin that it no longer covers the thickened bone ends. The bone ends touch, rub against each other, and start to wear away. The loss of cartilage, the wearing of bone, and the bony overgrowth at the edges all combine to change the shape of the joint. This forces the bones out of their normal positions and causes deformity.

Osteoarthritis of the knee is also more common in some racial groups than others. For example, it is more common in Afro-Caribbean people than in white people. Osteoarthritis of the knee is common in people who are overweight, especially middle-aged women. Being overweight also increases the chances of osteoarthritis getting worse once it has developed. Normal use does not normally lead to osteoarthritis, and neither does exercise (including running) unless it is excessive. However, injuries to the knee joint often lead to osteoarthritis in later life. A common cause is a tear of the meniscal cartilage or ligaments after a twisting injury. This is a common injury in footballers, who can face extra risks. The damaged cartilage can lead to osteoarthritis in later life, and we now know that the operation to remove the torn cartilage (meniscectomy) substantially increases the risk of osteoarthritis developing after a number of years.

What causes osteoarthritis of the knee?
Many factors seem to increase the risk of osteoarthritis developing in the knee joint. The risk does increase as we get older, but osteoarthritis of the knee joint is not a problem in all elderly people. It often runs in families. Genetic factors are very important. Genes may affect collagen, one of the main building blocks of cartilage, or the way the bone reacts and repairs itself, or even the inflammatory process. Osteoarthritis of the knee is twice as common in women as in men. It mainly occurs in women who are over the age of 50, but there is no strong evidence that it is directly linked to the menopause. It is often associated with mild arthritis of the joints at the end of the fingers (causing bony swellings called Heberden’s nodes).

Does osteoarthritis of the knee vary for different people?
Osteoarthritis of the knee affects different people in different ways. Some people have a problem with only one knee, others with both knees. Pain is the main problem for some people, while others find their main problem is difficulty in walking. Some people may notice little change in their condition over the years, while in other people the osteoarthritis keeps getting worse. As a result, it is not very helpful to compare the experience of one person with another, and we cannot predict the eventual outcome for any one individual with osteoarthritis.

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How can I tell if I have osteoarthritis of the knee?
People with osteoarthritis of the knee joint usually complain that the knee is painful or aching. Your knee joint may feel stiff at certain times, often in the mornings or after rest. Walking for a few minutes usually eases the stiffness. You may have pain all around the joint or just in one particular place, and the pain may be worse after a certain activity, such as using stairs. The pain is usually better when you rest. It is unusual to have pain in the knee joint which wakes you up at night, except in severe osteoarthritis. You will probably find that your pain will vary. There may be good days and bad days, or even good and bad months, for no apparent reason. Changes in the weather may make a difference in some people. All joints have nerve endings which are sensitive to pressure. The nerve endings may respond to the drop in atmospheric pressure which occurs before it rains. If you develop more severe osteoarthritis, your movement will be restricted. Walking any distance or climbing stairs can be a problem. Sometimes your knee joint may give way because of weak thigh muscles or damaged ligaments.

The thigh muscles are usually thinner and weaker than normal. With very severe osteoarthritis in the knee, the knee joint will tend to give way because of the damaged ligaments.

What tests can show osteoarthritis?
There is currently no routine blood test for osteoarthritis, although blood tests are sometimes used to rule out other types of arthritis. The x-ray is the most useful test to confirm osteoarthritis. Often it will show the space between the bones narrowing as the cartilage thins, and changes in the bone such as spurs (see Figure 4). Although the x-ray helps the diagnosis, it cannot predict how much trouble you will have. An x-ray that looks bad does not necessarily mean a lot of pain or disability. Rarely, a magnetic resonance imaging (MRI) scan of the knee can be helpful. This shows the soft tissues (e.g. cartilage, tendons, muscles) which cannot be seen on an x-ray.

