Living with

osteoarthritis

ARTHRITIS CARE Osteoarthritis

devised with and for people with arthritis

Osteoarthritis is a disease of the joints affecting almosteveryone as they get older. Around eight out of 10 peopleover the age of 50 are affected, but younger people – even teenagers – may develop it. Most people are likelyto experience some level of pain and some degree ofmobility problems.

Osteoarthritis cannot be cured, but an early diagnosis canhelp slow its progression and a lot can be done to ease thesymptoms. As this booklet explains, there is a wide rangeof treatments to try and there is a lot you can do to makeday-to-day living easier.

Contents

Introducing OA 1About the condition

Getting a diagnosis 6The process of getting diagnosed

Communicating with health professionals 7Who you will see, what you can do to manage your arthritis. Treatment with drugs

Looking after your joints 11Ways of living with arthritis. Using exercise, diet and complementarytherapies to look after your joints

Practicalities 20Managing at home, in work and education. Access to transport and benefits

Caring for yourself 26Considering your emotions, relationships and self-management

Useful organisations 29

All people pictured on the cover and quoted in this booklet have arthritis.

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INTRODUCING OA

■ What is OA?Osteoarthritis is a condition thatusually develops gradually, overseveral years. It affects a numberof different joints.

For some people, the changesare so subtle and develop oversuch a long period of time thatthey are hardly noticeable. Butothers may experience graduallyworsening problems, includingpain and restricted movement,particularly in large joints such asthe hip or knee. You may have tosee the doctor from time totime to discuss your conditionand your treatment.

We do not yet know thecauses or the cure for

osteoarthritis. Although there isa connection with the ageingprocess, doctors andresearchers are trying to identifywhat factors in this processtrigger the disease. They nolonger see osteoarthritis as beingan inevitable part of ageing or awear and tear disease, but morean important challenge to fight.

■ What happens?Healthy cartilage – theprotective layer that covers thebone end in the joint – is verysmooth, strong and flexible. Itabsorbs the stresses put on ajoint and protects the bonesfrom damage. In osteoarthritis,

A normal joint

SYNOVIALFLUID

CARTILAGESYNOVIALMEMBRANE

CAPSULE ANDLIGAMENTS

BONE

BONE

The early stages of osteoarthritis

THINNINGCARTILAGE

this becomes pitted, brittle andthin, and, over time, can wearout completely.

When the cartilage deteriorates,the bone underneath thickensand broadens out.

As the cartilage becomesthinner, the bones of the jointrub together, causing pain,inflammation and the gradualbuild-up of bony outgrowths(osteophytes), which make itlook knobbly.

At the same time, the jointcapsule becomes thicker and theamount of synovial (lubricating)fluid can increase, often causingthe joint to swell. It may alsobecome stiff and painful tomove.

■ CausesSpecific causes of osteoarthritisare hard to pin down. Severalfactors can increase the risk ofdeveloping it.

AgePeople usually developosteoarthritis from their late 40sthrough to old age and it is oftenundiagnosed. Although it isuncommon before the age of 40,young people can develop it. It isnot known exactly why olderpeople tend to develop it, but itis probably due to bodilychanges which come with oldage, such as the musclesbecoming weaker, putting onweight and the body becomingless able to heal itself.

GenderOsteoarthritis is more commonand often more severe inwomen, especially in the kneesand hands. It often starts afterthe menopause.

ObesityThe effects of obesity onosteoarthritis are welldocumented. Carrying extraweight puts pressure on weight-bearing joints, especially the

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More advanced osteoarthritis

THICKENEDJOINTCAPSULE

BONETHICKENS ANDSPREADS OUT

(OSTEOPHYTES)

CARTILAGETHINS

FURTHER

hips, knees and spine. It alsoincreases the chances ofosteoarthritis worsening once ithas developed.

‘I know it’s best not tobe overweight with OA,but it’s difficult’Joint injuryA major injury or operation on ajoint may lead to osteoarthritisat that site later in life. Normalactivity and exercise are goodfor the joints and do not causeosteoarthritis. However, veryhard, repetitive activity mayinjure joints.

Exercising too soon after aninjury has had time to healproperly may also lead toosteoarthritis in that joint lateron. It is always best to checkwith your doctor, physio-therapist or nurse when it is safeto exercise after you havesustained an injury.

HeredityOne common form ofosteoarthritis – nodalosteoarthritis – runs strongly infamilies. This particularly affectsthe hands of middle-agedwomen. In other common forms

of osteoarthritis, heredity plays asmall part compared withobesity, ageing and joint injury.There are some very rare formsof osteoarthritis that start at ayoung age and run in families andthese are linked with singlegenes that affect collagen – anessential component of cartilage.

The standard explanation forosteoarthritis is that it is a resultof wear and tear. Studies ofpeople who have led very similarlives show some will havevirtually perfect joints, whileothers have quite severeosteoarthritis. Therefore, itseems there must be an inbuiltsusceptibility to, or protectionagainst, osteoarthritis.

Other types of joint diseaseOsteoarthritis is sometimescaused by injury and damagefrom a different kind of jointdisease years before. Forexample, people withrheumatoid arthritis can developosteoarthritis in the joints thatwere most affected byrheumatoid inflammation.

MythsOsteoarthritis does have othercauses – we just don’t know

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what they are yet. But we doknow enough to correct somemyths.

‘My knee and spine aremore painful when theweather turns bad’Although there is no evidence tosupport the claim that weathermakes arthritis worse, manypeople find that their joints oftentend to feel worse when theatmospheric pressure is falling,for example, just before it rains.However, although the weathermay temporarily affectsymptoms, it does not affect theactual arthritis itself.

