OSTEOARTHRITIS AND RHEUMATOID ARTHRITIS

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Arthritis is a common condition that causes pain and inflammation in a joint. In the UK, more than 10 million people of all ages have arthritis or similar conditions that affect the joints. 

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that primarily affects the lining of the synovial joints, causing pain, swelling and  stiffness. The condition usually affects the hands, feet and wrists. There may be periods where symptoms become worse, often referred to as  flare-ups. A flare can be difficult to predict, but with treatment it's  possible to decrease the number of flares and minimise or prevent  long-term damage to the joints. RA also influences the brain causing  fatigue and reduced cognitive function; the lungs by causing  inflammatory and fibrotic disease; the exocrine glands by causing  secondary Sjogren’s syndrome; the skeletal muscles by causing sarcopenia; and the bones by causing osteoporosis.   

The chance of developing RA increases in individuals with a family history  of RA. It can be triggered initially as a result of an abnormal antibody  response to a range of proteins, all of which are distributed  throughout the whole body. A combination genetic and environmental  factors play a role. Research suggests that the joints may not be the  triggering spot for autoimmunity. Lung exposure to noxious agents,  including smoke, silica dust, nano sized silica, or carbon-derived nanomaterials can trigger mucosal receptors that activate  antigen-presenting cells. This resulting cartilage degradation is  visible as joint-space narrowing on radiography. Bone loss is also a pathological hallmark of RA, most likely due to changes in the subchondral bone marrow.   

Early diagnosis and appropriate treatment enables many people with the condition to have periods of months or even years between flares. They lead full lives and continue regular employment. The main treatment options include: Medicine that is taken long term to relieve symptoms and slow the progress of the condition Supportive treatments, such as physiotherapy, occupational therapy, podiatry and acupuncture to help keep you mobile and manage any problems you have with daily activities. Surgery, which may be required to correct any joint problems that develop.

The  main symptoms of osteoarthritis are joint pain and stiffness, and difficulty moving the joint. Some people also have symptoms such as: swelling, tenderness, grating or crackling sound when moving the  affected joints For some people, the symptoms can be mild and may come and go. Other people can experience more continuous and severe problems  which make it difficult to carry out everyday activities. Almost any  joint can be affected by osteoarthritis, but the condition most often causes problems in the knees, hips and small joints of the hands. 

As part of normal life, your joints are exposed to a constant low level of damage. In most cases, your body repairs the damage itself without you experiencing any symptoms. But in osteoarthritis, the protective  cartilage on the ends of your bones breaks down, causing pain, swelling  and problems moving the joint. Bony growths can develop, and the area  can become red and swollen. The exact cause is not known, but several  things are thought to increase your risk of developing osteoarthritis, including: joint injury, a previous or existing condition such as  rheumatoid arthritis or gout, family history, obesity, or being a woman.

Mild symptoms can sometimes be managed with simple measures including: Regular exercise Losing weight if you're overweight Wearing suitable  footwear Using special devices to reduce the strain on your joints  during your everyday activities. If your symptoms are more severe, you  may need additional treatments such as painkillers, a structured  exercise plan, and other management strategies such as acupuncture. In a  small number of cases, where the damage to the joints is particularly  severe, surgery may be done to repair, strengthen or replace a damaged joint. 

Acupuncture is a tried and tested system of traditional medicine. Its benefits are now widely acknowledged all over the world and in the past decade  traditional acupuncture has begun to feature more prominently in  mainstream healthcare in the UK. Osteoarthritis is a chronic condition that cannot be cured. But there are many ways that acupuncture can help in the management of osteoarthritis and rheumatoid arthritis, including: 

•  Reducing inflammation Relaxing muscles and fascia 
•  Regulating serum cortisol levels Stimulating nerves located in muscles and other tissues 
•  Stimulating the release of endorphins and other neurochemical messenger molecules that change the processing of pain in the brain and  spinal cord
•  Increasing local blood circulation 
•  Dispersal of swelling.   