Narrowed joint space from thinning cartilage A large osteophyte (‘spur’)

How do doctors diagnose osteoarthritis of the knee?
Your doctor will be looking out for the problems mentioned above. When your joints are examined, your doctor can feel the bony swelling and creaking of the joint and see any restricted movement. Your doctor will also be looking for tenderness over the joint, and any extra fluid. 8

Figure 4. X-ray of the knee joint showing osteoarthritic changes (front view of left leg)

What are the prospects if I have osteoarthritis of the knee?
Osteoarthritis does not always get worse. Most people with osteoarthritis carry on a normal life and do not become severely disabled. For many people, osteoarthritis 9

reaches a peak a few years after the symptoms start and then either stays the same or gets a little easier. However, osteoarthritis of the knee can worsen as the years go by, and it may become painful and disabling. Sometimes osteoarthritis gets better on its own, but this is unusual. Doctors cannot predict the outcome for individuals, although if you are overweight, bow-legged and often have a swollen knee you will probably do worse. However, there are a number of treatments that can improve symptoms, and certain changes in lifestyle can greatly reduce the risks of osteoarthritis progressing. Regular appropriate exercise, protecting the joints from further injury, and maintaining an ideal weight through healthy eating will all help. (See arc booklet ‘Diet and Arthritis’ and leaflet ‘Keep Moving’.)

risks of heart attack and stroke, so they are not suitable for people who have had either in the past, or for people who have uncontrolled high blood pressure. All NSAIDs may cause other side-effects such as rashes, headaches and wheeziness. (See arc leaflet ‘Non-Steroidal AntiInflammatory Drugs’.) Sometimes an injection of steroids may help, either into a tender spot around the knee or even into the joint itself. The effect can last for several months. Injections of hyaluronan (Synvisc, Hyalgan, Durolane) may also help by supplementing the joint’s natural synovial fluid.

Can surgery help?
Most people with osteoarthritis of the knee will never need surgery. But operations are sometimes used for badly damaged joints. These include joint replacement. A replacement knee joint is shown in Figure 5. Doctors will consider this for someone who is barely able to walk and who is in constant pain. (See arc booklet ‘A New Knee Joint’.) Sometimes, if your knee locks, ‘keyhole’ surgery techniques are used to ‘wash out’ loose fragments of bone

How can osteoarthritis of the knee be treated?
There are no cures for osteoarthritis. But there are many treatments. Treatment can help to: • relieve the discomfort and pain • reduce the stiffness • reduce any further damage to the joint.

Can drugs help?
At the moment there are no drugs which are proven to stop osteoarthritis worsening. But several drugs can help you deal with the symptoms. Painkillers (such as paracetamol) and anti-inflammatory and paprika (capsaicin) creams to rub into the knee can help pain and stiffness. Some people find them more helpful than others. (See arc leaflet ‘Drugs and Arthritis’.) Anti-inflammatory drugs (NSAIDs) help some people more than paracetamol but they can cause stomach ulcers. Newer NSAIDs called COX-2s are less likely to cause stomach problems but have been linked with increased 10

Femur

Patella

Femoral component

Tibial component

Tibia

Figure 5. X-ray of a replacement knee joint showing the two artificial parts (components) securely attached to the bones

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and other tissue from the joint. This is called arthroscopic lavage and is sometimes carried out during the course of a diagnostic arthroscopy. Rarely, additional procedures may be carried out – such as smoothing the surfaces of the joint, removing flaps of damaged hard cartilage, and trimming torn soft cartilage. This is called debridement. These techniques may offer pain relief in the early stages of osteoarthritis, but they cannot repair the damage caused by the osteoarthritis.

Can swimming or pool treatment help?
Swimming can be a very good way of exercising and keeping fit as it causes little pain. Water supports the body’s weight so that little force goes through the joints as you exercise. Also, warm water relaxes muscles and joints and is very soothing, allowing joints to move more freely. Prescribed exercises in a hydrotherapy pool can help get muscles and joints working better, without undue pain. Supervised swimming in natural spa waters is an ancient treatment – it is the exercise that helps rather than any healing properties of the water itself! (See arc leaflet ‘Hydrotherapy and Arthritis’.)

What can I do to help myself?
You can make a major difference to your osteoarthritis of the knee in two ways: 1. Lose weight (if overweight). Many people with osteoarthritis of the knee are overweight. Studies have shown that people who lose weight have fewer knee problems in the future than those who do not. Being overweight is also bad for your general health and increases the risk of heart disease, strokes and diabetes. So you should eat a balanced, healthy diet and keep your weight as close as possible to the ideal for your height and age. 2. Quadriceps (thigh muscle) exercises. The quadriceps muscles at the front of the thigh become weaker in everyone with osteoarthritis of the knee, because the normal nerve supply to the muscles is reduced. To overcome this it is essential to exercise the quadriceps muscles as often as possible (see the exercises shown on pages 14–15). It has been proved that strengthening these muscles not only improves your mobility but also reduces pain. Studies have shown that patients who can lose weight and do these exercises can improve their osteoarthritis most.

