Arthritis

223 Pages·2006·4.16 MB·English

Arthritis
Your฀comprehensive฀guide฀฀
to฀pain฀management,฀฀
medication,฀diet,฀exercise,฀฀
surgery,฀and฀physical฀฀
therapies
Howard฀Bird,฀Caroline฀Green,฀Andrew฀Hamer,฀฀
Alison฀Hammond,฀Janet฀Harkess,฀Mike฀Hurley,฀฀
Paula฀Jeffreson,฀Dorothy฀Pattison,฀David฀L.฀Scott
US฀Consultant:฀Robin฀K.฀Dore,฀md
London, New York, Munich, Melbourne, Delhi
Senior Editor Janet Mohun
US Senior Editor Jill Hamilton
Editor Pip Morgan
Designer Phil Gamble
Senior Art Editor Helen Spencer
Executive Managing Editor Adèle Hayward
Managing Art Editor Karla Jennings
DTP Designer Traci Salter
Picture Researcher Andrea Sadler
Medical Illustrator Philip Wilson
Production Controller Luca Frassinetti
This edition first published in the United States in 2006 by
DK Publishing, Inc., 375 Hudson Street, New York, New York 10014
06 07 08 09 10 9 8 7 6 5 4 3 2 1
Every effort has been made to ensure that the information in this book is accurate.
The information in this book may not be applicable in each individual case so you are therefore advised to obtain expert
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Foreword
Arthritis is a term that actually describes more than 100 different diseases.
As a rheumatologist treating patients with arthritis, I see people affected in many
different ways. No two cases of rheumatoid arthritis are exactly alike. No two
people with osteoarthritis have the same experience. Regardless, physicians like
me treat all patients the same—with individual focus and concern, and with
a goal to educate them about their arthritis so together we can improve the
quality of their lives.
In the not so distant past, a patient receiving an arthritis diagnosis might have
replied, “Well, I guess there is nothing I can do about it.” Thankfully, that is no
longer the case. Innovative treatment options, including biologic drugs and
improved surgical techniques, have dramatically improved the outlook for people
with arthritis. Other “innovations” have been renewed emphasis on appropriate
physical activity, patient self-management (like stress management, weight loss,
and joint protection), and patient-physician communication. Today, we want the
patient to be a partner in arthritis management. We want patients today and in
the future to say, “I can do something about my arthritis.”
To be a partner in his or her arthritis care, a person with arthritis needs to
know about the disease, the management options, and much more. Resources
like this book, in addition to the information, programs, and support provided
by the Arthritis Foundation throughout the United States, help people with
arthritis realize that they are far from alone, educate them about their chronic
disease, and help them, working in partnership with their physicians, to manage
and take control of their arthritis.
I hope you will use these resources, become well-informed about your
condition, and feel you can do something about your arthritis.
ROBIN฀K.฀DORE฀MD
CLINICAL฀PROFESSOR฀OF฀MEDICINE,฀
DAVID฀GEFFEN฀SCHOOL฀OF฀MEDICINE฀AT฀UCLA,฀
LOS฀ANGELES,฀CA
PRIVATE฀PRACTICE,฀ANAHEIM,฀CA
Contents
WHAT IS ARTHRITIS? Physical activity 64
The฀benefits฀of฀physical฀activity฀64
Exercise฀and฀medication฀66
Understanding arthritis 10 Range฀of฀movement฀67
Healthy฀muscles฀67
The฀characteristics฀of฀arthritis฀10
Fitting฀exercise฀into฀your฀life฀68
What฀is฀inflammation?฀13
Beginning฀to฀exercise฀70
Keeping฀going฀72
The main types of arthritis 14
Osteoarthritis฀14
TREATING ARTHRITIS
Rheumatoid฀arthritis฀18
Ankylosing฀spondylitis฀21
Psoriatic฀arthritis฀22
Gout฀23 Drug treatment 76
Pseudogout฀24
Starting฀medication฀76
Arthritis฀and฀infection฀25
Analgesics฀77
NSAIDs฀78
Related conditions 26
