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    dodgy-knee.jpg
    Lisa Bywaters
    18/May/2023
    Health InformationMSK articles

    Got dodgy knees? Find out what helps.

    Do you have osteoarthritis in your knees? Does the pain sometimes interfere with your ability to be as quick or mobile as you’d like? If so, you’re not alone – it’s a big club!

    Osteoarthritis (OA) is the most common type of arthritis, affecting 1 in 11 Australians. It can develop in any joint but commonly occurs in weight-bearing joints like your knees. And because it’s so common and causes lots of pain and distress, we’re all looking for effective treatments to manage the pain and keep moving.

    The good news is there’s strong evidence about the most effective treatments for knee OA, those that aren’t effective, and those that don’t have enough evidence to support their use.

    And yet, a recent study has shown an increasing number of people with OA are investigating some less effective treatments such as stem cells, platelet-rich plasma, and Botulinum toxin.

    There are likely many reasons for this.

    We’ve become much more familiar with searching online for information during the pandemic.

    Information about the effectiveness (or not) of treatments isn’t always translated for consumers. And unfortunately, to access much of this information, you need access to journals and databases that are often behind a paywall.

    Another problem is that it’s easy for anyone to create a video, blog, or social media post about the latest and greatest treatment without using current evidence. Their reasons for doing so can be many – from sharing personal experiences in the hopes of helping others to purely commercial gain. This info is everywhere online, easily accessible and often looks legitimate.

    So you need to weigh any information carefully, be cautious and discuss your options with your doctor.

    Here’s a snapshot of what we know works (or doesn’t) for knee OA

    Staying active and exercising regularly

    You had to know this was coming 😉. Research has repeatedly shown that exercise is key in managing knee OA (and other musculoskeletal conditions). A tailored exercise program developed by a physiotherapist or exercise physiologist can help reduce knee pain and improve knee function. If pain prevents you from exercising, you may find that warm water exercise is a good starting point. Warm water pools offer the comfort of warmth and the buoyancy of the water to ease the load on your joints.

    Managing your weight

    Being overweight or obese is directly related to the risk of developing knee OA. It’s also likely to speed up how quickly your OA develops or progresses. Evidence shows a relationship between weight loss and relief of symptoms such as pain and stiffness. But weight loss can be a long process for many people. And it’s challenging, especially when pain affects your ability to be as active as you’d like. However, it’s good to know that any weight loss can reduce your pain and increase your ability to exercise. So making small, achievable changes to your eating and exercise habits can bring big results. If you’d like to lose weight to improve your symptoms, your doctor and/or dietitian can assist you in losing weight safely.

    Dealing with stress and your emotions

    It’s natural to feel stress, anxiety and frustration when living with chronic pain. However, if you’re always fearful or worried about it, it can worsen your pain. That’s because pain isn’t just a physical sensation – it also involves your perceptions, feelings and thoughts.

    The worse you think your pain will be, the worse it can feel. It can affect your sleep, and you become less active. These feelings, thoughts and behaviours can become a vicious cycle.

    Talking with a family member, close friend, or a health professional about how you’re feeling can get it out in the open so you can start dealing with these feelings and hopefully break this cycle.

    Strategies like breathing exercises, cognitive behavioural therapy (CBT), meditation, heat, and gentle activities like tai chi, walking, swimming, and cycling can also help you control your stress and anxiety.

    What about medicines?

    No medicine can affect the underlying disease process of OA. Still, combined with self-care and lifestyle changes, medicines may provide temporary pain relief and help you stay active.

    There are a variety of medicines used in the management of knee OA, and each comes with varying degrees of evidence to support their use. They may be taken by mouth as a tablet or capsule (orally), applied directly to the skin in the form of gels and rubs (topical), or injected into the joint (intra-articular). Discuss the benefits and risks with your doctor if you’re interested in the following medicines.

    Non-steroidal anti-inflammatory medicines or NSAIDs (e.g. Nurofen, Celebrex, Voltaren). Depending on the dosage and other ingredients, NSAIDs are available over-the-counter or with a prescription. Oral NSAIDs are the preferred first-line drug treatment for OA and have been shown to reduce pain and symptoms in knee OA.

    It’s important to note that NSAIDs are designed to be taken at low doses for short periods. Always talk to your doctor before starting NSAIDs, as they can cause harmful side effects, especially in older people.

    Paracetamol (e.g. Panadol, Panamax). Research has shown that paracetamol provides only low-level pain relief and, in some cases, no pain relief compared to a placebo in knee OA. However, some people report that it helps reduce their pain so they can be more active. If you can’t take NSAIDs, they may also be an option. Before using paracetamol, talk with your GP to see if it’s appropriate.

    Some medicines aren’t effective

    Other medicines have been used for OA in the past that we now know aren’t effective and may have harmful side effects.

    Opioids. Opioids are powerful pain-relieving medicines. They’re effective at reducing acute pain (or the pain resulting from an injury or surgery), but evidence shows they have little effect on OA pain. Opioids also have many potentially serious side effects. That’s why they’re not recommended in the management of knee OA.

    Capsaicin. Capsaicin is the active ingredient in chilli peppers – it makes them ‘hot’. Capsaicin in creams and lotions has been used to help reduce OA pain, and some people report beneficial effects. However, evidence for its effectiveness in knee OA is low, and it’s generally not recommended. It also has side effects when applied, such as a burning sensation, which can take several uses to wear off.

    Glucosamine and chondroitin. Studies have found no benefit from taking glucosamine and/or chondroitin for osteoarthritis.

    The pointy end of the stick – intra-articular injections

    Intra-articular injections are given directly into the knee joint. They include steroids, platelet-rich plasma, stem cells, hyaluronic acid and Botulinum toxin. Let’s look at them a bit more closely.

    Corticosteroid injections. If you have persistent knee pain and haven’t had relief from oral medicines or other treatments (e.g. exercise, weight loss), your doctor may suggest a corticosteroid (steroid) injection. However, the duration of pain relief can vary from a few days to a few weeks, and the number of injections you can have is limited due to potential harm. There’s also emerging evidence that long-term use of these injections may cause OA to worsen in the affected joint.

    Hyaluronic acid injections. The benefits of hyaluronic acid joint injections (also known as viscosupplementation or hyaluronan injections) are uncertain. Research findings have been inconsistent, and although some people find the treatment helpful, it can be expensive and isn’t generally recommended. The Australian Rheumatology Association states, “emerging evidence indicates that the effect of hyaluronic acid could be smaller than previously reported.”

    Platelet-rich plasma (PRP) injections. Platelets are small cell fragments in the blood that help form blood clots to slow or stop bleeding and help wounds heal. PRP is a concentrated version of a person’s platelets injected into the affected joint. An Australian clinical trial led by researchers at the University of Melbourne, University of Sydney and Monash University has found that PRP was no better than a placebo at reducing symptoms in people with knee OA.

    Stem cell injections. Despite being commercially available, there’s no evidence for using stem cell injections in treating knee OA. The International Society for Stem Cell Research and the Australian Rheumatology Association do not support using stem cell injections for osteoarthritis.

    Botulinum toxin injections. The American College of Rheumatology/Arthritis Foundation Guidelines states that the small number of trials that have looked at the use of botulinum toxin in knee and hip OA ”suggest a lack of efficacy”.(1)

    What about surgery?

    Surgery may be an option for some people with knee OA when all non-surgical treatment options have failed, and knee pain and reduced function impact their quality of life. In this case, your doctor may refer you to an orthopaedic surgeon to discuss your options.

    A total joint replacement of the knee is the most common type of surgery for knee OA. However, having an artificial knee means there will still be some limitations. An artificial knee won’t have the same sideways movement as a natural knee. It won’t bend fully, so getting down and up from kneeling is more likely to be challenging.

