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23/Mar/2023

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 painmusculoskeletal condition, treatment options, mental health issuestelehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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13/Oct/2022

We get asked this question a lot! But unfortunately, it’s not a simple ‘yes’ or ‘no’ answer.

Arthritis is a general term used to describe over 150 different conditions. The more accurate name for them is musculoskeletal conditions, as they affect the muscles, bones and/or joints.

They include osteoarthritis, back pain, rheumatoid arthritis, fibromyalgia, gout, polymyalgia rheumatica, lupus, osteoporosis and ankylosing spondylitis.

Around 7 million Australians live with a musculoskeletal condition, including kids. So can you avoid becoming one of them?

Maybe? Not really? It depends? 🙄

Because there are many different types of musculoskeletal conditions, the answer depends on various factors.

For conditions like rheumatoid arthritis, juvenile arthritis, ankylosing spondylitis, and lupus, we don’t really know their cause. Without knowing the cause, it’s hard to prevent something from occurring.

What we do know is that they’re autoimmune conditions. That means they occur due to a malfunctioning immune system. Instead of attacking germs and other foreign bodies, the immune system targets joints and healthy tissue, causing ongoing inflammation and pain. We don’t know why this happens, but scientists believe that a complex mix of genes and environmental factors is involved.

At this stage, we can’t change a person’s genetics to prevent them from developing an autoimmune type of arthritis, or conditions like osteoporosis and Paget’s disease, which are also linked to genetics. Many musculoskeletal conditions also become more common as you get older and are more common in women.

Other health issues, such as diabetes, kidney disease, coeliac disease, and even other musculoskeletal conditions 😫, can also increase your risk of developing a musculoskeletal condition. For example, chronic kidney disease can increase your chance of developing gout, and rheumatoid arthritis increases your risk of developing osteoporosis and fibromyalgia.

So that’s the bad news.

The good news is there are things you can do to reduce your risk of developing a musculoskeletal condition. Or, if you develop one, reduce its impact and severity.

Maintain a healthy weight

Excess body weight puts more pressure on your joints and increases the stress on cartilage, especially in weight-bearing joints like your hips, knees, and back. For every kilo of excess weight you carry, an additional load of 4kgs is put on your knee joints.

In addition to putting added stress on joints, fat releases molecules that increase inflammation throughout your body, including your joints. Being at a healthy weight reduces this risk.

Being overweight or obese is strongly linked to developing osteoarthritis (OA), most often in the knees. Hand OA is also more common in people who are overweight.

Back pain and inflammatory conditions such as gout, rheumatoid arthritis, and psoriatic arthritis have also been linked to being overweight.

If you have a musculoskeletal condition, maintaining a healthy weight, or losing weight if you’re overweight, can decrease your pain, allow you to become more active, and decrease your risk of developing other health problems like heart disease and diabetes.

Quit smoking

As well as the obvious links to cancer and lung disease, smoking’s linked to back pain, neck pain, rheumatoid arthritis and osteoporosis. Smoking also causes fatigue and slower healing, which can make pain worse. And it can make some medications less effective.

So quitting smoking has many health benefits. Within weeks of quitting, you’ll breathe easier and have more energy, making it easier to exercise and do your day-to-day activities. Find out more about the impact of smoking and ways to quit for good.

Stay active and exercise regularly

Regular exercise is vital for overall good health and keeps you fit, independent and mobile. Being active helps keep your muscles, bones and joints strong so that you can keep moving. It reduces your risk of developing other conditions such as osteoporosis, heart disease, diabetes and some forms of cancer. It boosts your mood, benefits your mental health, helps with weight control and improves sleep.

Having strong muscles is also essential to reduce your risk of falls.

Look after your mental health

Mental health conditions can increase the likelihood of developing some musculoskeletal conditions. For example, people with depression are at greater risk of developing chronic back pain. And living with a painful musculoskeletal condition can have a significant impact on mental health.

If you’re living with anxiety, depression, or another mental health condition and feel that you’re not coping well, it’s important to seek help as soon as possible. This will ensure you don’t prolong your illness and worsen your symptoms. It becomes harder and harder to climb out of a depressive episode the longer you wait. Similarly, the longer you put off seeking help for anxiety, the more anxious you may become about taking that first step.