Figure 6. Swimming is good exercise.

How active should I be?
Joints do not wear out with normal use. In general, it is much better to use them than not to! However, you must strike a sensible balance between too much activity and too much rest. Most people with osteoarthritis find that their joints stiffen up if kept still for too long.

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Quadriceps (thigh muscle) exercises
The most important thing is to choose exercises which you can do regularly. The easiest one to do is when sitting down in a chair. 1. Straight-leg raise: sitting Get into the habit of doing this every time you sit down. Sit well back in the chair with a good posture. Straighten and raise the leg, hold it for a slow count to 10, then slowly lower it. Repeat this several times with each leg – at least 10 times with each. If this can be done easily, repeat the exercises with a weight on the ankle (buy ankle weights from a sports shop or improvise, for example with a tin of peas in a carrier bag wrapped around the ankle). 2. Straight-leg raise: lying Get into the habit of doing straight-leg exercises in the morning and at night while lying in bed. With one leg bent at the knee, hold the other leg straight and lift the foot just off the bed. Hold for a slow count of 5 then lower. Repeat with each leg 5 times every morning and evening. 3. Muscle stretch At least once a day when lying down do the following exercise. First, place a rolled-up towel under the ankle of the leg to be exercised. Then bend the other leg at the knee. With the straight leg, use your leg muscles to push the back of the knee firmly towards the bed or the floor. Hold for a slow count of 5. Repeat with each leg 5 times. Not only does this exercise help to strengthen the quadriceps muscles, but also it prevents the knee from becoming permanently bent. 4. Clenching exercises During the day, whether standing or sitting, get into the habit of clenching and releasing the quadriceps muscles. By constantly stimulating the muscles, they become stronger. 14
Quadriceps muscle

1. Straight-leg raise: sitting

2. Straight-leg raise: lying

3. Muscle stretch

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For most people with osteoarthritis the best advice is ‘little and often’: a little rest, followed by a little exercise. For example, do the housework or gardening in short spells interrupted by short rests. Avoid sitting in one place for too long – get up and stretch the joints from time to time. Break up a long car journey with frequent stops to walk around. Activities which cause severe pain afterwards are probably best avoided. If for some special reason you do need to do a lot extra, it can help to take a painkiller before you start. Even if the activity does cause extra pain you are unlikely to damage the joint, but your doctor or therapist will advise you if you are worried about this. (See arc leaflet ‘Keep Moving’.)

• • • •

bent. Even if the pain is severe, always fully straighten the knee several times a day. Wear cushioned training shoes as much as possible to act as a shock absorber for the knee. Keep using your knee, but rest it when it becomes painful and start again later. Use a stick to take the weight off the joint if you need to, but keep moving! Use a hand-rail for support when climbing stairs. Go upstairs one at a time with your good leg first. Come downstairs with your bad leg first followed by good, always using a rail for support.

What about diet and dietary supplements?
A large amount of research is being done on diet, nutrition and osteoarthritis. Many books, articles and advertisements claim benefits for particular diets or food supplements, but at the moment most are not supported by strong evidence. Many people try glucosamine and chondroitin tablets that they buy themselves from health food shops and chemists. These products may also be available on prescription. The reason behind their use is that joint cartilage normally contains glucosamine and chondroitin compounds and taking supplements of these natural ingredients may help improve the health of damaged osteoarthritic cartilage. Current research is trying to establish whether this is true. Nevertheless, many people report them to be effective and at least they appear to be safe, although they should not be taken by people who have an allergy to shellfish. They may need to be taken for several weeks before any pain relief is apparent. For information on other aspects of diet, including oily fish and fish oils, see the arc booklet ‘Diet and Arthritis’. 17

Can heat or other remedies help?
Warmth or other remedies applied to the affected area often relieve the pain and stiffness of osteoarthritis. Heat lamps are popular, but you can get a similar effect more cheaply with hot-water bottles (be careful, though – it is easy to burn yourself with either). There are also many creams, available at the chemist, that can produce localized heat. These measures make no long-term difference to the disease, but they can give you temporary relief. Used carefully, they are safe and soothing. Some people feel that copper bracelets help, although there is no evidence that these or other such measures can affect osteoarthritis.