    Arthroscopy is a surgical technique that involves the insertion of small surgical instruments, including a camera, into the knee. This allows the surgeon to examine the inside of the joint and cut, shave and remove material from the inside of the knee joint. “The Australian Government and most orthopaedic surgeons recommend against using arthroscopy for osteoarthritis of the knee. Research shows that doing an arthroscopy for this condition isn’t effective. Arthroscopy should only be used for knee OA if other treatments fail, such as losing weight, exercising and taking pain relievers.” (2)

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    References

    (1) Kolasinski, S.L., et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis & Rheumatology (2020).
    (2) Arthroscopy, Healthdirect

    CONTINUE READING
    blog-heat-wraps.jpg
    Lisa Bywaters
    18/May/2023
    MSK articles

    Let’s wrap this up!

    Low-level heat wraps:
    The gentle solution for managing musculoskeletal pain

    By: Dr Peter McCann MRes (c), MAppSc, BAppSc, FASLM, FAICE

    Musculoskeletal conditions such as arthritis, back pain, tendonitis, and the pain and stiffness they cause can be debilitating, causing a significant impact on a person’s quality of life.

    Fortunately, many treatments are available to help manage these symptoms and improve overall wellbeing. This article will explore one such option – low-level continuous heat wraps and their benefits for people with musculoskeletal conditions.

    How do they work?

    Low-level continuous heat wraps provide gentle, consistent heat therapy to pain-affected areas. Unlike traditional heat products such as wheat bags or hot water bottles, which can quickly become too hot and uncomfortable, heat wraps use low-level heat, penetrating deep into the affected area without causing discomfort. This helps increase blood flow to the region, reducing inflammation and promoting healing. Heat wraps can help relieve pain and stiffness by reducing inflammation and promoting blood flow, making it easier to move and enjoy your daily activities. Unlike other heat therapy options requiring frequent reheating or readjustment, heat wraps provide continuous heat for up to 10 hours, allowing for long-lasting relief without constant reheating.

    What are the benefits?

    The benefits of low-level continuous heat wraps for musculoskeletal conditions are numerous. First and foremost, they provide immediate pain relief, making it easier to manage discomfort and carry out daily activities.

    Additionally, heat wraps have been shown to increase the range of motion and improve joint function, making it easier to move and engage in physical activity. This is key to promoting recovery from back pain.

    Heat wraps keep you mobile, unlike a wheat bag or hot water bottle that requires you to sit or lay down. By reducing inflammation, these wraps can enhance healing, speeding up the recovery process and helping to prevent further injury.

    Heat wraps may reduce the need for medication, making it possible to manage symptoms without relying on potentially addictive or harmful drugs.

    Finally, heat wraps can significantly improve your quality of life by relieving pain and stiffness, allowing you to focus on the activities and experiences that bring you joy and fulfilment.

    What’s the evidence?

    The Australian Clinical Care Standard for low back pain recommends using heat wraps as a first-line approach alongside other treatments, such as regular physical activity, to relieve back pain. Heat wraps are Australian Physiotherapy Association and Osteopathy Australia Association endorsed products and are registered medical devices used in major hospitals for pain relief.

    How are they used?

    Using low-level continuous heat wraps is simple. To begin, remove the wrap from its packaging and gently unfold it. Next, open one or two heat patches. They activate on exposure to air, taking 20 – 30 minutes to warm up.

    Insert the patches into the wrap and apply them over the affected area, ensuring it covers the entire region of pain or stiffness.

    Finally, secure the wrap using the included Velcro strips, careful not to apply too much pressure. Once in place, the wrap will provide low-level continuous heat therapy, which can be used for up to eight hours.

    For best results, using heat wraps regularly as part of a comprehensive treatment plan that includes exercise, medication, and other therapies as needed is recommended.

    The ingredients are non-toxic and eco-friendly, so they can be disposed of in the garden as a soil improver.

    Are there any precautions?

    Users should also be aware of any precautions or warnings associated with using the wraps, such as avoiding use on open wounds or irritated skin and sleeping with the heat wrap on. Before use, read the information provided carefully, or discuss this with your pharmacist.

    The wrap-up 😉

    In conclusion, low-level continuous heat wraps are safe and effective for managing musculoskeletal conditions such as arthritis, back pain, fibromyalgia and the pain and stiffness they cause.

    By providing low-level continuous heat therapy, heat wraps can offer immediate pain relief, increased range of motion, improved joint function, reduced inflammation, enhanced healing, and improved quality of life.

    Heat wraps can be used alongside other treatments to create a comprehensive care plan. I encourage readers to try these heat wraps and experience the benefits firsthand.

    Talk with your doctor, pharmacist, physiotherapist or exercise physiologist for more information.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
    Autumn.png
    Lisa Bywaters
    23/Apr/2023
    Health InformationMSK articles

    Walking in a winter wonderland

    How to keep up (or start) walking for health and pleasure when it’s cold outdoors

    It’s not quite winter yet, but it sure feels like it!

    And if you’re like me and love to get outdoors and walk, it can be a little tough staying motivated when it’s cold, wet and wintery. But there are things you can do to boost your motivation, stay active and even come to relish the experience of walking in colder weather.

    But, I hear you ask, why would any sane person want to get off their warm, cosy couch, put aside the remote control and brave the elements??? Because exercise doesn’t take a break for the colder months 😐 and we need to engage in regular, consistent exercise year round.

    And while it can be challenging at times, we all know how much better we feel after we hit the pool, go for a walk, or take part in an exercise class. Being active every day helps us manage our pain, get better quality sleep, and improve our mood. It also helps us manage our other health conditions. And it gets us out of the house so we can connect with others – our friends, teammates, gym buddies, and other people walking their dogs in the park.

    Knowing all of that doesn’t make it easy though, so here are some strategies to help you get out there.

    Timing is everything

    Plan to go walk when your body has had a chance to loosen up. Do some stretches, or have a warm shower to relax your muscles and joints so you can walk more easily and with less pain. The Arthritis Foundation has some basic stretches you can use before you head out the door.

    Dress for the weather

    Your usual exercise gear may not cut it when it comes to walking in colder weather. You need to think layers. The clothes closest to your skin should draw moisture away from the skin (known as wicking) so your skin doesn’t stay damp. It should also dry quickly. Look on the labels for mention of wicking or polypropylene. Avoid cotton. When cotton clothes get wet, they stay wet, making you colder.

    Next, add an insulating layer of fleece or wool to keep you warm. And finally, add a layer that will resist wind and rain. The beauty of layers is that you can take them off and put them back on if/when needed.

    Choose bright colours so you’ll be seen through the fog and rain, even on the greyest days 👕👚🦺. And at the risk of losing my Melbournian status 😉, there’s something lovely about ditching the black clothes and wearing bright colours on a gloomy day.

    There’s no such thing as bad weather, just the wrong clothing, so get yourself a sexy raincoat and live a little.“ Billy Connolly

    Now accessorise!

    I’m not talking bling here, 💎💍 though; like adding colour, bling can definitely brighten your day 😊. But I’m referring to appropriate socks and footwear. It’s best to wear walking shoes that are waterproof or dry quickly. And they need good traction – it can get very slippery out there! If you’ve got old shoes from last winter, check the soles to ensure they’re still ok.

    It’s important to know that the walking shoes you wear in warmer months are unlikely to be suitable for walking in colder months. The tops of these shoes are generally a lightweight mesh that lets air in to keep your feet cool. Not what you need on a cold walk!

    You also need to protect your extremities (this is a must if you have Raynaud’s). Wear gloves or mittens, a hat that covers your ears, a scarf, sunglasses and sunscreen. Even in the colder months, your skin can be damaged by the sun’s rays.