Warmer regions in the worlddo not have lower incidences ofarthritis than colder regions.Osteoarthritis occurs all over theworld, in all types of climate.

While some types of arthritis –gout for example – are directlyaffected by diet, there is noevidence that a particular dietwill eliminate the condition.However, some people claimcertain foods make their pain orinflammation worse. It is veryimportant to keep your weightas close as possible to the idealfor your height and age.

Excess weight compounds theproblem by putting extra strainon damaged joints. It is also

important to eat a balanced dietto nourish muscles, cartilage andbone. This will reduce the risk ofosteoarthritis.

■ Which joints?Osteoarthritis is very variableand can affect different joints indifferent ways, but is mostcommonly found in the knees,hips, hands and spine.

Pain can vary in severity andcan be so mild that many peopledon’t even notice it, or so severethat mobility and quality of life isaffected.

The spine and weight-bearingjoints such as the knees, anklesand hips are most frequentlyaffected by osteoarthritis,making mobility difficult.Osteoarthritis in the fingers,thumbs and wrists affects gripstrength and the ability toperform everyday tasks such asopening jars, picking small thingsup, writing and doing up buttons.

Shoulder and elbow joints arealso susceptible to arthritisalthough this is much rarer.Some people may experience agrinding feeling in the shoulderand a reduced range ofmovement. Elbows are verysensitive to injury so very mild

arthritis here can lead to quite asignificant loss of mobility.

■ Early signs andsymptoms

The early signs of osteoarthritisare so mild that they are ofteneasy to miss. The mainsymptoms are stiff and painfuljoints, with the pain tending tobe worse while exercising thejoint and at the end of the day.

Stiffness usually wears off afterresting, but the joint may notmove as freely or as far asnormal and may ‘creak’ or‘crack’ when moved. Muscle-strengthening exercises canprevent the joint giving way.

Symptoms can vary and youmay have bad patches of a fewweeks or months followed bybetter periods.

You may find that it dependson how much physical activityyou do. Joints may appearswollen. In more advancedcases, there may be constantpain and everyday tasks andmovement may become difficult.

It is important you visit yourGP and don’t ignore yoursymptoms, as early diagnosis willhelp prevent unnecessarydamage.

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Your GP will be able to assesswhether you have osteoarthritisor whether your symptoms aredue to another illness.

■ Your historyYour GP will begin by asking youto describe the symptoms, andwhen and how the conditionstarted. Make sure you tell yourdoctor exactly how you feel,giving a good description of pain,stiffness and joint function, howthey have changed over time andhow your work and daily life areaffected. Finally, you will beasked about any other medicalconditions you may have andwhether you are taking anymedicines.

■ Physical examinationYour doctor will examine yourjoints and may check muscles,nerves and aspects of yourgeneral health, feeling for anybony swellings and creakingjoints. They will also look for anyrestricted movement, jointtenderness and any thinningmuscle, excess fluid or instabilityin the joints.

You may be referred, after a

time, to a physiotherapist oroccupational therapist who cangive you special exercises to doand advice on how to relax,overcome mobility problems,avoid joint strain and cope withpain. If your arthritis is severe,you may be referred to ahospital specialist such as arheumatologist or anorthopaedic surgeon.

■ Testing forosteoarthritis

There is no blood test forosteoarthritis although you maybe given one to rule out othertypes of arthritis.

X-rays are the most useful test to confirm osteoarthritis andto see how much damage hasoccured. These will show suchthings as cartilage loss, bonedamage and osteophytes (bonygrowths). X-rays do notdetermine how much yourarthritis will trouble you – an X-ray that shows severe changesdoes not necessarily mean thatyou will have a lot of pain ordisability. Also, they may notshow early osteoarthritisdamage.

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GETTING A DIAGNOSIS

Your GP will be your maincontact to do with mattersconcerning your treatment, andit is important to develop a goodrelationship to ensure that youare given the treatment that ismost effective for you.

Don’t be afraid of askingquestions if something is notclear. It may help you to writethings down or to take a friendor relative with you.

Doctors are often rushed, butit is important that you make themost of your consultations. Thiswill help you understand and feelconfident aboutany treatmentyou are given.

You and your GP must worktogether to help you manageyour arthritis and help you live as normal a life as possible.Ultimately, only you know howyou feel and the difficulties you face.

■ Getting the most out of your GPappointment

It is a good idea to make a list ofabout four questions to ask yourGP before your appointment incase your mind goes blank.

If you feel that you need moretime with your doctor, you canalways ask for anotherappointment or perhaps book adouble appointment. Yourlocal surgery will be ableto tell you about itsrules.

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COMMUNICATING WITH HEALTHPROFESSIONALS

When you join a practice youcan ask at reception if a GP has aparticular interest in arthritis.

‘I did a lot of researchbefore I went to my GP,it really helped me’Don’t be afraid to discusstreatment options or to take onmore responsibility for your ownneeds.

‘I took a friend to the surgery with me, to prompt me in case I forgot to askanything’It is worth reminding your GP ofany other conditions you have ormedications and supplements

you are taking.

■ Treatment versusprevention

While it can be difficult to avoid,injuries to a joint can increasethe risk of developingosteoarthritis in the same joint,years later. However,maintaining a normal weight foryour height and body structure,keeping physically active andavoiding excessive stress on thejoints as you get older, canreduce the severity and impactof osteoarthritis. Ways to reducestress on the joints include:● sticking to your ideal weight● pacing yourself. Instead of

attending to the chores thatneed doing all at once spreadthem out

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● wearing shoes with thick, softsoles can act as shockabsorbers and reduce jarring

● using a walking stick canreduce the weight and stresson a painful hip or knee joint.

