Dr Ibukunoluwa Dedeke, a consultant rheumatologist at the University College Hospital, Ibadan, in this interview by SADE OGUNTOLA says there are over 100 types of arthritis, and that all incidences of knee joint pain need to be assessed to know the cause and appropriate treat.
WHAT is arthritis, and how common is it, especially now that it is relatively cold?
Arthritis is a term that typically refers to more than one type of joint disease. It has been used colloquially to mean any joint pain, but not every joint pain is arthritis. There are over 100 types and causes of arthritis. So, when a patient has a joint problem, we try to confirm if it is arthritis and then what type of arthritis it is. And then, we want to know how severe this arthritis is and the number of joints it is affecting. So, it is wrong to assume that two people have the same type of arthritis. It’s always good to seek professional medical care so that joint pain can be evaluated and treated appropriately.
Arthritis is a medical term that means joint inflammation. When we see a patient complaining of joint pain, we always want to check to be sure the pain is not actually from the supporting structures around the joint like the ligaments and tendons. That is why I said not every joint pain should be assumed to be a joint problem and also that arthritis itself is not one disease. It is a general term saying there’s a joint problem.
However, the commonest one is called osteoarthritis. That’s the type commonly found in elderly people. With the increasing elderly population, its incidence is increasing. Most people assume that osteoarthritis is arthritis, but osteoarthritis is a type of arthritis. There are other forms of arthritis, like rheumatoid arthritis and gouty arthritis. The commonest joints that it affects are those joints that we use every day more frequently than others. They are weight-bearing joints: lower back, hip, and knee, as well as other frequently used joints depending on your vocation: hands, and shoulders.
Now, osteoarthritis has been termed as the wear and tear kind of arthritis due to years of use and overuse without rest, especially by athletes. As a result of the wear and tear on the joint, especially on the structure called cartilage, there’s a loss of the cartilage, which is the protective padding in the joint. This ends up allowing one bone to rub on another, and by that, they start destroying each other. The wear and tear manifests gradually later as one grows older.
Is it therefore a misconception that arthritis is associated with ageing or that everyone ageing must have arthritis?
I would say yes and no. The reason arthritis is associated with old age is that osteoarthritis is common in the elderly. The myth is to think that arthritis is the same as osteoarthritis. Arthritis is a general term, and depending on the type of arthritis, arthritis can affect any age group from toddlers to old people. I’ve seen a child that is three months old with inflamed joints, which is termed inflammatory arthritis. So, it is a misconception that only old people have arthritis.
What is the incidence of arthritis in Nigeria?
A study done in Jos puts its incidence at around 30% of the population in that rural area. Of course, there is a lot of underreporting because many patients with mild forms of arthritis, especially osteoarthritis, may not be symptomatic. Such patients will say that they are fine. However, by the time investigations like x-rays are done, arthritic changes will be seen. So long as you move, so long as you walk around or are active physically, the joints are predisposed to osteoarthritis.
All the different forms of arthritis are present in Nigeria, but osteoarthritis is still the commonest. However, one of our challenges as joint specialists is that oftentimes, especially earlier on in the joint disease, the patients would have consulted quack doctors and bone setters and would have mismanaged and complicated the problem before coming to the specialist. By then, more damage would have occurred in the affected joint. Sometimes, the patients just stay with their pain, not knowing that there is available care for their condition.
There are a lot of people in our community who only resort to the use of painkillers because they think that it is just pain, not knowing that the pain medication just reduces the sensation of pain, but does not treat the cause of the problem itself.
What damage can the use of pain killers instead of seeking appropriate care do?
People do not understand the role of pain medication; it is supposed to temporarily relieve the pain. It’s supposed to be complementary. It is not supposed to be a mainstay of treatment in that sense. Many people have the impression that when I have joint pain, I used this pain medication and I don’t feel it again; then that means it has gone. But that is not true. The medicine is merely reducing your feeling of that pain. It does not mean that the joint problem has gone. And oftentimes, doing this predisposes to worsening of the joint disease, because the pain sensation in that joint is protective.