    Oh, and depending on the length of the walk you’re planning, you might want to take a lightweight backpack or bag for your water bottle and to store any of the layers you remove.

    Get a walking buddy

    Having a buddy to walk with can be fun and boost your motivation on cold days. This could be your partner, kids, family, friend, neighbour, pet 🐕🐈, or a walking group.

    Or go on your own

    Sometimes you just need some time to yourself.

    Be aware of the walking surfaces

    Slips, trips and falls are enemies of anyone with a musculoskeletal condition. So we need to take care out there. Uneven surfaces, moss, wet leaves or mud on footpaths and trails, and slick tiles at the shopping centre can all be dangerous. So keep an eye on the surfaces. And check out this info from MyHealth.Alberta.ca for some tips to lower your risk of falling.

    Explore new areas

    Whenever you can, take the time to explore new walking paths, rail trails, parks, or neighbourhoods. It’s amazing what you discover when you go beyond your own backyard.

    Always check BOM 💣

    Visit the Bureau of Meteorology (BOM) or your weather channel of choice, and get the weather and rain forecast. This will help you dress appropriately and may also affect your timing. If you like walking in the rain, you may decide to head out regardless. But if you’re not a fan, the radar will give you an idea of when to go (just don’t forget your umbrella – just in case).

    Take your phone

    It’s handy for listening to music, podcasts, and audiobooks and taking pics of the things you discover on your walk. It’s also essential for safety. Unfortunately, accidents can happen to us all, so stay safe and take your phone in case you need help. Or so you can call someone to pick you up if the weather becomes nasty!! 🚗🚓🚕

    Add some mindfulness to your walk

    Much of the pleasure of walking outdoors comes from enjoying the beauty of the changing seasons. So on your next walk, focus on your surroundings and how you feel. Try using the 5, 4, 3, 2, 1 method. For example:

    • What are 5 things you can see – e.g. the stripes on your gloves, the different hues of autumn leaves, a dog chasing a ball, fluffy clouds, ducks enjoying rain puddles.
    • What are 4 things you can physically feel: e.g. your feet on the ground, your partner’s hand, the wind on your face, the way your stride lengthens as you get into your rhythm.
    • What are 3 things you can hear: e.g. leaves crunching under your feet, children laughing, thunder in the distance.
    • What are 2 things you can smell: e.g. cut grass, rain coming.
    • What is 1 thing you can taste: e.g. your coffee traveller. ☕

    Walk indoors

    If you’re not a fan of exercising in cold and wet weather or you’re worried about slippery wet surfaces, walk indoors. Do laps of your home, hire/buy a treadmill, or walk briskly in your local shopping centre, gym or community centre.

    Stay hydrated

    Even though you may not be sweating as much as you would be on a hot day, your body is still losing water through your sweat and breathing. Take a water bottle with you and drink when you need to.

    Set yourself a goal

    If you’re still finding it hard to get motivated, set yourself a goal. It may be the ability to walk a certain distance without being out of breath or taking part in an upcoming fun run/walk. Choose something that matters to you, then create a SMART goal – that is, it’s Specific, Measurable, Achievable, Realistic and has a Timeframe. Read more about goal setting.

    “Sunshine is delicious, rain is refreshing, wind braces us up, snow is exhilarating; there is really no such thing as bad weather, only different kinds of good weather.” John Ruskin

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available Monday to Thursday between 9am-5pm on 1800 263 265 or email (helpline@msk.org.au) or via Messenger.

    More to explore

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    AS-blog.jpg
    Lisa Bywaters
    20/Apr/2023
    Health InformationMSK articles

    Walk like an Egyptian

    DYK for many years it was believed that ancient Egyptian pharaohs Amenhotep (Amenophis) II, Ramses II (“The Great”), and his son Merenptah all had ankylosing spondylitis (AS)? In 2002, scientists examined X-rays of their mummies and found what they believed were radiological signs of AS. Cool story. And, if you have AS, it’s a mic drop moment. 🎤 Boom!

    Unfortunately, this has now been debunked 😑 and the mummies show signs of a completely different condition. But let’s not let facts get in the way of a good story 😁. And let’s find out about AS.

    Ankylosing spondylitis is an inflammatory arthritis that causes inflammation in the spine and the joints that connect the lower spine to the pelvis (sacroiliac joints). This inflammation causes back pain, stiffness and reduced mobility in the spine.

    The good news is there are effective treatments for AS.

    What causes it?

    Ankylosing spondylitis is an autoimmune disease. That means it occurs as a result of a faulty immune system.

    Instead of identifying foreign bodies (e.g. bacteria, viruses) and attacking them to keep you healthy, your immune system mistakenly targets healthy tissue in and around your joints, causing inflammation and pain.

    We don’t know why this happens. Genes are thought to play a role. You’re more likely to get AS if your family has a history of it. Most people with AS have the gene called HLA-B27; however, this gene can also be found in people who don’t have AS.

    Since this gene doesn’t automatically lead to the development of AS, scientists believe a complex mix of genes and environmental factors may be involved.

    We used to think AS affected more men than women, but recent research suggests men and women are affected relatively equally. AS tends to develop in late teens and early adulthood.

    Symptoms

    The symptoms vary from person to person. The most common are:

    • Pain and stiffness in the back, buttocks or neck, often worse after waking or resting and relieved by exercise and movement.
    • Enthesitis, or inflammation and pain where tendons or ligaments connect to bone. Common areas for enthesitis are in the front of the chest where the ribs join the breast bone, the back of the heel (Achilles tendon) or underneath the foot.
    • Fatigue or extreme tiredness that doesn’t get better after sleep or rest.

    Other symptoms can include:

    In AS, due to chronic inflammation, new bone may grow around the joints in the spine. This can lead to permanent stiffness in the back and neck of some people with AS. In severe cases, the bones of the spine can fuse together; however, this can usually be prevented by starting appropriate treatment as early as possible.

    Symptoms may change from day to day. At times your symptoms (e.g. pain, fatigue, inflammation) can become more intense. This is a flare. Flares can be unpredictable and seem to come out of nowhere.

    Diagnosis

    If you have ongoing back pain and stiffness or other symptoms of AS, it’s essential that you see your GP. Getting a diagnosis as soon as possible ensures treatment starts quickly. This will give you the best possible outcomes.

    No single test can diagnose AS, so your doctor will use a combination of tests. They may include:

    • Your medical history. Your doctor will ask about your symptoms, family history and other health issues.
    • A physical examination to assess joint tenderness, flexibility, and stiffness.
    • Genetic testing to look for the HLA-B27 gene.
    • Blood tests to check for inflammation.
    • Scans such as an X-ray and MRI (magnetic resonance imaging) to look for joint inflammation and damage.

    Your GP will refer you to a rheumatologist if they think you have AS. Rheumatologists are doctors who specialise in diagnosing and treating problems with joints, muscles, bones and the immune system.

    Treatment

    Ankylosing spondylitis is treated using a range of different treatments, including medicines, regular exercise and self-care.

    Medicines

    The two main types of medicines used to treat AS and help manage its symptoms are NSAIDs and targeted therapies:

    Non-steroidal anti-inflammatory drugs (NSAIDs) are nearly always used as the first medicine to treat the pain, inflammation and stiffness of AS unless there’s a reason you can’t take them. Research shows that NSAIDs are very effective in managing symptoms of AS. Some people may need to take them regularly, while others will only take them as needed. This will depend on your symptoms and how you respond to the NSAID.

    Your rheumatologist will discuss how often you should take NSAIDs and their long-term benefits and risks. There are many different types and brands; some are over-the-counter, while others are only available on prescription.