■ What you can do tomanage your arthritis

● General exercise – keepmoving. Don’t be afraid to useyour joints.

● Swimming in a heated poolcan help.

● Massaging the muscles aroundthe joints will help ease painand help keep you supple.

● Sleeping on a good mattresscan ease pain.

● Mild to moderate disease canusually be managed success-fully with painkillers, such asparacetamol or ibuprofen (anon-steroidal anti-inflamma-tory drug). Make sure youfollow the dosage instructionson the packet.

A GP may prescribe a differentnon-steroidal anti-inflammatorydrug (if this is appropriate foryou) or a stronger codeine-based painkiller.

Should your conditiondeteriorate to the point whereyour mobility is severely

affected, you may be advised byyour GP to see a rheumatologistfor specialist advice on medicalmanagement, or an orthopaedicsurgeon to discuss the possibilityof joint replacement surgery.

■ Treatment with drugsThe medication each person isprescribed and how often theytake them differs depending ontheir disease type and on howthey react to the drugs. Some ofthe most commonly used drugsfor osteoarthritis are listedbelow.

AnalgesicsThese are pain-relieving drugs,such as paracetamol, that do notaffect the arthritis itself, but helprelieve the pain and stiffness.They come in varying strengthsand the stronger ones are onlyavailable on prescription.

Paracetamol, which is availableover the counter, is the simplestand safest painkiller, and the bestone to try first. Side effects areunusual, although taking toogreat a dosage can cause liverdamage.

Many pain relieving drugs,including pain relief gels, can be bought over the counter.

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Never take more than therecommended dose and, if indoubt, talk to your pharmacistor doctor.

‘Painkillers don’tremove the paincompletely, but theyalter the nature of it,making it morebearable’Stronger, combined painkillerssuch as co-codamol and co-dydramol are available onprescription. They containparacetamol and a secondcodeine-like drug. These aremore likely to cause side effects,such as constipation or dizziness.Some anti-inflammatory drugssuch as ibuprofen can be used aspainkillers in low doses.

Non-steroidal anti-inflammatorydrugs (NSAIDs)If you have mild inflammation inyour joints, your doctor mayprescribe a course of non-steroidal anti-inflammatory drugs(NSAIDs). However, if there isno inflammation, as is often thecase with osteoarthritis, thesedrugs may have no advantageover painkillers.

NSAIDs are more likely tocause side effects – especiallyindigestion and diarrhoea. Theycan interfere with the effective-ness of other drug treatmentsused to treat high bloodpressure and heart disease.Ibuprofen and diclofenac arecommonly used NSAIDs butthere are many others. Yourdoctor will advise you which isthe appropriate one to take, andthe correct dose. Creams andgels can often help, especially forknee and hand osteoarthritis.

Cox-2sCox-2 inhibitors are a newertype of NSAID, designed to besafer for the stomach. However,concerns have been raised abouttheir side effects, includingincreased risk of cardiovascularproblems, especially for peoplewith a history of heart disease orstroke. Some drugs within theclass have been withdrawn. Atthe time of printing, the futureuse of Cox-2s is under review,although most Cox-2s are stillavailable on prescription. If youwant to know the latest aboutCox-2s, discuss with your doctorwhat treatment is most suitablefor you.

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Most people can lead a full,active life with osteoarthritis byproperly managing the conditionand making small, common-sense alterations to life.

There are many things thatcan be done to help alleviate thesymptoms and prevent thedisease from progressing.Regular exercise, protecting thejoints from further injury andmaintaining an ideal weightthrough a healthy diet will allbenefit you.

Inflamed or damaged jointsneed to be cared for andprotected. Keeping healthy ispart of this, but you also need toavoid straining joints byoverdoing things or doing themawkwardly.

You may have to give morethought to the clothes and shoesyou wear, to the way you lift,grip and carry things or to theway you arrange your home orplace of work. An occupationaltherapist can help with all of this.

■ Occupationaltherapists

Occupational therapists (OTs)can help if you are having

difficulty with day-to-day taskslike washing, dressing, cookingand cleaning. They can alsoadvise on your workenvironment.

OTs are experts on whatequipment is available to helpyou and where you can buythese items. They may also beable to supply some of the moreexpensive items on temporaryloan.

Your GP or hospital consultantcan put you in touch with anoccupational therapist. This maybe at your local hospital or theymay visit you at home. If you arehaving trouble getting a referralto an OT, then you can referyourself by phoning your localsocial services department andasking for an assessment.

■ Exercise and rest – a fine balance

Exercise can be the furthestthing from people’s minds whenthey live with pain on a dailybasis. However, for people witharthritis, the benefits of exerciseare enormous. Exercise protectsjoints by keeping the musclesstrong and keeping you mobile.

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LOOKING AFTER YOUR JOINTS

It is also good for pain and stressand can help you lose any extraweight which puts strain onjoints.

‘I’m a Walking forHealth leader. The factthat I have a new hipgives participantsconfidence’Change the way you move● Spread the load – use both

hands to lift and hold, forexample.

● Shift rather than lift – slideheavy pans along a kitchen top.

● Use larger, stronger joints –rather than pushing a dooropen with your hand andwrist, use your shoulder or hip.

● Don’t grip things too tightly –choose a fatter pen, forexample. Hold it as loosely aspossible or expand the gripwith padding.

● Changepositionsoften – shiftposition orstretch everyhalf an hour.