There are many different types of treatment options available for mental health conditions. The important thing is to find the right treatment and health professional that works for you. With the proper treatment and support, they can be managed effectively.

Get enough calcium and vitamin D

Calcium and vitamin D are essential to building strong, dense bones when you’re young and keeping them strong and healthy as you age.

Getting enough calcium each day will reduce your risk of bone loss, low bone density, and osteoporosis.

Calcium is found in many foods, including dairy foods, sardines and salmon, almonds, tofu, baked beans, and green leafy vegetables.

Vitamin D is also essential for strong bones, muscles and overall health. The sun is the best natural source of vitamin D, but it can be found in some foods.
If you’re unable to get enough calcium or vitamin D through your diet or safe sun exposure, talk about calcium and/or vitamin D supplements with your doctor.

Protect your joints

Joint injuries increase your risk of getting OA. People who’ve injured a joint, perhaps while playing a sport, are more likely to eventually develop arthritis in that joint. So it’s important to protect against injury by:

  • maintaining good muscle strength
  • warming up and cooling down whenever you exercise or play sport
  • using larger, stronger joints or parts of the body for activities, for example, carrying heavy shopping bags on your forearms, rather than the small joints in your fingers
  • using proper technique when exercising, for example, when using weights at the gym or when playing sports, especially those that involve repetitive motions such as tennis or golf
  • maintaining a healthy weight
  • avoiding staying in one position for extended periods
  • seeking medical care quickly if you injure a joint.

Drink alcohol in moderation

Excessive alcohol consumption contributes to bone loss and weakened bones, increasing your risk of osteoporosis. For people with gout, drinking too much alcohol, especially beer, can increase your risk of a painful attack.

It can also affect your sleep, interact with medicines, and affect your mental health. To find out more about the risks of drinking too much alcohol and how you can reduce your alcohol intake, read ‘Should I take a break from booze?’.

Manage stress

While stress on its own is unlikely to cause someone to develop a musculoskeletal condition, chronic stress or a stressful event may be a contributing factor, especially with conditions such as fibromyalgia and back pain.

It can also cause issues with sleep, mood, increase pain, and make you more prone to flares if you have a musculoskeletal condition. It can then become a cycle of stress, poor sleep, pain and more stress. And this can be a difficult cycle to break.

But there are things you can do to deal with stress. Try relaxation techniques such as meditation, breathing exercises and visualisation, and avoid caffeine, alcohol and cigarettes.

Talk to someone – whether it’s a family member, friend or mental health professional, about what’s stressing you out so you can deal with it.

Talk with your doctor

If you’ve been experiencing joint or muscle pain, it’s important that you discuss your symptoms with your doctor. Getting a diagnosis as soon as possible means that treatment can start quickly, reducing the risk of joint damage and other complications.

Final word

While at this moment in time, we can’t absolutely 100% prevent ourselves from getting a musculoskeletal condition, the good news is that early diagnosis and treatment will give you the best outcomes.

Treatments for many of these conditions have come a long way in recent years, and most people live busy, active lives with musculoskeletal conditions. 😊

Call our Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issuestelehealth, 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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13/Apr/2022

Rheumatoid arthritis (RA), osteoarthritis (OA) and osteoporosis (OP) have some similarities in their names, but is that where it ends?

This article will explore the similarities and differences of these common musculoskeletal conditions.

First – let’s look at those names

Rheumatoid arthritis – OK, this is a little convoluted, so hold onto your hat 😉. For those that don’t want the history lesson in ancient Greek, essentially it means inflammation of the joints. But for those who do read on…

Rheumatoid comes from rheumatism, which comes from the Greek word rheuma, which describes something that flows. Hippocrates (460-370BC), considered the father of modern medicine, ‘attributed many illnesses, especially those causing muscle achiness to the abnormal flow of body rheums or humors’.(1)

Arthritis – comes from the Greek word arthron for joint and itis, which means inflammation. Put together – inflammation of the joints.