    Targeted therapies are medicines that ‘target’ specific proteins in the immune system that produce inflammation. They include biological disease-modifying anti-rheumatic drugs (biologics), biosimilars and targeted synthetic disease-modifying anti-rheumatic drugs. These targeted treatments have dramatically improved the quality of life for people with AS who need more than NSAIDs to manage their condition.

    Your rheumatologist will talk with you about using these medicines if you need more than NSAIDs to manage your condition or if you can’t take NSAIDs.

    Exercise

    This is the most important thing you can do to help manage your AS. Exercise can improve symptoms, including stiffness, pain, fatigue, breathing capacity and posture. It helps increase your flexibility and range of movement, so it’s easier to do many everyday tasks.

    As soon as possible after receiving your diagnosis, you should ideally begin a personalised exercise program developed by a physio or exercise physiologist (EP) and aim to do some exercise every day. Being active is also essential for your overall health and wellbeing. It helps keep your muscles, bones and joints strong so that you can keep moving. It reduces your risk of developing other conditions such as heart disease, osteoporosis, diabetes and some forms of cancer. It boosts your mood, benefits your mental health, helps with weight control and improves sleep.

    Self-care

    As well as taking your medicines as prescribed and exercising regularly, there are other things you can do.

    Learn about your condition. Understanding AS allows you to make informed decisions about your healthcare and actively manage it.

    Manage your weight. Being overweight or obese increases inflammation throughout your body. This inflammation affects not only your joints but also blood vessels and insulin levels. This can increase your risk of chronic health conditions such as heart disease and diabetes. Losing weight is an important thing you can do to reduce your risk of these conditions and reduce your AS symptoms. Being overweight or obese also limits the effectiveness of some medicines used to treat AS. Losing weight can be challenging, so if you need to lose weight or advice on healthy eating, talk with your doctor or dietitian.

    Learn ways to manage your pain. Pain is the most common symptom of AS, so it’s crucial to learn ways to manage it effectively. Read our A-Z guide for managing pain for more information.

    Work closely with your healthcare team. The best way to live well with AS is by working closely with the people in your healthcare team (e.g. GP, rheumatologist, physio). Keep them informed about how you’re doing and if you’ve experienced any changes in your symptoms or tried new medicines, complementary therapies, supplements or other treatments.

    Use aids and equipment. Supports such as long-handled shoehorns, reachers and canes can reduce joint strain and make life easier, especially if your condition has reduced your flexibility and mobility. An occupational therapist can advise you on aids, equipment and home modifications.

    Sleep well. Not getting enough quality sleep can worsen your symptoms; however, getting a good night’s sleep when you have chronic pain can be difficult. If you’re having problems sleeping, talk with your doctor about how to deal with this.

    Manage stress. Stress can also aggravate your symptoms, so learning to deal with stress is extremely helpful. Things you can do to manage stress include planning your day and setting priorities, using relaxation techniques such as going for a walk, getting a massage or listening to music, and, where possible, avoiding people and situations that cause you stress.

    Practise mindfulness. Regularly practising mindfulness meditation can improve your mood, relieve stress, improve sleep, improve mental health and reduce pain.

    Eat a healthy, balanced diet. While there’s no specific diet for AS, it’s important to have a healthy, balanced diet to maintain general health and prevent weight gain and other health problems, such as diabetes and heart disease.

    Quit smoking. Smoking cigarettes harms your general health, negatively affects your bone health, and increases inflammation.

    Seek support from others. You might find it helpful to contact the Ankylosing Spondylitis Australia or the Ankylosing Spondylitis Group of Victoria and speak to others who have AS and know what you’re going through.

    Complications

    Some people with AS develop an eye problem called iritis or uveitis, which causes a painful red eye with blurred vision and sensitivity to light.

    If you develop eye symptoms, you’ll need to quickly get your eye checked and treated by an ophthalmologist. Treatment is usually with prescription eye drops, which reduce the chance of permanent eye damage.

    Understanding this risk and knowing what signs to be alert for can reduce the risk of eye damage. Ask your GP or rheumatologist what you should do if you develop any eye symptoms.

    One last thing

    If you think ankylosing spondylitis sounds like a dinosaur, you’re not far wrong. There was a dinosaur called an ankylosaurus. So, what you’ve lost in ancient pharaohs, you’ve gained with a very impressive dinosaur 🐉 😉.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
    parenting-blog.jpg
    Lisa Bywaters
    20/Apr/2023
    Health InformationMSK articles

    Planning to become a parent

    There comes a time in many people’s lives when the desire/hope/dream of becoming a parent takes hold. This is an exciting and anxious time for any person, but it can be made more challenging and stressful if you, or your partner, have a musculoskeletal condition.

    However, by working closely with your healthcare team and planning your pregnancy, you’ll be in the best position to have a safe pregnancy and a healthy baby.

    General planning

    Having a baby doesn’t happen in a vacuum. There are many considerations you need to take into account before becoming pregnant. The sooner you do this, the better.

    Pre-pregnancy health checks.

    Let’s put the musculoskeletal elephant in the room aside 🐘 🐘 for now. Potential parents should discuss many other things with their doctor to ensure they’re the healthiest they can be before conceiving. Some relate specifically to the person becoming pregnant, while others involve both parents-to-be. They may include:

    • Beginning folic and iodine supplements. Both are essential for your baby to grow and develop.
    • Other supplements may be necessary if you’re deficient or need help getting the essential vitamins and minerals through your diet. It’s important you discuss this with your doctor before taking any additional supplements.
    • Cervical screening.
    • Sexually transmissible infections (STI) screening.
    • Addressing lifestyle factors such as diet, exercise, smoking, alcohol and illicit drug use.
    • Having a dental check-up.
    • If you have a mental health condition, discuss how your pregnancy may affect your mental health and how you can manage this.
    • Ensuring your vaccinations are up-to-date.

    Consider the cost.

    The ugly truth is that having a baby is expensive – from medical and health bills to maternity and baby clothing, nappies, car seat, baby furniture, supplements, breast pumps, and formula 🍼👶. And there are many ongoing and future costs that you need to be ready for – food, healthcare, clothes, school costs, childcare, transport, shoes, and social and sporting activities 🛴🤸. Being prepared means that you can save and look at ways to budget for future costs. This Moneysmart article, ‘Having a baby: Budgeting for the costs of a baby’, has information, links and a budget planner to help you understand some of the costs you need to plan for.

    Which brings us to work.

    How long you and/or your partner choose to take for parental leave before and after the birth of your baby is an individual thing. Factors such as finances, your job/workplace, available leave etc., will impact this timing. Planning for this before you have a baby is a good idea.

    Baby furniture, equipment and other doo-dads.

    Preparing your home for a baby is important to ensure you and your baby are comfortable and safe. But there’s a big industry around baby bits and bobs. Raising Children Network has a very handy new baby checklist to help you prepare, including what’s essential and how to save money. Also, check out this ABC article, ‘Having a baby on a budget: What items can you buy second-hand?’ for more tips.

    Family planning and musculoskeletal conditions

    People with musculoskeletal conditions can and do have safe pregnancies and healthy babies. But the planning is even more critical.

    The first step is to gather your support team.

    Talk with your GP and rheumatologist about your plans. The best time to become pregnant is when your condition is well-managed and controlled. If your condition is active or flaring, it can harm you and your baby. By talking with your rheumatologist, you can develop a treatment plan to get your condition under control before you conceive.

    You’ll also see a midwife or obstetrician.

    A midwife is a health professional trained to provide support and care during your pregnancy, labour and birth. They’ll also provide you with support in the weeks after you have your baby. An obstetrician is a doctor trained to provide medical care during these times and has the skills to manage complex or high-risk pregnancies and births. Whether you see a midwife, obstetrician, GP, or a combination depends on where you plan to give birth and your health needs.