● Watch your posture– slouching can add strain on

muscles and joints.Exercise won’t make yourarthritis worse – as long as it isthe right sort. The wrong sort ofexercise could put strain on yourjoints and damage them further.Ask your GP whether it isappropriate for you to bereferred to a physiotherapist,who will help you work out aprogramme combining flexibility(range of movement), strength-ening or aerobic exercises.Arthritis Care’s booklet onexercise includes examples of these.

Range of movementRange of movement(ROM) exercises form thebackbone of everyexercise programme.Everyone should dothese as they helpmaintainflexibility,

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and are important for goodposture and strength.

The exercises involve takingjoints through their full range ofmovement and then easing thema little further. ROM exercisesare done smoothly and gently so they can be done even when in pain.

StrengtheningStrengthening exercises areespecially beneficial, becausethey help to strengthen themuscles which move, protectand support your joints. Manypeople become less active whenthey develop arthritis because ofthe pain and fear of causingdamage. This can lead to musclewastage and weaker joints.

By developing strong muscles,joints become more stable andactivities such as walking andclimbing stairs are easier.

Start slowly, gradually buildingup the repetitions. As themuscles get used to doing more,they become stronger. The typeof exercises you do will dependon which joints are affected andhow severe your condition is.Always check with a doctor orphysiotherapist before starting a regime.

AerobicAerobic just means exercise thatraises your heart rate. This typeof exercise burns off calories,speeds up the body’smetabolism, helps maintain astrong heart and helps muscleswork more effectively. It alsohelps control and reduce weight,improves sleep, strengthensbones, reduces depression andbuilds up stamina.

The best forms of aerobicexercise for people with arthritisare walking, cycling andswimming.

Begin any exercise bystretching to warm up. To getany benefit, aerobic exercisemust be done for a prolongedperiod (20-30 minutes) two tothree times a week. You are at agood level if you start to sweatand can still hold a conversationat the same time.

Check with a doctor beforebeginning any regime. Theseexercises done correctly andconsistently will provide somerelief from the pain of arthritis,help with good posture, andincrease your energy and vitality.

Warm water exerciseGentle exercise can be carried

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out in hydrotherapy pools thatwill usually be heated to around34 degrees centigrade.

The warm water soothes thejoints, relieves stiffness, andpromotes better bloodcirculation. The water enablesgentle and low-impact exercise,and also offers the resistanceneeded to keep muscles andjoints in shape.

As with any exerciseprogramme, consult your GPbefore you begin this type ofexercise. It is very important notto overdo things. Rest yourjoints – especially when they areinflamed or particularly painful.Resting painful joints will makethem more comfortable, but toomuch may make them stiff. Youneed to strike a balancebetween rest and activity.

Your doctor may refer you forhydrotherapy – exercising in aheated pool under thesupervision of a physiotherapist.Because the water supportsyour weight, the range ofmovement in your joints shouldincrease and pain decrease. Mosthydrotherapy pools range indepth and if you cannot loweryourself into the water, therewill usually be a hoist.

Hydrotherapy sessions may beheld in your local hospital.

■ A healthy dietYour body needs a range ofnutrients, so make sure you eata healthy, balanced diet. Includelots of fruit, vegetables, pasta,pulses (such as beans and lentils),fish and white meat. Try to also cut down on sugary andfatty foods.

There is a lot of debate aboutwhether what you eat affectsarthritis – certain foods mayhelp. Studies on essential fattyacids (found in oily fish) showthat they can ease joint pain andstiffness. Try to include more ofthese in your diet and considertaking a supplement.

Some people claim that somefoods seem to make their inflam-mation or pain worse. If you canwork out which food is thetrigger, talk to your doctor foradvice. It is important you don’tmiss out on essential nutrients.Research in this area iscomplicated and much moreneeds to be done.

If you are considering a diet,talk it over with your doctor ordietician first. Beware of dietsthat claim to cure osteoarthritis,

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and never begin a diet thatinvolves stopping medicationwithout discussing it with yourdoctor.

Read Arthritis Care’s bookleton diet and supplements forfurther information.

■ SupplementsPeople with arthritis take a hugerange of supplements includingherbal remedies, homeopathicmedicines, vitamins, mineralsand dietary supplements.

Many people withosteoarthritis believe they dooffer relief. So far there is littleevidence they improve arthritisor its symptoms, though recentfindings for omega-3 fatty acidsand glucosamine are promising.

Before you start takingsupplements:● find out as much as you can● remember that supplements

will not cure arthritis● check with your doctor or

pharmacist for interactionwith prescription drugs

● tell your doctor if you aretaking any supplements andreport any side effectsimmediately

● keep a record of how you feelso you can see if they are

having an effect● buy brands from reputable

manufacturers● consider the cost – taking

supplements can beexpensive.

Below are a few of thesupplements most commonlytaken by people withosteoarthritis.

‘I drink lots of semi-skimmed milk and takea supplement to keepmy bones strong’GlucosamineGlucosamine is popular withpeople who have osteoarthritis.It is a natural substanceextracted from crab, lobster orprawn shells. While it does notcure arthritis, some peoplebelieve that it does help ease

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pain and stiffness. There is notmuch scientific evidence tosupport this at this stage. If youhaven’t seen an improvementafter two months, it probablywon’t help you. There are noknown major side effects, butlesser ones include nausea andindigestion. Glucosamine, whichcomes in capsule form, is oftentaken in combination withchondroitin.

ChondroitinChondroitin sulphate existsnaturally in our bodies and isthought to give cartilageelasticity and to slow itsbreakdown. In supplement formit is derived from the trachea ofcattle or sometimes sharkcartilage.

