Correct body weight, lifestyle changes prevent arthritis

By Carol Aloysius

While the symptoms of arthritis, are usually visible when one reaches middle age and above, their debilitating effects take place much earlier, the foundation often being laid in early childhood. Arthritis, although a common condition, is not curable once a person is afflicted with it. Treating arthritis patients especially in a welfare nation such as ours, costs millions of rupees for the state. Preventing this disease is not costly or complicated, as it needs mostly a change in one’s life style, which will minimise the effect of arthritis to a large extent, says a leading Rheumotologist.

Consultant Rheumotologist National Hospital, Dr Lalith Wijayaratne gives us an insight into the disease and the rehabilitative services available for arthritis patients in state hospitals.

Excerpts…

Q. What are the objectives and significance worldwide and in Sri Lanka of Arthritis Day which fell yesterday?

A. The aims of World Arthritis Day are:

• To raise awareness of arthritis in all its forms among the medical community, among people with arthritis and among the general public.

• To influence public policy by making decision-makers aware of the burden of arthritis and the steps which can be taken to ease it.

• To ensure all people with arthritis are aware of the facilities available to them. Observing this Day worldwide, is significant due programs that educate people how they can prevent this disease with simple interventions such as changing their lifestyles.

Q. Is Arthritis mostly a disease of the elderly? Can a young person also get it?

A. It is a disease of middle age and elderly persons. But children too can get arthritis.

Q. What ages do you consider are the high risk groups?
A. From 20 to 40 years

Q. Are there different types of arthritis? Is osteoarthritis and arthritis the same?

A. Arthritis occurs as a result of inflammation (swelling, warmth and redness - soreness) of the delicate structures within the joint.

The common types of arthritis seen in Sri Lanka include: Rheumatoid arthritis, Psoriatic arthritis, Ankylosing spondylitis, Reactive arthritis, Gout and Systemic lupus erythematous.

Osteoarthritis is different to arthritis. The underlying problem with osteoarthritis is wear and tear or degeneration of the cartilage which gives a cushioning effect to the joints

Q. Of all these forms, what form of arthritis is most commonly found in Sri Lanka?
A. Osteoarthritis

Q. Arthritis is said to be a rheumatic and musculoskeletal disease. Which part of the body dues it affect specifically? The joints? Neck? Knees? Knuckles?

A. Rheumatoid arthritis affects the knuckles, hands, feet, ankles and wrists. Osteoarthritis affects the weight bearing and the frequently moving joints such as knees, hips, lower spine, neck and the hands. Ankylosing spondylitis affects the joints of the spine

Gout affects joints of the feet, ankles and knees

Q. What other organs are affected by arthritis?
A. Heart, lungs, skin, blood cells, blood vessels, nerves,

Q. What are the causes? Food ? Lifestyles? Genes?

A. Lifestyles and genes
Q. What are the symptoms of arthritis?

A. Pain, swelling and stiffness of joints. In extreme and long standing patients – excess of fluid within the joints and joint deformities.

Q. Is numbness of the toes and feet a symptom?
A. This is not a direct effect of arthritis, although some arthritis patients do feel numbness in their feet due to the involvement of the peripheral nerves.

Q. If pain and stiffness are symptoms, how can they be differentiated from the kind of pain and stiffness one experiences when sitting too long at a computer?

A. Stiffness of arthritis lasts for more than 30 minutes. Usually accompanied with symptoms of fatigue, tiredness, loss of appetite, night sweats and feeling low. The pain and stiffness that one experiences from arthritis can disturb their sleep in the early hours in the morning. They wake up with stiffness.

Q. Can early detection prevent or minimise arthritis?

A. Definitely YES.
Q. Can the condition be reversed with medication?

A. Not reversed. But it can arrest the progress of the disease.
Q. Can diet help? If so what kind of food should one eat?

A. Avoiding food which can put on weight (e.g. food with a high saturated fat content), can minimise an excessive load on the joint which can make the arthritis joint to get more damaged.

Q. How early in life should one prepare to prevent developing arthritis?

A. From a very young age. By doing regular exercises, preventing putting on too much of weight, training the mind not to get over active in stressful situations.