What else can I do?
There are a number of things you can do: • Make sure that you do not keep your leg bent in the same position for long periods. For example, do not put pillows under your knee at night. This may ease your pain for a while, but if you do it regularly it will affect the muscles and may leave your leg permanently 16

Who can I ask for advice?
As well as doctors, other health care professionals can help. Physiotherapists and occupational therapists can advise on exercise, heat and other treatment. If you have trouble in activities at home, such as bathing, using stairs or getting in and out of bed, they can advise on equipment to help you. Your GP or hospital doctor can refer you to one of these services for an assessment if necessary. Friends and family can help with shopping and domestic tasks, but remember to keep as mobile and independent as possible. (See arc leaflets ‘Physiotherapy and Arthritis’, ‘Occupational Therapy and Arthritis’.)

Sudden flare-ups of pain
It is quite common to have mild flare-ups. Sometimes they can be more severe and last longer. The joint may swell markedly. In most patients this is caused by inflammation and swelling of the lining of the joint; rarely this is caused by chalky crystals forming in the cartilage (see arc booklet ‘Pseudogout and Calcium Crystal Diseases’). The extra fluid is not good for the joint. Your doctor will usually attempt to drain off the fluid and may give a steroid (cortisone) injection at the same time to prevent it happening again.

Popliteal cysts
Popliteal (or Baker’s) cysts can form when the joint has been damaged by arthritis. They are often painless, but you may be able to feel a soft lump at the back of the knee. Sometimes a cyst can cause aching or tenderness when exercising, or the knee may give way. Occasionally a cyst can press on a blood vessel, which can lead to swelling in the leg, or the cyst may burst (rupture), which can be very painful. If you have pain or swelling in your calf, you should consult your doctor because these symptoms could indicate a more serious condition. Cysts can generally be treated by drawing off the extra fluid from the knee joint using a syringe (this is called aspiration) and injecting a steroid solution.

Are there any likely complications with osteoarthritis of the knee?
Most people do not suffer any complications. The problem often settles down to be a nuisance rather than a major problem. However, complications do occur occasionally in some people.

Rapid deterioration
This is more likely to affect older people with a severe form of the disease. The pain can increase with a reduction in mobility within a few weeks or months. This is rare and occurs in less than 1 in 20 people with osteoarthritis of the knee.

Questions and answers
Does the weather really affect osteoarthritis?
As mentioned earlier, painful joints are often sensitive to the weather. They tend to feel worse when the atmospheric pressure is falling, such as just before it rains. This helps to explain how some people with osteoarthritis can predict rain, and why joint pains seem linked with the damp. 19

Loss of stability
If the ligaments are damaged or the muscles have weakened, the knee joint can give way if weight is put upon it. You should be able to prevent this if you take regular exercise to move the knee joint. 18

However, there is no evidence that different climates have any long-term effect on osteoarthritis or its outcome. The weather may temporarily affect symptoms but not the arthritis itself. There is no point in moving to a different area in the hope of curing osteoarthritis. Osteoarthritis occurs all over the world, in all types of climate.

Who should I listen to?
Many well-meaning people offer advice. Magazines and the media are full of articles on arthritis and its treatment. Some offer new hope, others offer a special diet or medicine with miracle properties. Discuss things with your doctor and think about the advice in this booklet before spending money on new unproven ideas.

How important is it to keep my spirits up?
Depression, low morale, and poor sleep can all make pain worse – they can lower your threshold to pain. If you become depressed, your pain may feel worse. You might go to the doctor and be given bigger doses of tablets to relieve the pain. But sometimes what you really need is help for the depression and the demoralising effect of arthritis. If the depression is lifted, the pain becomes less. Some antidepressant drugs help pain directly. A positive and hopeful approach is half the battle, though this is easier said than done. Make every effort to make life fuller and more interesting than before. Your morale will drop after too much rest and inactivity, whereas hobbies and interests take your mind off your problems. Sleep is important. Taking a painkiller last thing may help if pain disturbs your sleep. If you have enjoyed vigorous activity and sport, you may have to develop less active pastimes, but there is no reason to let osteoarthritis get you down or stop you doing most everyday activities. Cycling and swimming are particularly good for knee problems. 20

Figure 7. Keeping your spirits up is important.