Don’t expect to see anyimprovement for at least twomonths. If you have severecartilage loss you probably won’t get any benefit. There do not seem to be any seriousside effects, but minor onesinclude nausea and indigestion.It could increase the chances of bleeding if you are taking any blood-thinning drugs. Thelong-term effects are notknown.

Fish oilsFish oils, like cod liver oil, canproduce a modest improvementin joint pain and stiffness andhave a good record of easing thesymptoms of osteoarthritis.

Recent research has foundthat omega-3 fatty acids areeffective because they reducethe activity of the enzymesresponsible for cartilage damage,and they switch off anotherenzyme known to cause much ofthe pain and inflammation ofarthritis.

A daily dose, often in capsuleform, must be taken for at leastthree to six months. Any benefitis lost when you stop taking it.Care should be taken not toexceed safe levels of vitamin Aand D when taking cod liver oil.Studies still need to be carriedout on the possible long-termtoxicity of taking fish oils.

■ Complementarytherapies

Many people with arthritis havetried a range of complementarytherapies in addition to theconventional drugs prescribedby their doctor. However, whatworks for one person may wellnot work for another.

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There are a multitude ofdifferent therapies. Some arethoroughly reputable and areregulated by statutory bodies.Other therapies make highlydubious claims with little or noevidence to back them up.

Complementary therapies cangenerally be used alongsideorthodox treatment, althoughdoctors may vary in theirattitudes to them. Anypractitioner of these therapieswho advises you to stop usingconventional medications shouldbe regarded with extremecaution.

‘I had hydrotherapysessions which werewonderful, but by thetime I drove 15 mileshome, I undid all thegood work’Some complementary therapiesare available on the NHS andsome private health insurance

companies will pay fortreatment. However, themajority of people pay for theirown treatment and they can be costly.

Complementary therapies donot offer a cure for arthritis.They can, however, helpalleviate some of the symptomssuch as pain and stiffness as wellas dealing with some of theunwanted effects of taking drugs.

Complementary therapies canplay an important role inencouraging positive changes inlifestyle and outlook, such asincreased self-reliance, a positiveattitude, learning relaxationtechniques and appropriateexercises. Lifestyle changes likethese may help to stabilise orimprove your arthritis.

Some of the most populartherapies are listed below.Acupuncture may be useful forosteoarthritis. It aims to restorethe natural balance of health byinserting fine needles into

specific acupoints in the

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body to correct imbalances inthe flow of energy, therebyrelieving pain.The Alexander techniqueconcentrates on how you useyour body in everyday life. Bylearning to stand and movecorrectly, people can alleviateconditions that are exacerbatedby poor posture.

‘The Alexandertechnique really helpsmy posture and relieves pain’Aromatherapy uses essential oilsobtained from plants to promotehealth and well-being. The oilscan be vaporised, inhaled, usedin baths or a burner, or as part ofan aromatherapy massage.Chiropractors use their hands toadjust the joints of your spine,aiming to improve mobility andrelieve pain.Massage can loosen stiff muscles,improve muscle tone, increasethe flow of blood and lymph, andease tension. A good massageleaves you feeling relaxed andcared for.Osteopaths manually adjust thealignment of the body and applypressure to the soft tissues of

the body to correct structuraland mechanical faults and allowthe body to heal itself.Tai chi is a non-combativemartial art designed to calm themind and promote self-healingthrough sequences of slow,graceful movements.

Finding a good therapistSome therapies are available onthe NHS, so it is worth askingyour GP if he or she canrecommend a therapist or aparticular therapy.

Ask other people withosteoarthritis if they canrecommend a therapist, butremember that what works forsomeone else may not suit you.

The Institute for Complemen-tary Medicine (see page 29 forcontact details) can also help youfind a qualified therapist.

Ask how much treatment willcost, and how many sessions youwill need to feel a benefit.

Ask if the therapist is amember of a professional body,what kind of training they havehad and how long they havebeen practising. Ask if they have insurance in case somethinggoes wrong. They must take afull medical history.

Tell your therapist about anydrugs you are taking, and yourdoctor about the therapy. Don’t stop taking prescribeddrugs without talking to yourdoctor first.

There is more information inArthritis Care’s booklet aboutcomplementary therapies.

■ SurgeryWhile some people with arthritiswill never need to have surgery,others find it is very successful inrelieving pain caused by arthritis,improving mobility and reducingstiffness. Surgery is usually onlyconsidered after all othersuitable treatment options havebeen explored and when thejoint is badly damaged byarthritis.

Surgery can be minor – toassess damage done or tosmooth joints and repaircartilage (known as anarthroscopy), or it can be moreintrusive – to replace or to fuse a joint.

There is a risk the operationwon’t work, or will lead tofurther physical complications.Recovery may take some timeand a lot of effort on your part.

However, many people decide

that the positive effects on theirlifestyle will outweigh any risks.Having surgery could bring abouta dramatic improvement in yourpain levels and quality of life.Surgery can also prevent jointsdeteriorating further andprevent disability.

‘I still have a bit ofpain since my op, but it doesn’t limit me like it used to’In spite of great progress withartificial joints, many people withosteoarthritis who have hadsurgery still live with difficultiesand pain because of theircondition.

You will find more informationin Arthritis Care’s booklet onsurgery.

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Living with osteoarthritis maynot be easy, but there are plentyof sources of help and there isplenty you can do to helpyourself. See pages 29 and 30 fora list of useful organisations.

■ At homeThere are many ways you canset things up at home to makesure that daily living is asstreamlined and stress-free aspossible.

