London: Is it arthritis? Is it rheumatism? What can I do to help it, or stop it getting worse? These are common questions – and not just for the elderly.
by Dr Charles Mackworth-Young, Consultant Rheumatologist, King Edward VII’s Hospital Sister Agnes London.

There are many kinds of arthritis. While osteoarthritis – which involves loss of cartilage within joints – tends to occur in older individuals, active inflammation of joints, such as rheumatoid arthritis, can strike people of any age. All forms of arthritis can eventually lead to joint damage. Most are partly genetic in origin: the majority of individuals with arthritis have probably inherited genes that have made them more susceptible to the condition. Other factors may contribute to arthritis – for instance certain infections, or even direct damage to joints, such as fractures.

“Rheumatism” is a rather vague term, but is generally used to mean pain in “soft” tissues in the back or limbs, such as muscles, tendons or ligament. This can be due to a number of causes, including strain and overuse. Examples include tendonitis at the wrist, tennis elbow, and heel pain due to “plantar fasciitis”. While many of these conditions are localised and may ultimately get better, they can be painful and debilitating while they last.

Most forms of arthritis cannot be cured by medical therapy. However the good news is that the majority can be improved considerably by treatment which reduces symptoms and may help prevent progression or damage. Therefore for symptoms that persist it is important to have an accurate diagnosis of what the problem is. This can be provided by a general practitioner or, if necessary, a specialist such as a rheumatologist.

There are a number of things that an individual with arthritis can do for him or herself. A lot is written about diet, much of it poorly supported by good evidence. However, for most people simple weight reduction is valuable, since it can result in less physical strain on joints in the back and legs. A diet low in animal fat – e.g. a “Mediterranean” diet – may help reduce joint inflammation, as may the addition of fish oil. Supplements, such as glucosamine, chondroitin and “MSM”, are available without prescription. They are widely used for osteoarthritis, and appear to be harmless: whether they genuinely help remains controversial. Various complementary therapies can be tried, including
chiropracticand acupuncture.

For most people with arthritis or rheumatism, orthodox professional help is needed. This is best given in a clinic or hospital where many different specialities and treatments are available. There are many good NHS hospitals that offer this. An outstanding unit in the private sector is King Edward VII’s Hospital Sister Agnes in Beaumont Street, London. Located in the Harley Street area of London, this remarkable hospital offers a wide range of services covering most disciplines. A unique feature is that each member of its consultant staff is hand-picked after a rigorous selection process, thus ensuring the highest standards of care. There is notable expertise in the area of arthritis and rheumatism, with an extensive range of medical, surgical and other specialities.

Many people with arthritis or rheumatism will need the advice of a rheumatologist. He or she may arrange tests at the hospital, including X-rays and scans; give advice about lifestyle and exercise; and prescribe drugs to help pain and tackle the disease. The rheumatologist may also recommend the opinion of other specialists. For instance there are orthopaedic surgeons who specialise in different areas, and carry out procedures ranging from keyhole surgery to joint replacement. Hand surgeons perform delicate work on tendons and joints. And spinal surgeons operate on the neck and back to release trapped nerves.

Supporting all of these activities are physiotherapists and occupational therapists who have particular expertise in arthritis and rheumatism. The physiotherapy department at King Edward VII’s Hospital is also lucky to have one of the few hydrotherapy pools in London: treatment in the water can be especially valuable for joint and muscle conditions, and in speeding up recovery after surgery.

Besides medical, surgical and physiotherapy approaches, direct control of discomfort can be important. At King Edward VII’s Hospital there is a specialised pain control team, who use a variety of injection and other techniques. They are supported by psychologists, who have particular experience in treating painful disorders.

This is an exciting time for the management of arthritic and rheumatic conditions. Many new and effective treatments are emerging, including “biological” therapies. Gene therapy may be the next great step.

For more information on treatments and specialists go to www.kingedwardvii.co.uk