    You may see a physiotherapist and/or occupational therapist if needed. Physios use strategies such as exercise, massage, heat and cold, and education to help keep you moving and functioning as well as possible. An OT can help you learn better ways to do everyday activities and can provide information on aids and equipment to make tasks easier.

    Both can help you learn to manage your musculoskeletal condition and the changes your body is experiencing through pregnancy. They can also help you manage after birth.

    Other vital members of your support team will be your partner, family and/or friends 💜💚💛.

    Fertility

    Having a musculoskeletal condition generally doesn’t affect fertility. Some studies have shown that women with rheumatoid arthritis may take longer to conceive; however, it’s unclear if this is related to the condition, medicines, or other factors.

    Men with musculoskeletal conditions may find that some medicines affect their sperm count; however, this can often be reversed with a change of medicines.

    If you want to conceive, or you’re having problems conceiving, discuss this with your doctor.

    Medicines

    The use of medicines for most musculoskeletal conditions is a necessity. Active or flaring disease is harmful to both the mother and the baby, so continuing to take your medicines while trying to conceive and during pregnancy is vital.

    However, some medicines aren’t recommended during this time. They need to be replaced with safer or ‘pregnancy-compatible’ medicines. You may also need to stop taking some medicines for several months before trying to get pregnant.

    This will depend on the medicines you or your partner are taking. Your doctors will help you understand and plan for this to ensure the least pain and disruption, and ensure safer outcomes for all.

    The Australian Rheumatology Association has developed a resource, ‘Medications and pregnancy: Information for women and men with rheumatoid arthritis thinking about starting a family’, which goes through many medicines used for treating musculoskeletal conditions. This is a great guide to help you during your discussions with your healthcare team as you plan your pregnancy.

    It’s important to understand that some medicines can’t be stopped immediately. So although you may want to become pregnant quickly, to protect the health of the person taking these medicines, as well as future babies, it’s critical that you follow the advice of your healthcare team.

    You may also need to use contraception until it’s safe to conceive.

    Self-care

    The journey to parenthood is full of ups and downs. When you add a painful, chronic condition, it’s even more challenging. So taking time during the pregnancy planning stage to look after yourself is essential. That includes all the usual self-care strategies – exercising regularly, eating a healthy diet, getting good quality sleep, and looking after your mental health.

    Lupus

    Most women with lupus can have children. However, there’s an increased risk of complications. Again, that’s why planning your pregnancy for when your condition is well-managed and less active, and working closely with your healthcare team, is best for you and the baby. You’ll likely need blood tests before you conceive to check for the anti-Ro and antiphospholipid antibodies that may affect a baby. This would require more frequent fetal monitoring.

    Other ways to become a parent

    If you can’t become a parent biologically for whatever reason, there are other ways to become one. They include:

    While these options may not be what you’d initially dreamed or planned, they provide other choices for many people and may be worth exploring.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
    Carers-blog.jpg
    Lisa Bywaters
    20/Apr/2023
    Health InformationMSK articles

    Caring for the carer

    NB: This article refers to unpaid or informal carers – people who provide care to those who need it within an existing relationship, such as a family member, a friend or a neighbour (1) – and not professional carers.

    DYK, there are almost 2.7 MILLION carers in Australia?(2) That’s about 1 in 10 Australians 😮.

    Carers are incredibly diverse. They come from all backgrounds, lifestyles, genders and ages.

    You’re a carer if you care for a family member or friend with a physical or mental health condition, disability, or is frail due to old age.(3) You may share the caring role with others or do it alone. And the time spent caring for someone could be from a few hours a week to caring for them 24/7. You may be a carer for a short period while someone is recovering from an illness, injury or surgery or for a more extended or indefinite period.

    Being a carer can be very fulfilling and bring you closer to the person you’re caring for. But at times, it can also be demanding and stressful. Here are some practical tips to help you look after yourself and the person you care for.

    R.E.S.P.E.C.T – Find out what it means to me

    It can be difficult for any of us to accept that we need help. That our body or health has let us down, and we can’t manage on our own as we once could. This loss of independence can make us feel vulnerable, afraid, or angry.

    When you become a carer for someone, it’s essential that you ask about their needs and how they want to be treated. This gives them control over their life and choices. It also maintains their dignity.

    Respect goes both ways. Just as you must respect the person you care for and their choices, preferences and boundaries, they need to respect yours.

    Discuss boundaries. Doing this from the outset with clear, open communication is essential. What are the needs of the person you’re caring for? What do they want your help with? And what don’t they want help with? What are you comfortable or able to do? Over time, you may need to revisit this as circumstances and needs change.

    Understand personal choices. It’s sometimes hard for carers to understand why the person they care for may not follow suggestions made to them by health professionals, such as taking medicines as prescribed, exercising, or quitting smoking. Try to encourage – but not push or nag – the person you care for. But if you’re concerned their behaviour is adversely affecting their health, discuss it with them. Is there something that’s putting them off? Do they need more information so they can make an informed choice? Are they worried, scared, or unsure about the pros and cons of a treatment? Having a respectful conversation about these feelings is important. And you may need input from the relevant health professional to move forward.

    Have fun together. Don’t let your relationship be consumed by the caring role. Have a cup of tea, discuss things you enjoy, go for a walk, visit parks/galleries/cafes, or share a hobby. Doing things together that don’t relate to health issues will give you both balance and quality of life. ☕

    Care for yourself

    You can’t pour from an empty cup – so take care of yourself first. Caring is rewarding but also tiring, stressful, and often lonely. You need to take care of your own physical and mental health so that (a) you don’t fall in a heap and (b) you can continue to be a carer. If you’re running on empty, you can’t give your best as a carer, daughter, husband, sister, friend, mum etc. Ensure you get enough quality sleep, eat well, exercise regularly, relax and take breaks, meet up with friends, and accept your feelings. I know, that’s a lot. 😴 Especially if you’re also working and have a family and other commitments. But you need to make your health a priority.

    Look after your mental health. As a carer, you may experience a range of emotions that can be difficult to deal with. Be aware of and acknowledge these feelings. If you need help, discuss your situation with your GP, a psychologist, or the Carer Gateway phone counselling or online carer forum.

    Get support. It’s hard for most people to ask for help, but you don’t have to do things alone. Whether it’s having someone to talk to about your stress or anxiety, help around the house, or respite care, options are available. Talk with your GP, contact Carer Gateway, or talk with a friend or family member. You might also consider joining a peer support group or seeing a mental health professional.

    Attending health appointments

    When caring for someone, you may need to attend some or all of their health appointments. Before attending any, you should discuss your role at these appointments with the person you’re caring for. For example, are they happy for you to discuss their health and ask questions, or would they prefer you provide silent support?

    It’s a good idea to write a list of questions you’d both like to ask before you go. And, if there’s a lot, consider booking a longer appointment so you have the time to get through them.
    Attending appointments also ensures you know of any changes to their health condition/s and treatments.

    Managing medicines

    Find out about the medicines the person you’re caring for is taking – the type, dose, and any possible side effects.

    It’s easy to forget to take medicines regularly, especially if there’s more than one and they’re taken at different times of the day. Talk to your pharmacist about using a pill dispenser if this is a problem. They contain individually sealed compartments to help make taking medicine easier. You can buy a pill dispenser and do it yourself, or your pharmacist can do it for you.

    You can also arrange with the pharmacist to do a Home Medicines Review. This review ensures the medicines are safe, effective, and taken correctly.

    Making things easier

    Access services. Many services are available to help make things easier for you and the person you’re caring for. The Commonwealth Home Support Program provides a variety of services, including delivered meals, respite care, domestic assistance, community transport and much more. Contact My Aged Care or your local council for more information.