Q. Once you get arthritis, can you cure it? Or simply have to live with it ?

A. We can CONTROL arthritis, which will stop the progression of the disease.

This is very much similar to the control of blood sugar and blood pressure in patients with diabetes and high blood pressure. Therefore, the emphasis is on early recognition and continued treatment.

Q. What happens when the disease advances? Is surgery the only answer?

A. There is medical rehabilitation where the allied health professionals such as physiotherapists, and occupational therapists join hands with the doctors and implement a comprehensive rehabilitation program mainly through exercises and various games which will help to control the disease to a certain extent. When both drugs and rehabilitation treatment fails the patient is referred for surgery.

Q. Are there different types of drugs to treat it? Are they available here?

A. Yes.

1. Analgesics – to relieve pain.

2. Non-steroidal Anti Inflammatory drugs ( NSAIDs) which will reduce the degree of inflammation and make the joints less painful and less stiff.

3. Steroids.

4. Disease Modifying Anti Rheumatic agents( DMARDs) which will act on the underlying immunological derangement which in turn will help to control the disease.

5. Biologics - Very special drugs which will target important cells and certain molecule which play an important role in propagating the arthritis thereby controlling the disease.

Q. What exercises do you recommend that have the least stress on the affected part?

A. The type of exercise the arthritis patient needs will strongly depend on the type of joints involved, the degree of the joint damage and on the patient’s overall health. Ideally a doctor should guide the patient on exercises. But as a rough rule, whatever physical activity does not cause pain should be practised daily on a regular basis.

Those patients whose hips, knees, ankles and feet are not much affected, a regular walk for about 15 to 20 minutes will help them.

Q. Can applying heat and cold help to reduce the pain?

A. Yes certainly. But if there is fluid in the joint or severe soreness indicated by redness and warmth we discourage using heat. In such instances ice will help more.

Q. Are there recent breakthroughs in treatment worldwide? Are they available in Sri Lanka too?

A. Yes. Today we target our treatment to achieve disease control or low disease activity. There are well tested and well defined end-points for the doctors to identify when patients achieve the target.

Most of us follow this concept of treat to target when we are treating all our patients with arthritis. There is this special group of drugs what we call as biologics (Biological DMARDs) which help to control the disease activity in patients whose disease is quite aggressive not responding to standard therapy. We do have Biological drugs in Sri Lanka.

Q. Does the National Hospital have a special unit to treat arthritis patients and provide them services they need under one roof? What does it do?

A. The National Hospital and also all the Teaching hospitals and some General Hospitals in Sri Lanka have special units to cater to the needs of patients with arthritis. These units are called “Rheumatology and medical Rehabilitation Units”.

A fully qualified (Board Certified) Consultant Rheumatologist is in charge of this unit. Nurses, physiotherapists and occupational therapists dedicated to care for patients with arthritis, also staffs these units.

Patients need to carry a referral letter from any doctor to be registered in these clinics.

The arthritis patients are treated with drugs as well as rehabilitation treatment in these units.

Drugs are issued for one month. All the patients are regularly followed up in these clinics and they are treated to achieve a disease control. Colombo, Ragama, Colombo South, Galle, Matara, Jaffna, Kandy, Nuwara-Eliya, Gampaha, Negombo, Kurunegala, Ratnapura and Kalutara are some hospitals in the State sector which have a fully functioning Rheumatology and Rehabilitation unit.

Q. You have recently started a peer group for arthritis patients. What is its objective?

A. To work together as a team to get their Rights. These include: The Right to get correct treatment. Right to be independent in their day to day activities.

Right to be part of the society. To help the clinicians to improve the services delivered to patients with arthritis by joining them to make representations to the government authorities.

Educate the general public on arthritis and its consequences.

To educate and counsel patients on whom arthritis has been newly diagnosed.

Q. Does having NCDs such as diabetes, hypertension and cholesterol lead to and aggravate arthritis?

A. No. But as Arthritis is a known major risk factor for the development of heart attacks and strokes these NCD conditions in an arthritis patient can make the arthritis patient more vulnerable.

Q. Your message to the public?

A. Arthritis is a common condition. The impact of arthritis can be made minimal by taking treatment as early as possible, preferably within the first three months after developing the first symptom. Maintaining correct lifestyles will minimise the effect of arthritis to a greater extent.

