Understanding
Arthritis and Rheumatism
Doctor Jennifer G. Worrall
Published by Family Doctor Publications Limited in association with the British Medical Association
IMPORTANT
This book is intended not as a substitute for personal medical advice but as a supplement to that advice for the patient who wishes to understand more about his or her condition.
Before taking any form of treatment YOU SHOULD ALWAYS CONSULT YOUR MEDICAL PRACTITIONER.
In particular (without limit) you should note that advances in medical science occur rapidly and some information about drugs and treatment contained in this booklet may very soon be out of date.
About the author
Doctor Jennifer G. Worrall is Consultant Rheumatologist at Whittington Hospital NHS Trust and Honorary Senior Lecturer at the Royal Free and University College Medical School, London. Her work covers all aspects of general rheumatology. Other interests are clinical effectiveness and scientific methodology.
Introduction
The locomotor system
The bones, joints and muscles of the body make up the locomotor system, which enables us to move around. All sorts of problems may develop in this system, particularly as we get older. Although only 3 per cent of people under 60 years of age have joint pain or stiffness, the figure rises to almost 50 per cent of people aged over 75.
What is arthritis and rheumatism?
‘Arthritis’ refers to problems with the joints. There are many forms of arthritis, ranging from mild to serious, and not all of them get progressively worse. ‘Rheumatism’ is a vaguer term with no precise medical meaning, which refers generally to aches and pains and problems with the soft tissues, such as muscles and tendons, rather than with the joints.
The aim of this book is to help you understand how your locomotor system works, what can go wrong with it and what help is available if it does. I hope especially to show you that there is a lot that you can do to help yourself, both to treat problems when they arise and to prevent them.
The problems of arthritis and rheumatism are not confined to older people – many common conditions affect people of all ages. Even people who do not have problems can learn to look after their joints better and so avoid problems in the future. So I hope that you will find something of interest to you whatever your age and whether or not you have arthritis. At the end, you will find a list of addresses for further information.
How your joints work
Synovial joints
Joints hold the bones together and generally allow movement. Some joints, such as those in the pelvis, do not move very much and those in your skull do not move at all. But many joints can move freely and those that do are called ‘synovial joints’. All of the most important joints in the body are of this type and have the same basic structure (see below). They are capable of a wide range of movement and come in many different shapes and sizes – compare the joints in your finger with those in your knees, for example; the joints look different but are made up of the same basic elements.
The ends of the two bones forming the joint are covered by cartilage. This is a gristly material which acts as a shock absorber and helps the bones to move smoothly over each other. The bones are held together by very strong ligaments and the whole joint is contained in a bag called a ‘capsule’. The inside of the capsule is covered with a lining called ‘synovium’ (hence the name ‘synovial joint’) which forms a slippery surface and so allows the joint to move easily. The joint capsule contains a small amount of lubricating liquid, called ‘synovial fluid’, which is produced by the synovium.
When a joint moves, the muscles and tendons around it need to slide easily over each other and this smooth action is helped by structures called ‘bursas’. A bursa is a flattened sac, rather like a balloon before it has been blown up. It contains a small amount of synovial fluid, which makes the internal surfaces slippery and allows them to slide over each other. Many tendons run in lubricated sheaths, also lined by synovium.
Case history: Alan
Alan went to his GP because he started feeling a pain in his groin whenever he walked any distance, and thought he might have developed a hernia. After examining him, Alan’s doctor found that his right hip was rather stiff and sent him for an X-ray. This showed that, at 70, Alan had mild osteoarthritis in his right hip joint. His GP advised him to take simple pain-killers when necessary but stressed the importance of keeping active and taking regular exercise. Alan joined an over-50s swimming group at his local leisure centre and, after a few weeks of regular sessions, he found the groin pain much less troublesome.
Case history: Cathy
Cathy was just 35 when she noticed that her hands were becoming swollen and painful. She also felt tired and under the weather and very stiff all over her body first thing in the morning. After about six weeks, it was taking her an hour and a half to get going in the morning, and this was a problem as she needed to get her children off to school. She saw her GP and eventually investigations revealed that she had rheumatoid arthritis. Cathy was referred to hospital where the consultant started her on drugs to ease the pain and swelling and to slow the progress of her condition. Cathy saw a physiotherapist, who advised her on suitable exercise to keep her joints working, and she saw an occupational therapist, who advised her on ways of doing her daily tasks to limit the strain on her joints. She had to attend the outpatient clinic regularly for monitoring and, after a few weeks, her symptoms were far less of a problem than before.
KEY POINTS
- Arthritis is very common and there are many different types
- There is a lot of help – including self-help – available for arthritis sufferers
- All joints that move freely have the same basic structure
- The soft tissues making up a joint – ligaments, cartilage, capsule and the lining of the joint or synovium – are just as important as the bones