Osteoarthritis – this is much more straightforward. Osteo – means bone and arthritis (inflammation of the joints).

Osteoporosis – another straightforward one 😉. Osteo (bone) and porosis means porous. So we have porous bones.

OK, we’ve had a trip through history and etymology, but what does this mean? I’ll admit rheumatoid had me scratching my head trying to work it all out. It seems to me that the rheuma part isn’t as helpful in the 21st century as it may have been for the ancient Greeks! But the arthritis part obviously is much closer to the mark. And you’ll see that the rest of the names pretty well match up with what’s going on with these conditions.

Rheumatoid arthritis (RA) vs osteoarthritis (OA) – what are the similarities and differences?

We know they’re both a type of arthritis. That’s the easy part. People who have these conditions will have some common symptoms – inflammation, joint pain and stiffness.

That’s about where the similarities end.

Rheumatoid arthritis is an ongoing health condition that causes pain, stiffness and swelling in your joints.rheumatoid arthritis

It’s the result of your immune system working in a faulty way. This is an autoimmune condition.

Your immune system is designed to look out for and attack foreign bodies – like bacteria and viruses – that can make you sick. For reasons that 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.

Symptoms:

  • swelling, pain and heat in the joints, usually the smaller joints of the hands or feet
  • stiffness in the joints, especially in the morning
  • persistent mental and physical tiredness (fatigue)
  • same joints on both sides of the body are usually affected (symmetrical).

Less often, RA may also affect other systems in your body, like your eyes and lungs.

RA can affect people of any age but most often appears between 30 and 60. It affects women more often than men. However, when women reach menopause, the incidence of RA becomes the same for men and women.

How RA develops and how severe it is will be different for each person. Symptoms can develop gradually or can start with a sudden, severe attack. Your symptoms can change from day to day, and at times they can become much worse (called a flare). At other times, your symptoms may go away (called a remission).

The good news is that modern treatments for RA are extremely effective at controlling the disease and reducing its impact on people’s lives.

Osteoarthritis is the most common form of arthritis and affects the cartilage covering your bones’ ends.osteoarthritis

Healthy cartilage acts like a slippery cushion absorbing shock and helping your joints move smoothly. With OA, the cartilage becomes brittle and breaks down. Some pieces of cartilage may even break away and float around inside the joint. Because the cartilage no longer has a smooth, even surface, the joint becomes stiff and painful to move. Eventually, the cartilage can break down so much that it no longer cushions the two bones. Your body tries to repair this damage by creating extra bone. These are bone spurs. Bone spurs don’t always cause symptoms, but they can sometimes cause pain and restrict joint movement.

OA is most likely to develop in people over 45, but it can also occur in younger people.

Symptoms:

  • joint stiffness
  • joint swelling (inflammation)
  • grinding, rubbing or crunching sensation (crepitus)
  • joint pain
  • muscle weakness.

It was once thought to be an inevitable part of ageing, a result of a lifetime of ‘wear and tear’ on joints. However, it’s now understood that OA is a complex condition and may occur due to many factors. The good news is that many of these factors can be prevented.

Treating RA and OA

Both rheumatoid arthritis and osteoarthritis can be managed effectively. Things you can do – whether you have RA or OA – include exercising regularly, maintaining a healthy weight (or losing weight if required), and taking any medicines as prescribed.

Treatment for rheumatoid arthritis will also focus on controlling your overactive immune system and preventing joint damage.

What about osteoporosis (OP)?

Osteoporosis doesn’t affect the joints as OA and RA do. It affects the bone itself.

Bones are living tissue that’s constantly growing, rebuilding, replacing and repairing. From birth to about 25 years of age, you build more bone than you lose. Your bones are not only getting bigger as you grow during this time, but they’re developing their density. This determines how strong they are.

From about 25 to 50 years of age, your bones break down and rebuild at about the same rate. They’re in a state of balance. This is when you’ve achieved your ‘peak bone mass’. Your bones are at their strongest.

After about 50 years of age, you start to break down more bone than you rebuild. While this means that we’ll all experience some bone loss, it doesn’t mean that everyone will develop osteoporosis.