What does research mean for the future?
We do not yet know the causes or the cure for osteoarthritis. However, recent research, much of it sponsored by arc, is uncovering the mechanisms which lead to joint damage as well as the factors which control the healing response. For example, we now know much more about the importance of genetic factors and the chemicals which thin out the cartilage. We are now testing new drugs that inhibit these chemicals and finding out how genes work. We are also testing magnets, acupuncture and the best forms of exercise. Studies are also uncovering ways of predicting whose disease is likely to get worse, and new tests are likely to be available in the future. Cartilage transplants are now being tested in younger patients and may be a future treatment. 21

Glossary
Arthroscopy – a method of viewing the inside of a joint using a special instrument (the arthroscope) which is inserted through a small incision under a general anaesthetic. The technique can be used to carry out treatment or surgery using miniaturized instruments (often called ‘keyhole’ surgery) in rare cases, or to help with diagnosis. Capsule – the tough, fibrous sleeve around a joint; its inner layer is the synovium. Cartilage – strong, tough material on the bone ends that helps to distribute the load within the joint; its slippery surface allows smooth movement between bones. Collagen – the building material of tissues. Femur – the upper-leg or thigh bone – the longest bone in the body. Heberden’s nodes – firm, bony swellings of the end joints of fingers, often painless when fully formed – the hallmark of finger osteoarthritis. Ligament – tough, fibrous bands which hold two bones together in a joint. Magnetic resonance imaging (MRI) – a type of scan which uses a strong magnetic field to build up pictures of the inside of the body. It works by detecting water molecules in the body’s tissue which give out a characteristic signal in the magnetic field. Menisci – free rings of cartilage, like washers, lying between the cartilage-covered bones in the knee. Each knee has an inside (medial) and outside (lateral) meniscus.

Osteophytes – overgrowth of new bone around the sides of osteoarthritic joints, also known as ‘spurs’. Patella – the kneecap, a small bone that helps the front thigh muscles work the knee. Synovial fluid – the fluid produced by the synovium to nourish and lubricate the joint. Synovium – the inner layer of the capsule that produces synovial fluid. Tendon – strong fibrous guiders that connect muscles to bones. Tibia – the lower-leg or shin bone – the second largest bone in the body.

Useful addresses
The Arthritis Research Campaign (arc) PO Box 177 Chesterfield Derbyshire S41 7TQ Phone: 0870 850 5000 www.arc.org.uk As well as funding research, we produce a range of free information booklets and leaflets. Please see the list of titles at the back of this booklet. Arthritis Care 18 Stephenson Way London NW1 2HD Phone: 020 7380 6500 Helpline (freephone): 0808 800 4050 www.arthritiscare.org.uk Offers self-help support, a helpline service, and a range of leaflets on arthritis.

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Dial UK (Disability Information & Advice Line) St Catherine’s Tickhill Road Doncaster S Yorks DN4 8QN Phone: 01302 310123 www.dialuk.org.uk The helpline will put you in touch with a local office for information in your area. Disabled Living Foundation (DLF) 380–384 Harrow Road London W9 2HU Phone: 020 7289 6111 Helpline: 0845 130 9177 www.dlf.org.uk Offers advice and information on equipment to help you in daily activities.

Booklets and leaflets
These free publications are available from arc. Please send for our order form (stock code 6204) which gives a summary of the topics covered or write to: arc T rading Ltd, James Nicolson Link, Clifton Moor, York YO30 4XX for up to 3 titles.
SPECIFIC CONDITIONS TREATMENTS AND SURGERY