‘Don’t let your prideget in the way of usingequipment that mayreally help you’In the kitchen, for instance, thismight include:● rearranging cupboards and

drawers so the things you usethe most are nearby

● lightweight pans, mugs or akettle

● equipment with easy-to-usebuttons

● an electric tin opener, a capgripper, or knives and peelerswith padded handles

● a stool to sit on while you arepreparing food, or a trolley for

moving heavy items● devices for turning taps more

easily● evening-up your worktops,

or raising the oven and fridge,so they are at the right heightfor you and you can slidethings around.

Help with costsYour local social servicesdepartment (social workdepartment in Scotland, healthand social security agency inNorthern Ireland) may be ableto help with equipment oradaptations to your home.

You are entitled to have yourneeds assessed – usually by anoccupational therapist – to seewhether you are eligible forhelp. Eligibility variesthroughout the UK andyou may have tocontribute towardsthe cost. Youmay also haveto wait a longtime for anassessment orfor equipment.If your needschange, contact social

PRACTICALITIES

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services so they can move youup the waiting list.

Some equipment may also beavailable on the NHS. Localhome improvement agenciesand voluntary organisations alsooffer help or funding forequipment and adaptations.

There is more informationabout home life in ArthritisCare’s booklet on independentliving.

You have the right to anassessment of your care needs athome – again, contact your localsocial services department. Ifyou have a specific carer, theassessment must also take theirneeds into account.

Help varies a lot from area toarea, but social services may beable to arrange for care workersto visit you for domestic care,such as cleaning and shopping, orto give you support withpersonal tasks.

■ Work and educationYour arthritis may notsignificantly affect your work atall, but struggling on if you havedifficulties could make yourarthritis worse. The best policyis to be positive, honest andclear about your needs, and help

people understand whatosteoarthritis means for you.

Smarter ways of working willhelp protect your joints andconserve energy. They caninclude:● organising your work –

rearranging your work area,using computer equipmentcorrectly, taking regularbreaks, relaxing, pacingyourself and varying tasks

● flexibility – perhaps working ashorter day or different hours,or being based at home someof the time if that fits in withyour job.

‘After I gave up workI went back touniversity and got adegree. It really keptme occupied’An occupational therapist canhelp you figure things out, as cana disability employment adviser(DEA). DEAs are based at yourlocal Jobcentre Plus (Jobs andBenefits Offices in NorthernIreland) and offer support andadvice to disabled people andemployers, referring to trainingschemes where appropriate.

Access to Work advisers offer

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in-depth information on theAccess to Work programme – aGovernment scheme that helpsdisabled people and theiremployers overcome work-related obstacles. This could beby providing equipment oradaptations to your workplace,and work-related expenses, suchas taxi fares. Contact your localJobcentre Plus for moreinformation.

There is also financial andpractical help on offer if youwant support finding work,handling application forms andinterviews, or making the movefrom benefits to work. YourDEA can help you access this.

Depending on how yourarthritis affects you, the timemay come when you need toconsider changing jobs. Somepeople do have to stop workingaltogether. It’s important to getprofessional advice about yourrights and options beforehand.

Giving up work doesn’t meanthat you are giving up your life:retraining, further education andvoluntary work may all opennew doors. It is important todiscuss options before makingyour decision.

The Disability Discrimination

Act (DDA) says that allemployers must take reasonablemeasures to ensure they don’tdiscriminate against disabledpeople. These can includechanging the workingenvironment, moving yourworkspace to the ground floor,or retraining you and reallocatingyour duties. But you will only beprotected by the DDA if youremployer knows about yourarthritis. The DDA also coversrecruitment, training, promotionand dismissal.

More information for peoplewith arthritis looking for – oralready in – work can be foundin Arthritis Care’s booklet onworking.

If you are going into highereducation (post-18), you may beeligible for a Disabled Students’Allowance. The allowancecovers any extra costs orexpenses students have becauseof a disability. For moreinformation, contact Skill (seepage 30).

■ TransportGetting around is veryimportant. If it becomes difficultfor you to use public transportor drive a car, your life can

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become very restricted. Thereare some transport schemes andservices run by local authorities,and voluntary and commercialorganisations to allow you tomaintain your mobility, butservice provision throughout theUK can be patchy.

Some local authorities (in thephone book) produce guides toaccessible bus, train, minicabservices and transport schemes.Your local disability organisation(in the phone book), library orlocal newspaper may also beable to tell you about what’s onoffer locally.

If you receive AttendanceAllowance or the higher rateDisability Living Allowance youcan purchase a Disabled PersonsRailcard. This is valid throughoutthe UK and entitles you to up toa third off many rail tickets(www.disabledpersons-railcard.co.uk).

You can apply for a BlueBadge, which means that you will be allowed to park in adesignated parking space closerto your destination. The badgebelongs to the disabled personwho qualifies for it (who may ormay not be a car driver) and canbe used in any vehicle they are

travelling in. For further detailsvisit the Department forTransport website atwww.dft.gov.uk

If you drive, then a few minoradjustments – such as a paddedsteering wheel, a headrest, extraside-mirrors or a wide-angledmirror – may help. An automaticgearbox and power steering canreduce strain on joints andmuscles.

‘The mobilitycomponent of the DLAallows me to run a car – it has opened upmy life’If you receive the higher rate ofthe mobility component of the

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Disability Living Allowance, youmay be able to use it to hire orbuy a car, wheelchair or scooterthrough the Motability scheme(see page 30).

If you need a specially adaptedcar, contact an accredited drivingassessment centre. The Forumof Mobility Centres has a list ofcentres. Don’t forget to tell theDriver Vehicle Licensing Agency(DVLA) and your insurancecompany if your arthritis affectsyour ability to drive.