Women commonly experience a period of rapid bone loss after the onset of menopause. After this time, there’s a steady but less rapid loss of bone.

When a person develops osteoporosis, their bones become more porous, lose strength and become fragile. Osteoporotic bones break (or fracture) more easily than normal bones. Even a minor bump or fall can cause a serious fracture.

Many people with osteoporosis don’t know they have it. It doesn’t have any obvious signs or cause pain unless a bone has broken.

Common risk factors for osteoporosis include a family history of OP, having conditions such as RA, coeliac disease or diabetes, smoking, and not getting enough calcium or vitamin D. You can check if you’re at risk of OP by using the Know Your Bones online tool.

Treating osteoporosis

OP can also be effectively managed and involves regular weight-bearing exercise and a healthy diet incorporating calcium-rich foods. Depending your age, general health and fracture risk, your doctor may prescribe medicines to help slow down bone loss or increase the amount of bone that’s made. Find out more about OP and the ways it’s treated.

Contact our free national Help Line

Call our nurses if you have questions about managing your painmusculoskeletal condition, treatment options, mental health issues, COVID-19, 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) How rheumatism got its name
The Rheumatologist


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27/Aug/2020

…in books, movies and TV?

One in three people lives with a musculoskeletal condition. 1 in 3. But it was almost impossible to find any decent books, TV shows or movies that feature realistic portrayals of people living with these conditions, or living with chronic pain. Even when you extend it to people living with chronic illness in general, which is an even bigger proportion of the community, it’s a tough slog through mediocrity.

I was astounded at the lack of characters living with these conditions. And when I did find some, I found many to be annoying, improbable and insulting.

Many of the stereotypes used include:

  • the person addicted to pain medications
  • the person who’s just too good to be true – nothing turns their frown upside down because they’re amazingly brave and stoic – they conquer all
  • the person who’s angry all the time, hates the world and everyone in it.

Few real people are like this all the time. Some elements may appear in our personalities and our lives, but no one is this one dimensional. So it’s sad that this is the way we’re portrayed.

It was also really depressing to see how some conditions – particularly fibromyalgia – are disparaged and often treated as a punchline. That’s so unfair.

So here’s my call to action – before I even delve into the stories I did find – let’s get our stories out there!

We can create stories and characters that are multi-faceted – we know people have more than one side or feature – because we are those people. We’re good, bad, positive, negative, strange, unique, parents, siblings. We work, we study, we get sad, we love, we hurt. We are and do all of these things, often at the same time! There’s so much more to a person that an addiction or stoicism.

So use whatever medium inspires you – fiction, film, photos, art, humour – and share it with us. We’d love to see it.

And if you’ve come across some great characters that we’ve missed in this list – let us know. We’ll add them to our blog.

Ok, rant over.

Here’s the list of the books, movies and TVs I did come across that featured more interesting characters. And a confession here –I’ve only seen/read a few, but have added lots to my enormous ‘must watch list’ and my towering ‘to be read’ pile.

Renoir (movie)

Based in the summer of 1915 in the French Riviera, this movie features an ageing Pierre-Auguste Renoir (Bouquet), dealing with the loss of his wife, the effects of rheumatoid arthritis, and the terrible news that his son Jean (Rottiers) has been wounded in action. But then a young girl (Théret) enters his world and Renoir is filled with a new, unexpected energy as the beautiful Andrée becomes his last model. Then Jean returns home to recover from his wounds and queue the love story.
Director: Gilles Bourdos
Year: 2012
Stars: Michel Bouquet, Christa Théret, Vincent Rottiers
Language: French (English sub-titles)
IMDB: https://www.imdb.com/title/tt2150332/

Words and pictures (movie)

In this romantic comedy, an art instructor (Binoche) with rheumatoid arthritis and an English teacher (Owen) form a rivalry that ends up with a competition at their school in which students decide whether words or pictures are more important.
Director: Fred Schepisi
Year: 2014
Stars: Clive Owen, Juliette Binoche
IMDB: https://www.imdb.com/title/tt2380331/?ref_=fn_al_tt_1

The Good Doctor (TV)