Steroid฀therapy฀81
Complementary therapy
Lupus฀(SLE)฀26 Treating฀osteoarthritis฀81
options 108
Fibromyalgia฀27 Treating฀rheumatoid฀arthritis฀82
Lower฀back฀pain฀28 Therapies฀that฀treat฀the฀body฀and฀
Localized฀soft-tissue฀disorders฀29 Surgical treatments 88 ฀ mind฀108
Accompanying฀conditions฀32 The฀rise฀in฀popularity฀of฀the฀฀
Candidates฀for฀surgery฀88
฀ therapies฀109
Who฀performs฀surgery?฀89
Symptoms and diagnosis 36 Categories฀of฀therapy฀109
Surgical฀treatment฀options฀89
Finding฀a฀reputable฀practitioner฀110
Recognizing฀arthritis฀36 Washing฀out฀90
Talking฀to฀your฀doctor฀about
Diagnosing฀arthritis฀39 Synovectomy฀90
฀ therapies฀111
Resection฀of฀a฀joint฀90
Looking after your arthritis 42 Joint฀realignment฀91
Natural remedies and
Fusion฀of฀a฀joint฀91
Working฀with฀your฀healthcare฀ Total฀joint฀replacement฀92฀ supplements 112
professionals฀42฀
Hip฀replacement฀92 Common฀dietary฀supplements฀112
Your฀treatment฀options฀44
Shoulder฀replacement฀94 Herbal฀medicines฀115
Professional฀care฀45
Knee฀replacement฀94 Trace฀minerals฀118
Replacing฀other฀joints฀95 Homeopathic฀medicines฀119
Spinal฀surgery฀96
FOOD, DRINK, AND
Preparing฀for฀the฀hospital฀98
PHYSICAL ACTIVITY Bodywork therapies 120
The฀preoperative฀assessment฀clinic฀100
Admission฀to฀the฀hospital฀100 Chiropractic฀120
Anesthetic฀techniques฀101 Osteopathy฀121
Eating to ease your The฀day฀of฀surgery฀102 Massage฀122
Recovery฀in฀the฀hospital฀103 Rolfing฀122
arthritis 50
Rehabilitation฀milestones฀104 Reiki฀123
Food฀and฀arthritis฀50 Complications฀during฀rehabilitation฀105 Acupuncture฀123
What฀makes฀up฀a฀healthy฀diet?฀50 Long-term฀outcome฀106 Aromatherapy฀124
Nutrients฀that฀may฀help฀your฀arthritis฀56 Revision฀surgery฀107 Reflexology฀125
Weight฀control฀62
Movement therapies 126 Maintaining your mobility 158 LONG-TERM
Yoga฀126 Follow฀the฀exercise฀routine฀158 OUTLOOK
Pilates฀127 Neck฀exercises฀160
Tai฀chi฀129฀ Shoulder฀exercises฀162
Qi฀gong฀129 Back฀exercises฀164 The outlook for arthritis 204
Alexander฀technique฀130 Leg฀and฀hip฀exercises฀166
What’s฀likely฀to฀happen?฀204
Feldenkrais฀method฀131
Changes฀in฀long-term฀treatment฀205
Trager฀approach฀131 Protecting your joints 172
Keeping฀a฀replacement฀joint฀working฀
Why฀protect฀your฀joints?฀172 ฀ 206฀
LIVING WITH Changing฀your฀habits฀173 Problems฀in฀the฀elderly฀206
ARTHRITIS Key฀principles฀to฀protect฀your฀joints฀174฀ Living฀with฀arthritis฀207
Posture฀178
Arthritis in the future 208
Day-to-day living 134 CHILDREN AND Making฀progress฀208
Working฀134 SPECIAL RISK GROUPS The฀development฀of฀new฀drugs฀209
Investigating฀infections฀211
Household฀chores฀136
Stem฀cell฀transplants฀211
Splints฀138
The฀genetic฀approach฀212
Home฀modifications฀138 Arthritis in children 182
Improvements฀in฀surgery฀213
Assistive฀devices฀140
Types฀of฀childhood฀arthritis฀182 How฀you฀can฀help฀with฀research฀213
Family฀life฀and฀looking฀after฀
Diagnosis฀184
฀ children฀141
Managing฀a฀child’s฀arthritis฀185 Glossary 214
Personal฀relationships฀142
Special฀needs฀at฀school฀188
Traveling฀and฀moving฀around฀143 Useful addresses 215
Special฀needs฀at฀play฀189
Occupational฀therapists฀144
Special฀needs฀at฀home฀190 Index 218
Asking฀for฀help฀145
Long-term฀outlook฀190 Acknowledgments 224
Coping with pain 146
People at special risk 192
What฀causes฀pain?฀146
Post-menopause฀and฀arthritis฀192
Treating฀pain฀147
Sporting฀risks฀197
Ways฀to฀reduce฀pain฀147
Occupational฀risks฀198
Heat฀and฀cold฀147
Obesity฀198
Massage฀148
Ethnic฀groups฀198
Water฀therapy฀149
Inherited฀markers฀or฀traits฀200
Electrical฀stimulation฀149
Relaxation฀and฀breathing฀150
Alternating฀activity฀with฀rest฀151
Coping฀with฀stress฀152
What฀is฀stress?฀152
Changing฀your฀responses฀to฀
฀ stress฀153
The฀ABC฀method฀153
Mind–body฀exercises฀156

What is
arthritis?