    Carer Gateway also provides info about accessing services to make life easier in and around the home.

    Pace yourself. Caring can take a toll on you physically and mentally. So pace yourself, and don’t try to do everything at once. For example, stagger the cleaning over several days instead of cleaning the whole house at once. Or cook meals in larger batches to freeze the leftovers for those days when you don’t feel up to cooking, or you’ve run out of time. By pacing yourself, you’ll have more energy and feel less frazzled – which is good for you and the person you care for.

    Investigate aids, gadgets and home modifications. There’s a huge range of aids and equipment available to help you manage. They can help reduce stress on muscles and joints, save energy, prevent fatigue, and make life easier – with everything from personal safety, bathing, writing, dressing, bedding, mobility, seating, and lifting.

    Simple things like long-handled shoehorns can allow the person you care for to put on their own shoes. Items such as grab rails in the bathroom can make bathing easier and safer. To find out more, speak with an occupational therapist.

    Sharing the care

    Caring, while fulfilling, can sometimes be challenging work. It’s essential that there are others who can share the work to make it easier for the primary carer. This help could be in the form of cleaning, shopping, or being available for you to talk to. 🧡

    As a carer, you need to know your limits and boundaries. For example, if you can’t lift the person you care for, seek alternative devices or assistance to make things easier. Occupational therapists can assess the home and suggest modifications, aids and equipment.

    Carer payments

    You may be eligible to receive government benefits to help you provide care. There are different payments depending on your circumstances and those of the person you care for. Visit the Services Australia website for more info.

    Planning ahead

    It‘s essential to think about Powers of Attorney and Guardianship if the person you care for can no longer make their decisions known. Planning ahead ensures that their wishes are met and they can make necessary plans.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    References

    (1) Australian Government. Australian Institute of Health and Welfare. Informal carers. 2021.
    (2) Australian Bureau of Statistics. 2018. Disability, ageing and carers, Australia: Summary of findings.
    (3) Australian Government. Department of Social Services. Supporting carers.

    CONTINUE READING
    Andrew-Zhang.jpg
    Lisa Bywaters
    20/Apr/2023
    Health Information

    A physio’s perspective: Ankylosing spondylitis

    In recognition of World Ankylosing Spondylitis Day on Saturday 6 May, Andrew Zhang, a rheumatology physiotherapist, has written this blog.

    My name’s Andrew, and I work at a large tertiary hospital in Sydney. I have the privilege of working with some amazing rheumatologists in the management of people living with ankylosing spondylitis (AS).

    Ankylosing spondylitis is an uncommon disease that isn’t well recognised. Even some health professionals struggle to identify it early on. It’s frequently mistaken as common back pain, with the average time to be accurately diagnosed for many people being around 5-9 years!

    AS is an autoimmune inflammatory arthritis. That means the body attacks its own joints, tendons and ligaments, mainly in the spine, resulting in pain and stiffness. Over time, this inflammation can lead to fusion (ankylosis) of the spine and ribcage. If AS is not well managed, it can result in permanent changes to the spine and a hunched posture. The back is also susceptible to fractures, and breathing may be more difficult due to restricted movements.

    We don’t know why, but it’s speculated that genetic and environmental factors are involved in developing the disease, including a strong family history and correlation with the HLA-B27 gene – but not with everyone. It’s quite common for people to notice symptoms from early adulthood.

    People with ankylosing spondylitis commonly experience acute flares of back or buttock pain and tend to feel stiff in the mornings when they wake. They may also feel pain in areas other than the spine – commonly the back of the heel, underneath the foot, chest wall and eyes.

    In addition, people with AS may also experience high levels of fatigue and other inflammatory conditions such as uveitis, inflammatory bowel disease and psoriasis.

    Early recognition and referral to a rheumatologist, specialist doctors who diagnose and manage musculoskeletal conditions and autoimmune diseases, is crucial for this progressive disease.

    Diagnosis is based on a thorough history and physical examination, as well as blood tests and imaging which are usually requested to look for evidence of active inflammation. Nonetheless, someone can still have ankylosing spondylitis with these results being completely normal!

    Rheumatologists treat ankylosing spondylitis patients with medications that reduce inflammation. This can include non-steroidal anti-inflammatory drugs and/or biological disease-modifying anti-rheumatic drugs (biologics). Biologics dampen the immune system to reduce disease activity; however, this immunosuppression may increase the risk of infections and illnesses.

    Physiotherapy is also important to help manage AS. The aim is to reduce pain, stiffness, and joint damage and increase physical function and quality of life. This should always involve a personalised exercise program consisting of movements and stretches to maintain flexibility and strength, as well as aerobic exercises to improve cardiovascular fitness and chest expansion. Hydrotherapy (exercise in warm water) also has a positive effect. Physiotherapists should also be great health educators highlighting the importance of regular exercise, back care and posture, and a healthy and active lifestyle!

    Many patients I see with ankylosing spondylitis have bounced between many health professionals before their eventual diagnosis; which for them can both be a relief and overwhelming. That’s why working closely with my patients as a health educator and treating the whole person is essential. It’s also very rewarding work.

    With the advancements in modern medicine, most people living with ankylosing spondylitis can go about their usual activities without limitations if it’s diagnosed early and well-managed with medication and physiotherapy.

    So join me and help spread the word about AS on World Ankylosing Spondylitis Day!

    Andrew Zhang

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    CONTINUE READING
    Tim_Allen.jpg
    Lisa Bywaters
    19/Apr/2023
    MSK articlesMSK Kids Blogs

    Embracing life with Perthes’ disease

    A journey of overcoming challenges and finding opportunities

    Written by Tim Allen.

    Living with Perthes’ disease has presented numerous challenges, especially during my school years and early 20s. However, despite the limitations imposed by this condition, I never lost my fascination for life and my desire to experience everything the world has to offer.

    When I was 6 years old, my mother noticed I was beginning to limp, and that it was uncomfortable for me to move. I was diagnosed with Perthes’ disease and pretty quickly underwent surgery and had a plate inserted and my legs cast in a splint. I had a frame and got around in a wheelchair for a bit. My friends and class mates coined the nickname ‘Timmeh’ after South Park’s Timmy, but not once did it ever feel like bullying. I was lucky enough to have a good bunch of friends, and although they probably had no idea what I was going through, they were supportive and kind.

    When I came out of the cast and splint, I had to sit out from all sports, even non-contact sports, due to the pressure on my right hip. While I longed to play football, basketball, and skateboard like the other kids, my condition made it difficult. It was hard to understand at the time, but it would set me up for a really meaningful life. Not being able to participate in high-impact sports and the communities around them was challenging, but it presented me with other unique opportunities and experiences, which I’m incredibly grateful for.

    One of those drivers was to become creative, and I began to develop interests in art, music, photography and computers. While I wasn’t aware of it at the time, the life that these interests would present to me would allow me to see, travel, and experience more than I could imagine.

    I had always been interested in photography, playing around with the family camera and looking through the hundreds of 6x4s in family photo albums. Full of birthdays, events and family holidays my teenage brain was in overdrive! My grandparents on both sides amazed me with all the places they went, and I enjoyed looking into this portal into the past. What would my future look like?

    I really wanted to play the drums and did for a while, however, it became more and more difficult to deal with the pain. I knew I had to be selective about my interests and focus on what I enjoyed. Photography became my number one passion.

    Some of the more severe instances of pain I experienced were on extremely hot and cold days during my early 20s. I had become a little complacent as I developed from my teen years into early adulthood and thought my hip was strong enough to bear my weight and movement and do most of the things I wanted to do. I was wrong. The pain would present as a sensation of expansion and contraction which aligned with the weather conditions. I used a heat bag to sooth the pain and looked for ways to build the muscle once the conditions had settled.