This popular TV medical drama revolves around young surgeon Dr Shaun Murphy (Highmore) who has autism. In season 3 one of his colleagues, Dr Morgan Reznick (Gubelmann) opens up to senior surgeon Dr Glassman (Schiff) about having been diagnosed with rheumatoid arthritis. She needs his help to get a cortisone injection so she can perform her first surgery. She discusses with him her concerns about how the other surgeons may assume RA will affect her ability to operate and do her job.
Creator: David Shore
Year: 2017-
Stars: Freddie Highmore, Richard Schiff, Fiona Gubelmann and many others.
YouTube: Dr Reznick wants Dr Glassman to keep her condition a secret

The Big Sick (movie)

Written by Emily V Gordon and her husband Kumail Nanjiani, this romantic comedy is loosely based on the real-life courtship before their marriage in 2007. While they were dating Gordon became ill and was put into a medically induced coma. She was later diagnosed with Still’s disease.
Director: Michael Showalter
Year: 2017
Stars: Kumail Nanjiani, Zoe Kazan, Holly Hunter, Ray Romano
IMDB: https://www.imdb.com/title/tt5462602/

Five feet two (doco)

This documentary follows Lady Gaga as she gets ready to release her fifth album and struggles with the physical and mental ups and downs. During the documentary she talks openly about her fibromyalgia.
Director: Chris Moukarbel
Year: 2017
Stars: Lady Gaga
IMDB: https://www.imdb.com/title/tt7291268/

Maudie (movie)

This romantic drama is based on the real life story of Canadian folk painter Maud Lewis (Hawkins). Maud was born in 1903 and diagnosed with juvenile arthritis as a child. This movie tells the story of love of painting, her marriage to Everett Lewis (Hawke) and her recognition as an artist.
Director: Aisling Walsh
Stars: Sally Hawkins, Ethan Hawke
Year: 2016
IMDB: https://www.imdb.com/title/tt3721954/?ref_=fn_al_tt_1

Cake (movie)

Cake tells the story of Claire (Aniston) who struggles with chronic pain and depression after a car accident that also killed her son. She becomes addicted to pain killers (sorry) and joins a chronic pain support group. Through this group she meets Nina (Kendrick) who later commits suicide. The story goes on to explore Claire’s relationship with Nina’s husband (Worthington) and son, her relationship with her estranged husband and how she tackles physical and emotional pain. https://msk.org.au/persistent-pain/
Director: Daniel Barnz
Stars: Jennifer Aniston, Anna Kendrick, Sam Worthington
Year: 2014
IMDB: https://www.imdb.com/title/tt3442006/

Cursed (YA book)

As if her parents’ divorce and sister’s departure for college weren’t bad enough, fourteen-year-old Ricky Bloom has just been diagnosed with juvenile arthritis. Her days consist of cursing everyone out, skipping school–which has become a nightmare–daydreaming about her crush, Julio, and trying to keep her parents from realizing just how bad things are. But she can’t keep her ruse up forever. https://msk.org.au/juvenile-idiopathic-arthritis/
Author: Karol Ruth Silverstein
Year: 2019
Publisher: https://www.penguinrandomhouse.com/books/588565/cursed-by-karol-ruth-silverstein-author/

Sick kids in love (YA book)

Isabel has one rule: no dating. All the women in her family are heartbreakers, and she’s destined to become one, too, if she’s not careful. But when she goes to the hospital for her RA infusion, she meets a gorgeous, foul-mouthed boy who has her rethinking the no-dating rule and ready to risk everything.
Author: Hannah Moskowitz
Year: 2019
Publisher: https://www.panmacmillan.com.au/9781640637320/


cold-hands.jpg
30/Jul/2020

….your hands!

Did you know that each of your hands has 27 bones, 27 joints, 34 muscles, and over 100 ligaments and tendons?

They really are amazing, complex and delicate structures. And we often take them for granted – until something happens – we hit our thumb with a hammer, we slam a finger in a drawer or we develop a musculoskeletal condition.

Many conditions such as osteoarthritis and rheumatoid arthritis cause pain, swelling and sometimes disfigurement in hands. Other conditions such as Raynaud’s phenomenon and carpal tunnel syndrome can make your hands painful, and can cause pins and needles, as well as numbness.