■ BenefitsYou may be entitled to statebenefits to help with the extracosts of having arthritis or if youare unable to work. Claimingbenefits can be complicated andtime consuming so,before you start, itis worth gettingexpert help andadvice from:● your local social

security office orJobcentre Plusoffice (Jobs andBenefits Office inNorthern Ireland– see the phone book)

● a social worker or welfarerights officer at your social

services department (socialwork department in Scotland,health and social securityagency in Northern Ireland)

● your Citizens Advice Bureauor other advice centre

● Benefit Enquiry Line – aninformation line run by theGovernment, which aims toadvise disabled people of theirbenefit entitlements and assistthem in making a claim. Call0800 882 200, or 0800 220674 if you are based inNorthern Ireland.

‘If you get turneddown, then fight. I hadto fight for DLA and gotit in the end’For more information, see

Arthritis Care’s informationsheets on benefits.

DLA and AAWhether you are workingor not, you can claimDisability Living Allowance(DLA) if you are under 65and need help gettingaround or with personal care(such as washing and

dressing). If you are 65 or overyou may be entitled to

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Attendance Allowance (AA) forhelp with personal care.

DLA and AA are not meanstested, are tax free and are paidin full on top of other incomeand all other benefits you get.

They also mean you mayqualify for other benefits or help,so it is worth applying for them ifyou think you are eligible. If yourclaim is initially unsuccessful it isworth reapplying as manypeople go on to qualify onfurther attempts.

To help complete yourapplication keep a diary over acouple of weeks, listing anythings you have trouble doingand the time it takes you to dothem, so you don’t under-estimate how much help youneed. Reflect the bad days aswell as those when you canmanage.

Working tax credit and child taxcreditIf either you or your partnerwork 16 hours a week or moreand you have a disability,Working Tax Credit (WTC) cantop up earnings if you are on alow income. There is no upperlimit on the amount of savingsyou can have, but income from

savings will be taken intoaccount.

Child Tax Credit (CTC) is alsoavailable if you are responsiblefor children, whether you are inwork or out of work even ifyour income is quite high.

Incapacity BenefitIf you can no longer workbecause of health problems, you may be able to claimIncapacity Benefit.

You usually need to have paida certain amount of nationalinsurance contributions to get it.

Any occupational pension orhealth insurance you receivemay reduce the amount ofIncapacity Benefit you are paid.See the Arthritis Care websitefor up-to-date details.

Other benefitsIf you are on a low income,there are several other benefitsyou can apply for such as IncomeSupport, Pension Credit (if youare over 60), Housing Benefitand Council Tax Benefit.

Carers can apply for benefitstoo, but should check first thatclaiming Carer’s Allowance willnot affect the benefits of theperson they care for.

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■ Your emotionsEveryone’s experience ofarthritis is different. Not allpeople experience the samesymptoms, level of pain orfatigue or the same feelings.Don’t be surprised if you feelfrustrated one day and perhapsangry the next.

It is good to let your emotionsout. Bottling them up can makethings worse.

‘The invisibility of painis most frustrating’Pain can usually be controlled,stiffness and inflammationrelieved, and there are ways toovercome the loss of strength,grip and mobility.

Some people find that theirlives do not change that muchand that they can more or lesscarry on as normal. Some peoplebecome stronger and moredetermined as a result of havingto adapt their lives to fit in withtheir arthritis – everyone isdifferent.

Your own reactions to arthritiswill differ from week to week,but it is perfectly natural to feel

out of sorts sometimes. You mayfind Arthritis Care’s booklet onemotions helpful.

■ Your relationshipsSharing information about yourcondition with family and friendscan really help them tounderstand what you’re goingthrough. They may really wantto help, but not know how.

You may be worried aboutletting them down or aboutdepending on them too much.Talking and listening is the key.Explain how your arthritis affectsyou and be as clear as you canabout how you are feeling.

Relationships may come undera bit of strain. If you have apartner, talk to them about howyou feel, both physically andemotionally and encourage themto ask questions.

‘Nothing is moreannoying than whensomeone says: “But youlook so well”’If you are feeling stiff or havingtrouble moving around, it is hardto be spontaneous; even a hug

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CARING FOR YOURSELF

can be difficult if you are in pain.There will be times when youare just too tired or painful toget close to your other half, butthere are alternatives.

Try different positions orsupporting your body withpillows and cushions to makelove-making more comfortable.A warm bath or showerbeforehand will help to loosenyour joints. You could even trypersuading your partner to giveyou a gentle massage.

Don’t be embarrassed to raisethe issue with your healthcareteam. Some people find ArthritisCare’s booklet on relationshipsuseful.

■ Living wellFrom time to time, your arthritiswill get on top of you. Anger,

frustration, uncertainty,depression and fear are all veryunderstandable and verycommon. Several things mayhelp:

‘If I go out socialising, Iaccept I might feel a bitoff colour the nextday’● try to build a good relationship

with your health professional● find out as much as you can

about your arthritis. It willmake you feel less worriedabout the future

● accept your limitations.Remind yourself about whatyou can do and enjoy, ratherthan the things you can’t

● try to make space for yoursocial life

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● include exercise in your day. Itwill build your strength, helpyou to keep flexible and boostyour mood

● talk to somebody whounderstands how you arefeeling. This could besomeone close to you orsomeone else with arthritis.

■ Consider a self-managementprogramme

Arthritis Care’s popularprogramme, ChallengingArthritis, focuses on what youcan do for yourself, how to getthe most from your healthprofessionals, handling pain,fatigue and depression,relaxing, and keeping active.