The use of acupuncture for the management of arthritis is now widely accepted. It is recommended by NICE for chronic primary pain including low back pain and sciatica, osteoarthritis, rheumatoid arthritis and  spondyloarthritis along with other treatments. The American College of  Rheumatology conditionally recommends acupuncture for severe to chronic  osteoarthritis of the knee when the patient is unwilling or unable to  undergo total knee arthroplasty. The Osteoarthritis Research Society  International recommend acupuncture for the symptomatic treatment of  patients with osteoarthritis of the knee. And The Joint Federal  Committee of Physicians and Health Insurance Plans in Germany  (Gemeinsamer Bundesausschuss, G-BA) have recommended acupuncture for osteoarthritis of the knee since 2006!

Many patients come to us for help with pain. In fact 80% of our patients are  suffering from some kind of pain, often for over a year, and around 20% of those people have either osteoarthritis or rheumatoid arthritis. So we are very used to helping people with arthritis. Whilst we can't cure arthritis, we can usually help to manage the flare-ups and associated symptoms such as swelling, inflammation and pain, making huge  differences to the quality of our patients lives.   
 

At the first appointment, our skilled practitioner Helen Trill will ask you lots of questions about your medical history, and your health and lifestyle now. She will use  this information to choose an appropriate course of treatment and make  recommendations.

“It's surprising just how many people have arthritis, whether it is just in one joint in the hand or both knees. I most frequently see people with an arthritic knee or two - usually after a big flare-up of symptoms that include swelling and pain which has made it difficult to walk far or to bend the leg properly. Sometimes as an acupuncturist, I don't know if I can help someone. Many conditions do have well documented treatment protocols and research supporting their treatment with acupuncture these days, but some things don't. But when someone comes to me with a  swollen painful knee, I usually feel very confident that a course of acupuncture will help significantly!"
 

Acupuncturist, Dr Helen Trill PhD ARA 

'I was diagnosed with arthritis in my knees. A course of traditional drugs had no effect. I was consequently prescribed Co-codamol. I embarked on a  course of acupuncture with an open mind. The acupuncture and electro-acupuncture Helen provided significantly reduced the swelling and virtually eliminated the pain in my knees. I am happy to say that I am walking well again.' - Iris 

 'I've long suffered with my knees. Myself and my husband have both been to see Helen and she always helps us to get back to our cycling and walking. We both have arthritis and sometimes it really flares up. We've  always believed in looking after ourselves, so after the initial course  of Acupuncture that helped us about 5 years ago now, we go back and see  Helen if we find we need another few sessions. We are both really glad  to have found her.' - Joan 

https://www.nhs.uk/Conditions/Arthritis/ 

Guo Q, Wang Y, et al, Rheumatoid arthritis: pathological mechanisms and modern pharmacologic therapies. Bone Res. 2018; 6: 15

Fernandes  L, Hagen KB, Bijlsma JWJ, et al. EULAR recommendations for the  non-pharmacological core management of hip and knee osteoarthritis. Annals of the Rheumatic Diseases 2013;72(7):1125. doi: 10.1136/annrheumdis-2012-202745  

Hochberg  MC, Altman RD, April KT, et al. American College of Rheumatology 2012  recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care & Research 2012;64(4):465-74. doi: https://doi.org/10.1002/acr.21596 

Zhang  W, Nuki G, Moskowitz RW, et al. OARSI recommendations for the management of hip and knee osteoarthritis: part III: Changes in evidence  following systematic cumulative update of research published through  January 2009. Osteoarthritis And Cartilage / OARS, Osteoarthritis Research Society 2010;18(4):476-99. doi: 10.1016/j.joca.2010.01.013  

Zhang  W, Moskowitz RW, Nuki G, et al. OARSI recommendations for the  management of hip and knee osteoarthritis, Part II: OARSI  evidence-based, expert consensus guidelines. Osteoarthritis And Cartilage / OARS, Osteoarthritis Research Society 2008;16(2):137-62. doi: 10.1016/j.joca.2007.12.013    

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