For many people who have hand conditions, the colder months can make it worse. Your joints may ache more because of the cold, the constant hand washing can make your skin dry and the use of hand sanitiser (which often has a cooling effect) makes it feel like your fingers are about to drop off.

But there are things you can do to decrease hand pain, deal with the cold and COVID, and make everyday activities easier.

Look after your hands. Inspect them for things such as swelling, nail and skin changes and any changes to the joint shape or direction of fingers and/or thumbs. By being aware of our hands and any changes that occur, you can seek advice sooner and prevent things from getting worse..

Wash and dry your hands regularly and thoroughly. Just as washing with soap and water for at least 20 seconds is necessary to help prevent the spread of germs (including SARS-CoV-2), drying your hands thoroughly is also important. Germs love moisture and thrive in moist places. Drying your hands reduces your chances of spreading or picking up germs when you touch things with damp or wet hands.

Apply a moisturising hand cream regularly to keep your skin healthy and nourished. With our more frequent hand washing and use of hand sanitiser, it’s easy for our hands to become dry and cracked. Cracked skin is an opening for germs to get in and potentially cause an infection. And if you have a condition such as scleroderma or psoriatic arthritis, skin care is an important part of your overall management plan. You may need to use a medicated skin cream, rather than an over-the-counter product. Talk with your doctor or pharmacist for more info.

Use assistive devices if your hands are painful and stiff. They can help if you have difficulty gripping or holding everyday items. Assistive devices such as jar openers, book holders, tap turners, button hook and zipper aids and easy grip utensils can make tasks easier by reducing joint stress and eliminating tight grasps. You may need to speak with an occupational therapist about what equipment is best suited to you. Also check out our online shop. We have some products available to help you with your everyday activities.

See a hand therapist if you have hand/wrist pain or a condition that affects your hands, especially if it’s causing you issues with your day to day activities. Hand therapists are occupational therapists or physiotherapists that have undergone advanced training to become experts in the assessment, diagnosis and treatment of upper limb problems (shoulder to hand). They can provide advice on joint protection and energy conservation (e.g. splints) as well as recommendations for adaptive devices/equipment to improve hand function.

Splints and other supports may be an option. They can give support to a painful joint by providing mild compression, warmth and/or joint protection. There are two main types of hand or wrist splints – resting splints and working splints. The choice of splint will depend on your condition and your current needs. Splints need to fit your hand comfortably and correctly, so speak with a hand therapist about what’s best for you and how often you should wear them.

Exercise your hands, as well as the rest of your body. Regular hand exercises can reduce stiffness and support your joints by keeping your muscles strong. If you’re considering hand exercises, it’s best to get advice from a hand therapist or other specialist as to which exercises are most suitable for you. Exercises should be mild and should not cause you additional pain when you’re doing them. See our Hand information sheet for some basic range of motion exercises.

Wear gloves in the cold weather, especially if you have Raynaud’s phenomenon. Hand warmers are also helpful. If you’re going to the shops for supplies and you have to use hand sanitiser before you enter, be aware that many of them have a cooling effect. This can really aggravate your condition. Having a couple of hand warmers in your pockets can help. You can get disposable hand warmers, or reusable ones. Just remember if you use the reusable ones to thoroughly wash the fabric pouch it’s contained in between uses. They can easily become contaminated, and hygiene is everything during this pandemic.

Also wear gloves when you’re gardening, washing dishes or doing any tasks that have the potential for your hands to get dirty or damaged.

Medications may provide some temporary pain relief, depending on the underlying condition causing the problem in your hand/s. Your doctor may suggest analgesics (pain relievers like paracetamol) as well as nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen. A cortisone injection is generally not recommended for osteoarthritis of the hand, but may be used for rheumatoid arthritis or acute attacks of gout. In conditions such as rheumatoid arthritis you may also be taking disease modifying anti-rheumatic drugs (DMARDs). It’s important to take these medications as prescribed by your doctor.

