Arthritis is a vague term that could be used to describe anything where a joint suffers inflammation. Most commonly, it is used in reference to osteoarthritis (OA).
Osteoarthritis Basics
Osteoarthritis (OA) is the “wear and tear” form of arthritis. More recently, the description has shifted to “wear, tear, and repair” in reference to the body’s capacity to improve.
OA is a condition of cartilage. Cartilage coats the joint surfaces throughout most of the body, providing a smoother movement and less friction. However, cartilage has a poor blood supply. Unlike muscles, it does not receive enough nutrition through blood to keep it healthy. Instead, it takes nutrients from the fluid in the joint. Some of this exchange happens due to close proximity, but movement also helps. In this sense, the cartilage is like a sponge. Compression squeezes out waste, and decompression allows the fresh fluid in.
Other Forms of Arthritis
The way we use the word “arthritis” means we might sometimes dismiss something more complicated as straightforward OA. Often when taking a case history, a patient will mention that a relative had arthritis, but might not know if it was OA when directly asked. This could be a vital piece of information, as osteoarthritis is very different from more inflammatory forms.
Rheumatoid Arthritis
Rheumatoid arthritis (RA) is autoimmune. This means that the damage to the joints is done by the immune system. RA tends to show its first symptoms in patients between 30 and 50 years old. Small joints are affected first, such as those in the hands, feet, and neck.
Inflammatory conditions like RA have a few defining features:
- Symptoms are worse with rest, so early morning pain is common.
- Over-exercising can also exacerbate things.
- Joints may be hot, swollen, and red.
- Late-stage RA can cause changes to the shape of affected joints. Hard swelling on the knuckles, as well as a change in the angle of the wrist are common.
Ankylosing Spondylitis
Chronic lower back pain, especially with the inflammatory features listed above, might be another form of arthritis. Ankylosing spondylitis is another autoimmune arthritis that mainly targets the spine and pelvis. Similar to RA, it affects the younger population, with symptoms usually appearing before 40 years old. However, there is an average eight-year delay for diagnosis. Knowing the other symptoms beyond back pain can help:
- Uveitis: inflammation in the eye
- Enthesitis: inflammation where tendons meet bone (often at the back of the heel)
- Alternating buttock pain
- Personal or family history of other autoimmune conditions, including inflammatory bowel disease
Your osteopath is in a good position to assess your back pain if you suspect there may be more to it. However, a diagnosis must be made by a rheumatologist. We can help explain the condition to support you in accessing a rheumatologist if appropriate.
Managing Arthritis
Your osteopath is qualified to help manage your osteoarthritic joints. We may also be able to help with some of the symptoms of rheumatic forms of arthritis. Because of the way OA develops, we will want to improve the movement in affected joints. We can use both hands-on treatment in clinic and personalised exercises to achieve this. We will also look beyond the affected joints for areas that may be compensating. Managing these areas before they become symptomatic may even prevent OA elsewhere.
A key part of managing inflammatory forms of arthritis is striking a balance on movement. Too little or too much will irritate the joint. Returning to exercise whilst in pain can be daunting, but we can work with you to develop a comfortable plan. Hands-on treatment can be useful to encourage areas of swelling to refresh. Swelling is not inherently bad as it brings new nutrients to the area, but if it stays there for too long the nutrients are replaced with waste. Periodically moving the fluid along is part of a holistic treatment plan.
This article is written by Freya Gilmore, one of our Registered Osteopaths.