Q. Do you have any ‘ golden’ rules for preventing arthritis ?

A. Maintain ideal body weight

Do regular exercises

Food in moderation

Tame and train your mind so that it does not get over-active in stressful situations.

Is food addiction a step closer to formal diagnostic status?

Food addiction is not yet recognised as a mental disorder but certain obese individuals clearly display addictive-like behaviour towards food. To achieve a formal diagnostic status, ‘food addiction’ requires a stronger evidence base to support the claim that certain ingredients have addictive properties identical to addictive drugs of abuse. This topic is up for debate in the session, ‘Binge eating obesity is a food addiction'.

This year's fifth edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders) recognises ‘binge eating disorder’ (BED) as distinct from Anorexia nervosa and Bulimia nervosa, but it remains debatable whether BED is underpinned by an addiction disorder and should be prevented and treated like other addictive disorders.

The new category ‘Substance related and addictive disorders’ in DSM-5 combines the DSM-IV categories of substance abuse and substance dependence into a single disorder measured on a continuum from mild to severe.

Importantly, the term ‘dependence’ is not used any more in DSM-5, because most people link dependence with addiction when, in fact, dependence can be a normal body response to a substance.

Speaking at the 26th ECNP Congress Professor Suzanne Dickson, neuroscientist from the Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Sweden said, “the introduction of ‘addictive disorders’ allows classification of behavioural addiction for the first time, for example with pathological gambling, but this does not apply to food addiction.

Although there might be neurobiological and clinical overlaps between ‘addictive-like’ overeating and substance related and addictive disorders, a major difference is that is that food consumption, unlike alcohol, cocaine, or gambling or internet gaming behaviour, is necessary for survival.”

“A subgroup of obese patients indeed show ‘addictive-like’ properties with regard to overeating, such as loss of control,” continued Prof Dickson, “but this does not automatically mean they are addicted.”

According to some studies, at least 10-15 percent of obese individuals suffer from BED. However, BED also occurs in people that are normal weight.

The term ‘food addiction’ has been coined by the popular press and by many sufferers as a reasonable explanation for their predicament. Studies exploring the brains of obese patients that score highly for food addiction on the Yale

Food Addiction Scale show that certain areas known to be involved in reward and addiction have an altered response to both images of appetising foods and even to the taste of food.

However, more evidence is needed to support inclusion of food addiction as a diagnostic category.

Prof Dickson said: “This evidence itself is insufficient to support the idea that food addiction is a mental disorder.

- Medicalxpress

Healthcare providers should target unhealthy lifestyles

Healthcare providers should treat unhealthy behaviour as aggressively as they treat high blood pressure, cholesterol and other heart disease risk factors, according to an advisory published in Circulation .

“We're talking about a paradigm shift from only treating biomarkers - physical indicators of a person's risk for heart disease - to helping people change unhealthy behaviour, such as smoking, unhealthy body weight, poor diet quality and lack of physical activity,” said Bonnie Spring, lead author of the statement and a professor of preventive medicine and psychiatry and behavioural sciences at North-western University in Chicago.

“We already treat physical risk factors that can be measured through a blood sample or a blood pressure reading in a doctor's office, yet people put their health at risk through their behaviour.

We can't measure the results of these behaviour in their bodies yet.” Among the statement's recommendations, healthcare providers should create “inter-professional practices” to connect patients with behaviour change specialists such as dietitians or psychologists and implement the five A's when caring for patients:

- Assess a patient's risk behaviour for heart disease.
- Advise change, such as weight loss or exercise.
- Agree on an action plan.
- Assist with treatment.
- Arrange for follow-up care.

For inter-professional practices to work, reimbursement policies must be revised, Spring said.

Under an effective healthcare system, professionals can work with patients and draw on community and technology resources to provide intensive behaviour interventions. “This isn't a problem that can be solved alone by the patient or the doctor who is strapped for time,” Spring said. “We need to break out of our silos and get ahead of the curve in prevention.” She said to achieve the American Heart Association's 2020 impact goals - to improve the cardiovascular health of all Americans by 20 percent while reducing deaths from cardiovascular diseases and stroke by 20 percent-we must make preventing cardiovascular diseases a priority.

- MNT