With conditions such as Raynaud’s, if simple measures like keeping your hands warm hasn’t helped, you may need to be prescribed medications that widen your blood vessels and improve circulation. Talk with your doctor for more info.

Making life easier on your hands

Sometimes simply changing the way you do everyday tasks can reduce pain and protect your joints. You can make life easier on your hands by considering the following:

Listen to your body – pain can serve as a warning sign that your joints are being overworked. Try to find a balance between activity and rest by pacing yourself. Take regular breaks when completing tasks and try not to overdo it on a good day. You might like to try heat or cold packs to help relieve pain. Some people also like to soak their hands in warm water or wrap their hands around a warm mug of tea.

Try to avoid using a tight grip for long periods. For example:

  • use foam or sponge to increase the grip size of handles on cutlery, pens and other hand held devices
  • use assistive devices with thick rubber grip handles (e.g. key turners, jar openers)
  • use rubber squares and gloves to help improve grip
  • consider lever handles around your home to minimise any twisting forces (e.g. mixer taps in bathrooms/kitchens).

Avoid repetitive movements. For example:

  • prolonged typing, pruning and power tool usage particularly those that vibrate
  • when gardening ensure your tools are sharpened and well maintained for ease of use
  • if you can’t avoid these repetitive movements, make sure you take regular breaks.

Try to use your body’s larger joints and muscles when you can. For example:

  • use your forearms to carry bags instead of your hands
  • when carrying items hold them closer to your body
  • when lifting heavier items squat and use your thigh muscles.

Spread the load – try to spread the load of an object over more than one joint. For example:

  • when picking up objects use two hands
  • slide sheets and swivel pads can help move items with less strain
  • divide shopping into smaller bags and try using a backpack and/or trolley.

Find an alternative. For example:

  • buy pre-cut meat and vegetables instead of trying to cut them up yourself
  • use electrical items instead of manual (e.g. can openers and graters)
  • look for items that are easier to use (e.g. push on pegs)
  • keep a pair of scissors handy to open packaging.

Rethink personal care/hygiene – for people with decreased hand function or fine motor skills, everyday tasks such as showering and toileting can be quite challenging. To make things easier you could use:

  • a bidet to help with cleaning difficult to reach areas
  • baby wipes/moist towelettes instead of toilet paper (but remember that they’re not flushable)
  • toilet paper tongs/aids to help with grip
  • soap dispensers instead of a bar of soap
  • items to make dressing easier e.g. sock sliders, elastic shoe laces, button hole hooks/zip pullers, front fastening bras as well as dressing aids for coats and cardigans o shoes with velcro fasteners instead of laces.

Our hands are complicated and important and we depend on them more than we realise. Painful hands can often be managed with simple self-care strategies, however if your hands are causing you a lot of grief, and affecting your day to day functioning, talk with your doctor for information and support.

Contact our free national Help Line

If you have questions about things like managing your pain, COVID-19, your musculoskeletal condition, treatment options, telehealth, or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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gumboots.jpg
30/Jul/2020

Looking after your feet

Our feet are amazing ‘feats’ of engineering (sorry, I just couldn’t resist that one).

Each foot has 26 bones, 33 joints, and more than 100 tendons, muscles, and ligaments. They support us through thick and thin – whether we’re walking, running, jumping, dancing, skipping or hopping. We cram them into ill-fitting shoes, torture them in high heels and stub them against the bedside table in the middle of the night (or is that just me?).

As well as the many injuries and calamities that befall our feet, many musculoskeletal conditions, such as osteoarthritis, rheumatoid arthritis and gout can affect the feet.

They’re the unsung heroes of this pandemic as we hit the streets, parks and trails for exercise. Walking has become the exercise of choice for people at the moment. Many of us can’t – or don’t feel safe to – return to gyms or exercises classes. And lots of people are walking instead of catching public transport to avoid being in close contact with others. As a result we’re all walking many more steps than we did pre-COVID.

So we need to stop taking our feet for granted. We need to look after them so we can continue to do the things we want and need to do as pain-free as possible.

So what can we do?