    Referred pain became more common, and I knew I’d have to step up my game. I began a program of light exercise, walking, stretching, and breathing techniques. Gradually the pain began to lift, and I became more mobile. The solution was making these activities fun, encouraging me to build them into my routine, resulting in regular exercise and a much healthier lifestyle.

    Having Perthes’ disease helped me realise that without it, I wouldn’t have found the drive to develop myself as I did. And I wouldn’t have met the circle of people who are now lifelong friends. I knew my journey would be different, so I learned to embrace that. I attribute much of my success to the support of my family and friends. They’ve always encouraged me to keep moving forward and just keep moving!

    Living with Perthes’ Disease isn’t always easy. But it’s taught me to embrace challenges and find opportunities where others may not see them. I’m grateful for the lifelong friendships and the unique opportunities and experiences they presented to me. I hope sharing my story can inspire others living with similar conditions to keep looking forward and making the most of every moment.

    Tim is now working in the final stages of completing a Master of Arts Photography at Photography Studies College and will present his first debut solo show in June 2023. You can find more information through his website and social channels.

    CONTINUE READING
    RAblog.jpg
    Lisa Bywaters
    23/Mar/2023
    Health InformationMSK articles

    Riddle me this…

    What do Lucille Ball, Kathleen Turner, Caroline Wozniacki, Pierre-Auguste Renoir, Edith Piaf, James Coburn and more than 450,000 Aussies have in common?

    They all live (or lived) with rheumatoid arthritis (RA).

    So, what is RA?

    Rheumatoid arthritis is a type of inflammatory arthritis that causes pain, swelling and stiffness in the joints.

    The most commonly affected joints are in the hands, feet and wrists.

    What causes it?

    Rheumatoid arthritis is an autoimmune disease. That means it occurs as a result of a faulty immune system.

    Your immune system is designed to look out for and attack foreign bodies – like bacteria and viruses – that can make you sick. For reasons we don’t fully understand, when you have RA, your immune system gets confused. It targets your joints and healthy tissues as if they were foreign bodies. This causes ongoing inflammation and pain.

    We don’t know why this happens, but scientists believe a complex mix of genes and environmental factors, including smoking, is involved.

    What does RA do?rheumatoid arthritis

    To understand how RA affects your body, it’s helpful to know a little about your joints.

    Joints are places where bones meet. Bones, muscles, ligaments and tendons work together so you can twist, bend and move about.

    The ends of your bones are covered in a thin layer of cartilage. It acts like a slippery cushion absorbing shock and helping your joint move smoothly.

    The joint is wrapped inside a tough capsule filled with synovial fluid. This fluid lubricates and nourishes the cartilage and other structures in the joint.

    When you have RA, and the immune system targets your joints, it causes a build-up of synovial fluid and inflammation of the tissues that line the joint (synovial membrane). This causes pain, heat and swelling.

    Cartilage becomes brittle and breaks down. Because the cartilage no longer has a smooth surface, the joint becomes stiff and painful.

    Ligaments, tendons and muscles surrounding the joint can also be affected, causing joints to become unstable.

    What are the symptoms?

    The most common symptoms of RA include:

    • joint pain
    • joint swelling, heat and redness
    • joint stiffness, especially in the morning or after sitting or being inactive for a while
    • fatigue, or tiredness that doesn’t go away, even after sleeping or resting.

    RA can affect any joints in the body, but most often affects the small joints in your hands and feet first.

    Usually, the same joints on both sides of your body are affected – but this doesn’t always happen.

    Other symptoms of RA can include:

    • fleshy lumps called rheumatoid nodules; they form under the skin around affected joints and at places where your bones are close to the skin (e.g. elbows)
    • dry eyes
    • fever
    • short-term interruption of blood flow to your extremities (e.g. fingers and toes), called Raynaud’s phenomenon.

    RA can affect other parts of your body, including the eyes, heart and lungs.

    Anyone can develop RA, but it most often appears in people aged between 30 and 60. It affects women more often than men. However, when women reach menopause, the incidence of RA becomes about the same for men and women.

    How RA develops, and its severity will differ for each person. Symptoms can develop gradually or can start with a sudden, severe attack. Your symptoms can change daily, and they can sometimes become much worse. This is called a flare or flare-up. At other times, your symptoms may go away. This is called remission.

    How is it diagnosed?

    If you’re experiencing joint pain and inflammation, discussing your symptoms with your doctor is important. Many things can cause joint pain and swelling, including injuries, infection, and arthritis.

    Getting a diagnosis as soon as possible means that treatment can start quickly. Early treatment will help you to control the inflammation, manage pain more effectively and minimise the risk of long-term joint damage and disability.

    No single test can diagnose RA, so your doctor will use a combination of tests to confirm your diagnosis. They may include:

    • Your medical history. Your doctor will ask about your symptoms, family history and other health issues.
    • A physical examination to assess joint tenderness, flexibility, and stiffness.
    • Blood tests to check for inflammation and antibodies associated with RA.

    Scans such as an x-ray or MRI (magnetic resonance imaging) may be used to exclude other conditions or to look for joint inflammation or damage.

    Your GP will refer you to a rheumatologist if they think you have RA. Rheumatologists are doctors who specialise in diagnosing and treating problems with joints, muscles, bones and the immune system.

    How is RA treated?

    While there’s no cure for RA, there are many treatments to help you manage the condition and its symptoms so you can continue to lead a healthy and active life. The ultimate goal is to reach a stage where you have very low or no disease activity – or remission. This can take trial and error, but some people can achieve remission or low disease activity once they start treatment.

    Medicines

    Your rheumatologist will recommend and prescribe medicines for your RA. Most people need to take more than one medicine because different medicines work differently.

    The types of medicines used to treat RA and manage its symptoms include:

    • disease-modifying anti-rheumatic drugs (DMARDs), which reduce the activity of your immune system. There are different categories of DMARD:
      • conventional synthetic DMARDs or csDMARDs – e.g. methotrexate. Your rheumatologist will prescribe one of these medicines when you’re first diagnosed. They’ve been used for many years to treat RA and are very effective for most people. They’re called first-line medicine because they’re tried first. They may be used on their own or along with other DMARDs.
      • biological DMARDs or bDMARDs – e.g. adalimumab. bDMARDs are used if the csDMARD hasn’t worked well enough to control your RA or stops working. They’re called second-line medicines.
      • targeted synthetic DMARDs (tsDMARDS) – e.g. tofacitinib. They’re also a second-line medicine.

    All DMARDs reduce the activity of your overactive immune system; however, the biological and targeted synthetic DMARDs are both more targeted to specific immune cells or processes.

    • corticosteroids (or steroids) – e.g. prednisolone, act quickly to control or reduce inflammation and may be used in the short-term while you’re waiting for the DMARDs to take effect. They aren’t used for long periods as they’re associated with serious side effects.
    • pain relievers (also called analgesics) for temporary pain relief
    • non-steroidal anti-inflammatories drugs (NSAIDs) for temporary pain relief.

    The medicines that your rheumatologist prescribes will depend on your particular symptoms and how much pain and inflammation you have.

    Your medicines may also change over time. Your rheumatologist might try different medicines to find out which will work best for you, or you may need an additional medicine if your condition or symptoms worsen.

    Usually, you need to have tried a certain number of medicines before another is recommended for you. For example, bDMARDs are only prescribed if your RA is active and you haven’t had success with standard treatments.

    You’ll need to see your doctor regularly for blood tests to see if the medicines are working for you and to monitor for side effects.

    Exercise

    This is one of the most important things you can do to manage your RA. Exercise can improve symptoms, including stiffness, pain, and fatigue, and reduce inflammation. It helps increase your flexibility and range of movement, so it’s easier to do many everyday activities.