When you have pain in a joint, it will restrict how long you stand or walk or make use of that joint and that is protective. Having joint pain indicates a joint injury or damage and should make you mindful of how you use it so that you will not worsen it or further damage it. But if you now use a medication that doesn’t allow you to feel the pain, you’re more likely to now overuse that damaged joint, which further worsens the damage.
Can remedies like massage, hot or cold water compress or shea butter treat an aching joint?
Ideally, they’re supposed to be adjuncts. Also, the timing and use of some of these therapies depend on the type of arthritis and the severity of the disease. But it’s not just automatic that you use hot water every time. The treatment of arthritis is very dynamic and it is dependent on the form of arthritis and the severity of the disease as well as how the patient is responding. All these remedies are to be explicitly used and under the guidance of a professional to get the best benefit from them.
One challenge is that when a patient stumbles on one or more of these remedies and feels that temporary relief, they assume that what they have applied or done is working, and so, they continue; but this is not so. Massaging the joint is wrong. We typically massage muscles; we don’t massage joints. A joint is a bony area. When the joint is inflamed, it is a sore. It is like if you have a wound over your skin and you are now rubbing over it. Of course that wound will not heal.
Also, not all ‘hot’ balms are medicinal. And the hotness of the balm does not translate to effectiveness. Often what people feel and experience after applying certain local/herbal hot balm is that the hot sensation blunts the feeling of pain. It now gives them that feeling of “it has worked. Meanwhile, the joint disease is still there and the chances of it getting worse are higher.
So, when can hot or cold water be used to relieve a painful joint?
Most patients with arthritis, especially osteoarthritis, have more symptoms during cold seasons. During that period, we advise such patients to keep their joints warm by possibly putting a warm water bottle around that joint region, especially at night when the environment is cool. That relieves those symptoms overnight and early in the morning. Now, cold therapy is typically reserved for acute inflammation; maybe someone suffered a strain or a trauma and there is some swelling due to damage or injury to that joint. But even then, we still advise that such a person should come to seek care at the hospital as soon as possible. We need to be sure that there is no fracture.
Is it therefore correct to say that weather and arthritis are connected in a way?
Yes, especially the cold weather. Patients tend to experience more stiffness and pain in their joints during cold weather, especially those that live in cool climes. So, keeping the joints warm is important. Warm weather helps relieve some of those symptoms. Patients tend to have a better experience during warm weather than in the cold just because of this.
Cold weather is not a trigger for arthritis, but it can exacerbate the pain in an arthritic joint. Other things that can exacerbate arthritis symptoms in weight-bearing joints include being overweight.
Then not exercising is not the best. Safe exercise needs to be prescribed because if it is not done safely, it can do more harm than good. We don’t advise patients with any form of arthritis to go to the gym. Exercise instructors in the gym are not trained to use exercise to treat. An arthritic joint confers certain restrictions on what type and amount of exercise is safe and will not worsen the condition.
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Can arthritis be prevented, or cured when it happens?
That depends on the type of arthritis. One type of arthritis that is curable is gouty arthritis because it is caused by the elevation of certain chemicals in the blood which is called uric acid. Once the uric acid in the blood is reduced by the treatment, the inflammation will stop. However, this is before any irreversible joint damage has occurred.
That’s why it’s important to present early once you have any joint problem because by the time there is irreversible damage, we can only improve symptoms and maintain function but we can’t reverse medically the damage that has occurred in that joint; and in very severe cases, the patient may require surgery for that joint.
To prevent arthritis, we need to be more conscious of the activities that we do, especially exercise. Exercising moderately and carefully is important. Also, at home when during domestic work, abnormal or stressful postures when working should be avoided.
Bending posture to work is not good for the back. Excessive standing to work is not good. Joint pain as a sensation is protective. So, if you feel pain in certain joints while standing, it is a signal that the standing is stressing that part and there is a need to change position or sit. So, learn to listen to your body and change posture when feeling any pain in any particular joint while doing any activity.
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