Give your feet the TLC they deserve. It’s really important to look after your feet. Wash and dry them regularly. Inspect them for anything unusual such as cuts, blisters, changes to the nails and skin. By being aware of your feet and any changes that occur, you can seek advice sooner. And if they’re sore after a day of walking, maybe give them a warm soak in the bath, or in a bucket or a foot spa (if you have one) while you watch TV. Then dry them thoroughly and rub a moisturising foot cream into your skin. Take your time and give your feet a nice massage. Better yet, see if you can talk someone else into giving them a massage while you relax on the couch.

Manage your condition. If you have a musculoskeletal condition that affects your feet, it’s important that you work with your doctor and healthcare team to look after your feet and manage your condition effectively. The treatments used for foot conditions will vary from person to person, depending on your condition and how it’s affecting you. And this may change over time as your condition and your feet change.

See a podiatrist. If you have foot pain, or a condition that affects your feet, visit a podiatrist. They’re feet experts and can assess, diagnose and treat foot and lower limb problem, including skin and nail problems, foot and ankle injuries, foot complications related to medical conditions and problems with your gait or walking. Podiatrists can also give you advice on appropriate footwear, and can prescribe custom foot orthotics.

Consider orthotics. Orthotics are corrective insoles that can help alleviate pain by redistributing pressure away from the painful area and support your arches. You can buy off-the-shelf orthotics or you can have orthotics made that are specifically fitted to your feet by a podiatrist.

Fit your feet with appropriate footwear. With our worlds turned upside down due to COVID, and many of us having to stay home, it’s tempting to stay in our slippers all day. There’s something so comforting about warm, fluffy slippers. However our feet and ankles need proper support. Wear the right footwear for whatever you’re doing. Going for a walk? Put on your sneakers. Working at home? Wear your casual shoes/boots that support your feet and keep you warm. And lounging around in the evening? Get those slippers on.

If you’re buying new shoes, make sure they fit properly, support your feet and are comfortable. Look for shoes that are light, flexible at the toe joints and are hard wearing. Shoes made of leather are preferable over synthetic materials as they breathe better. Avoid slip-on shoes and if laces are difficult to fasten due to arthritis in your hands, Velcro or elastic laces may be an option.

Let them breathe. Did you know you have about 250,000 sweat glands in each foot? That’s a lot of sweat! So let your feet breathe to avoid smelly feet and fungal infections. Change your socks and shoes at least once a day. Wear shoes that allow air flow around your feet: leather, canvas, and mesh are good options, avoid nylon and plastic. And avoid wearing the same shoes two days in a row. Give your shoes time (at least a day) to dry and air out. And if the weather’s warm, set your feet free and let them go au naturale. There’s nothing better than walking barefoot on warm grass on a sunny day.

Exercise your feet. I’m not talking about walking here…but other exercises that keep your joints moving. Try non-weight-bearing exercises such as swimming, especially if you have foot pain, as they take the pressure away from the painful areas. You can also do exercises while sitting in a chair. NHS Inform (Scotland) has some foot exercise videos you can try. If you want exercises tailored specifically for you, visit a podiatrist or physiotherapist.

Medications might help. If you’re having a lot of foot pain, speak with your doctor about whether medications may be an option. Depending on the underlying condition causing the problem, your doctor may prescribe a short-term course of pain relievers or anti-inflammatory medications, or they may prescribe other medications, such as a cortisone injection into a joint for rheumatoid arthritis or medication for acute attacks of gout.

Diabetes and feet. Many people with musculoskeletal conditions also have diabetes. So it’s really important if you have diabetes that you take care of your feet every day because of the increased risk of developing nerve damage, ulcers and infections. Talk with doctor about how to look after your feet properly if you have diabetes.

Surgery may be required. For some people, surgery may be needed if other conservative treatments haven’t helped. A referral to an orthopaedic surgeon who specialises in feet is usually required.

Contact our free national Help Line

If you have questions about things like managing your pain, COVID-19, your musculoskeletal condition, treatment options, telehealth or accessing services be sure to call our nurses. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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Musculoskeletal Australia (or MSK) is the consumer organisation working with, and advocating on behalf of, people with arthritis, osteoporosis, back pain, gout and over 150 other musculoskeletal conditions.

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