    Being active is also essential for your overall health and wellbeing. It helps keep your muscles, bones and joints strong so that you can keep moving. It reduces your risk of developing other conditions such as heart disease, osteoporosis, and diabetes. It boosts your mood, benefits your mental health, helps with weight control and improves sleep.

    Low-impact aerobic activities like exercising in warm water, cycling and walking can be a good place to start. Activities like strength training and tai chi are also beneficial. A physiotherapist or an exercise physiologist can give you information and support if you need help starting. They’ll also ensure you exercise safely to avoid injuring or straining your joints.

    Self-care

    There are other things you can do to manage your RA.

    Learn about your condition. Understanding RA allows you to make informed decisions about your healthcare and actively manage it.

    Manage your weight. Being overweight or obese increases inflammation throughout your body. This inflammation affects not only your joints but also your blood vessels and insulin levels. This can increase your risk of other chronic health conditions, including heart disease and diabetes. People with RA already have a higher risk of developing these conditions, so losing weight is an important thing you can do to reduce this risk. Being overweight or obese also limits the effectiveness of some medicines used to treat RA. Losing weight can be challenging, especially when pain impacts your ability to participate in physical activity. But it may help you to know that even a small amount of weight loss can help to improve your symptoms.

    Learn ways to manage your pain. Pain is the most common symptom of RA, so it’s crucial to learn ways to manage it effectively. Read our A-Z guide for managing pain for more information.

    Work closely with your healthcare team. The best way to live well with RA is by working closely with the people in your healthcare team (e.g. GP, rheumatologist, physio). Keep them informed about how you’re doing and if you’ve experienced any changes in your symptoms or tried new medicines, complementary therapies, supplements or other treatments.

    Use aids and equipment. Supports such as long-handled shoehorns, reachers and canes can reduce joint strain and make life easier, especially if your condition has reduced your flexibility and mobility. An occupational therapist can advise you on aids, equipment and home modifications. You can also check out our range of aids in our online shop.

    Protect your joints. Splints, orthotics and other supports may help reduce pain and prevent joint damage or inflammation. A physiotherapist or podiatrist can advise you on whether these strategies could be helpful for you.

    Talk to an OT. An occupational therapist can advise on pacing yourself and managing fatigue, and how to modify your daily activities at home and work to reduce strain and pain on affected joints.

    Sleep well. Not getting enough quality sleep can worsen your symptoms; however, getting a good night’s sleep when you have RA and chronic pain can be difficult. If you’re having problems sleeping, talk with your doctor about ways to deal with this. There are many options available to help you sleep better.

    Manage stress. Stress can also aggravate your symptoms, so learning to deal with stress is extremely helpful. Things you can do to manage stress include planning your day and setting priorities, using relaxation techniques such as going for a walk, getting a massage or listening to music, and, where possible, avoiding people and situations that cause you stress.

    Practise mindfulness. Regularly practising mindfulness meditation can improve your mood, relieve stress, improve sleep, improve mental health and reduce pain.

    Eat a healthy, balanced diet. While there’s no specific diet for RA, it’s important to have a healthy, balanced diet to maintain general health and prevent weight gain and other health problems, such as diabetes and heart disease.

    Quit smoking. Smoking cigarettes harms your general health, negatively affects your bone health, and increases inflammation. Smokers also have a greater risk of developing more severe RA, may be less likely to have remissions, and are more likely to have RA-associated lung disease. Smoking can make it more difficult to manage your pain. It causes fatigue and slower healing, which can make your pain worse. And it can make some of your RA medicines less effective. If you’re a smoker, you may be less likely to be as active, and less physical activity can increase your pain too.

    What about surgery?

    Surgery may be needed in some cases. Your doctor may suggest surgery as an option to:

    • improve your joint movement
    • improve your mobility and independence
    • correct the position of joints that have become misaligned
    • relieve pain that’s no longer controlled with treatments such as medicines, heat and cold, massage or exercise
    • improve health and wellbeing if joint pain affects your sleep, mental health, and ability to work or participate in other important activities or events.

    If your doctor thinks surgery might be a good option, they’ll refer you to an orthopaedic surgeon. Together, you can discuss the benefits and risks of surgery, alternatives and what will happen if you do nothing. You can then decide if it’s right for you. For more information, read Choosing Wisely Australia’s 5 questions to ask your doctor or other healthcare provider before you get any test, treatment, or procedure.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

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    doctor_patient_consult-1200x800.jpg
    Lisa Bywaters
    23/Mar/2023
    Health InformationMSK articles

    5 reasons to see your Dr about pain

    Chronic (or persistent) pain is a common and complex problem affecting 1 in 5 Australians aged 45 and over.(1)

    Dealing with chronic pain can be challenging. But there are many things you can do and resources available to help you manage. The first step starts with seeing your doctor.

    Here are five reasons you should see your doctor about your pain.

    1. You want to take control

    Talk with your doctor about pain management programs if you want to learn about managing your pain more effectively. These programs are available in person and online.

    Pain management programs aim to reduce the impact that pain has on your life. They treat you as a whole person and don’t focus solely on your pain. That means they address everything from exercise to mood, stress, goal setting, sleep, managing your activities, returning to work, and more.

    By attending a pain management program, you’ll learn from doctors, physiotherapists, occupational therapists, nurses, and psychologists. They’ll provide information, advice and support to help you take control of your pain.

    Talk with your doctor about whether a pain management program would be helpful.

    2. You’re not coping with your pain

    It’s important to talk with your doctor if you feel like you’re not coping, especially if:

    • you’re taking more of your medicines than prescribed
    • you’re mixing your medicines with other drugs, including alcohol
    • you’re drinking excessive amounts of alcohol
    • you’re having problems sleeping due to pain
    • you’ve been feeling very low for more than a few weeks
    • you’ve been missing work because of pain
    • you’re more worried, frustrated and irritable than usual.

    Your doctor understands that living with pain is difficult. They can work with you to find the right pathway to help. They can also refer you to other health professionals, including physical and/or mental health specialists.

    3. You’re struggling at work

    If you’re not coping with your work responsibilities or just getting to and from work has become difficult because of your pain, discuss this with your doctor.

    Evidence shows that working improves general health and wellbeing for most people and reduces psychological distress.

    That’s why finding ways to stay at work, even with chronic pain, is important. Your doctor can give you information and support to do this. They can also refer you to other healthcare professionals – e.g. physiotherapists, occupational therapists and specialist doctors (occupational physicians) – to help you stay at work.

    And check out our resource WorkWise for info and tips to help you at work.

    4. You’ve decided to stop taking your regular medicine for pain

    You should talk openly with your doctor if you’re considering stopping any medicines. Some may need to be reduced gradually to avoid potential side effects. Your doctor will advise you on this.

    5. You’ve noticed significant changes to your symptoms

    It’s also important to be aware of other health changes that may occur. They can appear for various reasons, many unrelated to your pain.

    However, if you’ve been experiencing any of the following symptoms, talk with your doctor:

    • a sudden increase in the intensity of your pain
    • sudden loss of muscle power in your legs or arms
    • sudden change in your ability to empty or control your bladder or bowel
    • a lack of sensation anywhere in your body
    • sudden onset of pins and needles or numbness in either hands or feet
    • sudden onset of poor balance or a lack of coordination
    • unexplained and ongoing loss of weight
    • sweats at night time
    • moderate or severe pain at night or at rest
    • new pain in your abdomen, chest or head which doesn’t go away.

    These ‘red flags’ tell your doctor that something has changed. Changes in pain and other signs and symptoms are treated with caution. Your doctor will investigate potential causes to understand what’s happening and how/if to treat it.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    Reference

    (1) Chronic pain in Australia, Australian Institute of Health and Welfare, 2020.

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