Ankylosing Spondylitis Antiphospholipid Syndrome (APS) Back Pain Behçet’s Syndrome Carpal Tunnel Syndrome Fibromyalgia Gout Joint Hypermobility Introducing Arthritis Lupus (SLE) Pain in the Neck Osteoarthritis Osteoarthritis of the Knee Osteomalacia (Soft Bones)* Osteoporosis Paget’s Disease of Bone Polymyalgia Rheumatica (PMR) Polymyositis and Dermatomyositis Pseudogout Psoriatic Arthritis Raynaud’s Phenomenon Reactive Arthritis Reflex Sympathetic Dystrophy Rheumatoid Arthritis Scleroderma The Painful Shoulder Sjögren’s Syndrome Tennis Elbow Vasculitis
LIVING WITH ARTHRITIS

Complementary Therapies Hand and Wrist Surgery A New Hip Joint Hydrotherapy and Arthritis A New Knee Joint Occupational Therapy and Arthritis Physiotherapy and Arthritis The Rheumatology Nurse Specialist Shoulder and Elbow Joint Replacement
CHILDREN AND TEENAGERS

When Your Child Has Arthritis Growing Pains (for children) Da Kimzta Has a Joint Injection (for children) Knee Pain in Young Adults Arthritis: a Guide for Teenagers Tim Has Arthritis (for children) When a Young Person Has Arthritis
DRUG INFORMATION

Caring for a Person with Arthritis Diet and Arthritis Fatigue and Arthritis Feet, Footwear and Arthritis Gardening and Arthritis Looking After Your Joints Keep Moving Pain and Arthritis Pregnancy and Arthritis Taking Part in Research Sexuality and Arthritis Sports and Exercise Injuries Work and Arthritis Work-Related Rheumatic Complaints

Drugs and Arthritis (general info.) Adalimumab Azathioprine Ciclosporin Cyclophosphamide Etanercept Gold by Intramuscular Injection Hyaluronan Injections Hydroxychloroquine Iloprost Intravenous Immunoglobulin Infliximab Leflunomide Methotrexate Mycophenolate Non-Steroidal Anti-Inflammatory Drugs Pamidronate Rituximab Local Steroid Injections Steroid Tablets Sulfasalazine * Also available in Bengali, Gujarati, Hindi, Punjabi and Urdu

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Arthritis Research Campaign

How we raise our funds
We constantly need to raise money by our own efforts to fund our work. As well as a head office fundraising team we have an extensive network of regional staff, volunteer fundraising groups and charity shops throughout the UK.

The Arthritis Research Campaign (arc) is the only major UK charity funding research in universities, hospitals and medical schools to investigate the cause and cure of arthritis and other rheumatic diseases. We also produce a comprehensive range of over 90 free information booklets and leaflets covering different types of arthritis and offering practical advice to help in everyday life. arc receives no government or NHS grants and relies entirely on its own fundraising efforts and the generosity of the public to support its research and education programmes. Arthritis Today is the quarterly magazine of arc. This will keep you informed of the latest treatments and self-help techniques, with articles on research, human interest stories and fundraising news. If you would like to find out how you can receive this magazine regularly, please write to: Arthritis Research Campaign, Ref AT, PO Box 177, Chesterfield S41 7TQ.

Where our money goes
Every year, we raise approximately £25 million to fund around 350 research projects across the whole of the UK. In addition, arc funds the Kennedy Institute of Rheumatology in central London, at a cost of £4 million per year. We also set up the arc Epidemiology Unit in Manchester, currently funded at £1.8 million per year, which collates data on arthritis and its cost to the community.

Photo courtesy of the Eastbourne Gazette

Please add any comments on how this booklet could be improved.
Feedback is very valuable to arc. However, due to the volume of correspondence received, we regret that we cannot respond to individual enquiries made on this form.

Information on drugs
Separate arc leaflets are available on many of the drugs used for arthritis and related conditions. We would recommend that you read the relevant leaflets for more detailed information about your medication.

Please return this form to: Arthritis Research Campaign, PO Box 177, Chesterfield S41 7TQ
The Arthritis Research Campaign was formerly known as the Arthritis and Rheumatism Council for Research. Registered Charity No. 207711.
6027/OAK/04-3

A team of people contributed to this booklet. The original text was written by a doctor with expertise in the subject. It was assessed at draft stage by doctors, allied health professionals, an education specialist and people with arthritis. A non-medical editor rewrote the text to make it easy to understand and an arc medical editor is responsible for the content overall.

Printed on 75% recycled paper

Cover illustration © Sara Hayward 1998. All rights reserved.