In the last 50 years our understanding of
arthritis has improved enormously. Where
once it was seen as one condition, it is now
known to be a group of almost 200. This
knowledge has helped doctors to be more
specific about diagnosing the type of arthritis
and to be able to devise treatments for
individual people.
We still don’t know what causes arthritis,
although we have a much better idea of the
risk factors involved—from inheritance and
gender to obesity and infections. As a result,
we are better able to know who is likely to
develop one or other of the arthritic conditions.
Improvements in diagnosis have
accompanied innovations in scanning
techniques, so arthritis can now be detected
earlier and with more precision. Specialized
healthcare professionals and organizations
capable of helping you with your arthritis have
grown in number and expertise. They all agree
that people with arthritis who communicate
well with their physicians and specialists stand
a better chance of successfully managing
their condition.
Understanding
Arthritis
Arthritis is not a single disease but a number of different
disorders that can affect the joints at any stage of life, from
the early days of childhood until the closing stages of old
age. Arthritis has two key characteristics—joint pain and
inflammation. Some people with arthritis only have pain
but most have a combination of the two. To make sense of
arthritis it is important to understand some key general
information, such as the types of joints and the causes and
consequences of joint inflammation.
Anyone can develop The characteristics of Degenerative arthritis, such as
arthritis
arthritis. It affects osteoarthritis, is characterized by
more bony swelling and less soft-
men and women
The hallmark of arthritis is joint tissue swelling; stiffness usually
of all ages, and inflammation, which leads to occurs at rest or after exercise.
sometimes even tenderness and swelling. People When only one joint is involved
with arthritis usually complain of the condition is sometimes called a
children.
joint stiffness as well. monoarthritis. When many joints
The many types of arthritis can are affected the condition may be
be divided into inflammatory and described as a polyarthritis.
degenerative groups, although the Oligoarthritis is sometimes used to
distinction is not always clear-cut. describe a condition involving a
In inflammatory arthritis, such as few joints. One feature of some
rheumatoid arthritis, there is more forms of arthritis is that similar
swelling of the soft tissues around joints are involved on both sides
a joint, and stiffness is most of the body. This symmetrical joint
noticeable in the morning, when it involvement is very typical of
may last an hour or more. rheumatoid arthritis.
UNDERSTANDING ARTHRITIS 11
progressive damage to your joints
Q&A
makes your muscles weak, making
Are฀women฀usually฀more฀affected฀ you less active. Third, the chronic
by฀arthritis฀than฀men?฀ pain wears you out and restricts
the amount of exercise you are
Yes.฀It฀is฀mainly฀due฀to฀the฀fact฀that฀
impaired฀immunity฀is฀a฀significant฀ able to do. Finally, the conditions
factor.฀Most฀medical฀conditions฀in฀
that are commonly associated with
which฀there฀is฀impaired฀immunity฀are฀
arthritis can put a strain on your
three฀times฀more฀common฀in฀women.฀
However,฀other฀diseases,฀such฀as฀ quality of life.
ankylosing฀spondylitis฀and฀gout,฀are฀ Many forms of arthritis, especially
more฀common฀in฀men.
rheumatoid arthritis, are associated
with changes in the skin or
internal organs because they affect
Which฀joints฀are฀affected? all the systems in the body, not
Most forms of arthritis affect the just locally in the joints.
small joints in the hands and feet
and the large joints of the knees Who฀is฀affected฀by฀arthritis?฀
and hips, although any joint can Anyone can develop arthritis. It A฀COMMON฀CONDITION
be involved. affects men and women of all ages, Arthritis฀is฀a฀common฀condition฀in฀
countries฀throughout฀the฀world฀
Different forms of arthritis affect and sometimes even children (see
and฀most฀characteristically฀affects฀
different joints. Osteoarthritis, for p.182). No one knows for sure people฀in฀later฀life.฀
example, usually affects the top
two joints of the fingers and the
base of the thumb, as well as the
knees and the hips. Rheumatoid
arthritis usually involves the
bottom two joints of the fingers
and thumbs, and also the wrists.
Gout characteristically affects the
joint at the base of the big toe.
Challenges฀to฀overcome฀
People with arthritis often have to
face difficulties and challenges that
can compromise their way of life,
although many of these can also
be overcome.
There are four main reasons for
these challenges. First, the pain
and inflammation immediately
limit what you can do. Second, the