It is a great chance to meet withothers in the same position. For more on what Arthritis Careoffers, see the back page.

‘The more you knowabout your condition,the more powerful you feel’Osteoarthritis does not need totake over your life – there areplenty of things you can do toavoid this, and there is a lot ofhelp available. If you have anyquestions about living witharthritis, contact Arthritis Careor one of the organisations listed

on the following pages.

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GENERAL● arc (Arthritis Research

Campaign)Copeman House, St Mary’s Court, StMary’s Gate, Chesterfield, DerbyshireS41 7TD. Tel: 01246 558033www.arc.org.uk.Funds medical research into arthritisand produces information.

HEALTH SERVICES● NHS DirectTel: 0845 4647www.nhsdirect.nhs.ukInformation on conditions,treatments, support groups and localNHS services.

● British Association/College ofOccupational Therapists

106-114 Borough High Street,Southwark, London SE1 1LBTel: 020 7357 6480www.cot.org.ukDetails on local practitioners.

DAILY LIFE ● Disabled Living Foundation380-384 Harrow Road,London W9 2HUTel: 020 7289 6111Helpline: 0845 130 9177www.dlf.org.ukAdvice and information on equipment.

● DIAL UKSt Catherine’s, Tickhill Road,Doncaster DN4 8QNTel: 01302 310123

www.dialuk.org.ukDetails of your nearest disabilityadvice and information service.● Ricability30 Angel Gate, City Road, London EC1V 2PT. Tel: 020 7427 2460www.ricability.org.ukConsumer guides on products andservices for disabled people.● RADAR12 City Forum, 250 City Road, London EC1V 8AFTel: 020 7250 3222www.radar.org.ukNational campaigning organisationwhich also publishes a wide range ofinformation on disability issues.

COMPLEMENTARY THERAPIES● Institute for Complementary

MedicinePO Box 194,London SE16 7QZTel: 020 7237 5165www.i-c-m.org.ukUmbrella body. Can help you findqualified practitioners locally.MONEY AND BENEFITS● Disability AllianceUniversal House, 88-94 Wentworth Street, London E1 7SATel: 020 7247 8776 (voice and minicom). www.disabilityalliance.orgProvides information on benefits.

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USEFUL ORGANISATIONS

● Benefit Enquiry Line fordisabled people

Tel: 0800 882 200Mon-Fri, 8.30am-6.30pm.Sat, 9am-1pm.

In Northern Ireland, the BenefitsEnquiry Line is run by the SocialSecurity Agency.Tel: 0800 220 674

PAIN MANAGEMENT● The British Pain Society21 Portland Place, London W1B 1PY. Tel: 020 7631 8870www.britishpainsociety.orgInformation about chronic pain andpain clinics.

● Pain ConcernPO Box 13256, Haddington EH41 4YD. Tel: 01620 822572www.painconcern.org.ukInformation and helpline.

GETTING AROUND● MotabilityMotability Operations, City GateHouse, 22 Southwark Bridge Road, London SE1 9HB. Tel: 0845 456 4566www.motability.co.ukProvides cars and poweredwheelchairs through the Motabilityscheme.

● Forum of Mobility CentresKilverstone Mobility AssessmentCentre, 2 Napier Place, Thetford,Norfolk IP24 3RL. Tel: 0800 559 3636www.mobility-centres.org.uk

A network of 17 organisations acrossthe UK offering information, adviceand assessment to individuals whohave a condition that might affecttheir ability to drive or access a motorvehicle.

PREGNANCY AND PARENTING● Disability Pregnancy and

Parenthood InternationalUnit F9, 89-93 Fonthill Road, London N4 3JHHelpline: 0800 018 4730www.dppi.org.ukInformation and advice for disabledparents.

RIGHTS AND DISCRIMINATION● Disability Rights CommissionDRC Helpline, Freepost MID 02164,Stratford-upon-Avon CV37 9BRTel: 08457 622 633www.drc.org.ukWorks to eliminate discriminationagainst disabled people.

WORK AND EDUCATION● Skill: National Bureau for

Students with DisabilitiesChapter House, 18-20 Crucifix Lane,London SE1 3JWVoice/text: 020 7450 0620Information line: 0800 328 5050www.skill.org.ukInformation about further, higher andcontinuing education, training andemployment for disabled youngpeople and adults.

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USEFUL ORGANISATIONS

Arthritis Care is the UK’s largestorganisation working with and for allpeople who have arthritis.

Our booklets and magazine, website and professional helpline are tools to enable people to make positive choices. Our network of localgroups, self-management programmes andinternet forums bring people together to support each other in living life to the full. Our campaigning work promotes civil rights,better access to health and social care provision,and tackles issues important to people in theirlocal area.

Get in touch with us● Our helpline offers confidential information

and support. Call free on 0808 800 4050 (10am-4pm weekdays) or emailHelplines@arthritiscare.org.uk

● Our website provides information on all aspectsof arthritis and what we are doing in your area.Visit us at www.arthritiscare.org.uk

● Call us to find out more about what we do orhow to become a member.

Arthritis Care contact numbers:

UK Head Office: 020 7380 6500South England: 020 7380 6509/10Central England: 0115 952 5522North England: 01924 882150Northern Ireland: 028 9448 1380Scotland: 0141 954 7776Wales: 01239 711883

Published by Arthritis Care, 18 Stephenson Way, London NW1 2HDReprinted August 2006 ACR124 Registered Charity No. 206563 ISBN 1-903419-35-2

OSTEOARTHRITIS