Health

Wednesday 24 September 2014

Is the joint pain I'm suffering at 60 an inevitable part of growing old?

Dr Nina Byrnes
Dr Nina Byrnes

I FEEL like I'm getting old. I turned 60 last year and recently I've been suffering with pain and stiffness in my shoulder and knees. The pain gets bad when I try to go for a walk and is limiting what I can do. Is this a normal part of ageing?

JOINT pain is a condition that many people worry about. The word arthritis comes from the Greek word "athron" meaning joint and the Latin word "itis" meaning inflammation. So arthritis is a condition in which inflammation occurs in the joints of the body. Joints occur where bones meet each other.

Arthritis is quite common and it has been estimated that one in six Irish people suffer from this condition. Women are more likely to be affected than men and arthritis-type pain is a mentioned in up to 30pc of GP consults. Arthritis, however, is not a single disorder – there are over 100 different types.

The severity of arthritis can vary greatly but it shouldn't be underestimated. It is the single biggest cause of disability in Ireland and is estimated to cost over €1.5bn per year to the State in lost working hours.

Inflammation in joints can lead to pain and stiffness and if it is prolonged can lead to damage to the joint. The majority of cases of arthritis occur in people over the age of 55. The most common form of arthritis in this age group is Osteoarthritis. This develops when cartilage (a tissue that covers the ends of bone in a joint) becomes worn down.

Cartilage normally protects the bones and helps absorb pressure and movement in the joint. When this becomes thinner the bony surfaces become exposed, rubbing off each other and this leads to pain and inflammation. Over time, the joint then becomes worn down, and serious joint damage can occur.

Osteoarthritis is most common in the hips, knees, and spine, although it can occur in other joints such as the shoulders. Those affected commonly complain of pain and stiffness that gets worse with exercise or use of the joint and there is often a sense of clicking or grinding. Movement can become quite limited. The symptoms are often worst when you're starting to move after a prolonged rest or sleep.

Most people suffering from pain will visit their doctor seeking answers. This appointment is important in order to get a correct diagnosis, as other illnesses can cause similar symptoms. Unlike other forms of arthritis, blood tests are not usually helpful. X-rays are not always necessary to diagnose arthritis but can help assess the extent of joint damage. Answers can be difficult to get, as the exact cause of osteoarthritis is not known.

Obesity makes arthritis worse. The skeleton is put under serious strain by excess body weight. Maintaining activity is vital, as exercise helps preserve the movement and function of the joint. Water-based exercise can be especially helpful.

Osteoarthritis can develop in joints that were injured earlier in life so it is important to take any joint damage or injury seriously and ensure proper rehabilitation and follow-up. Returning to exercise too soon can have consequences down the road. People often associate a change in weather with increased pain, particularly if the weather is damp. This has not been confirmed in clinical trials and osteoarthritis occurs in all climates.

There is no cure for osteoarthritis so the goals of treatment are to reduce pain, improve mobility and improve muscle strength. Painkillers are core to the treatment. It is much better to take regular analgesia and be as active as possible, as inactivity leads to deterioration. Paracetamol and anti-inflammatory agents are the main drugs prescribed.

Paracetamol is a safe drug when taken in correct doses, rarely interacts with other drugs and has few, if any, side-effects. Anti-inflammatory drugs such as Ibuprofen are usually very helpful but long-term use should be under medical supervision, as side-effects can occur.

Mobility is improved through exercise and joint strengthening. Following a recommended exercise plan can provide huge benefits. Physiotherapists can be a great source of advice and help for those suffering from arthritis. For some people, the joint damage becomes so severe that a surgical joint replacement is necessary.

This can be a very daunting operation but the improvement in quality of life is often dramatic. As with many chronic illnesses, people often seek alternative remedies. Glucosamine, a mineral derived from shellfish, is often used. Most benefits were shown for glucosamine sulphate at doses of 1,500mg a day but it has had mixed results in studies. I often recommend trying this but if there are no benefits after three months it's probably not worth continuing, as it doesn't help everyone. Omega 3 fatty acids have shown some anti-inflammatory action and can help in some people.

It does sound like you might be developing some signs of osteoarthritis but I would advise a check-up with your doctor to confirm this. There is a lot of ongoing research into the cause and treatment of osteoarthritis. Although we often refer to "wear and tear" in the joints it is not considered a normal part of the ageing process. What we do know is that prevention is better than cure and, as for many chronic diseases, leading a healthy, active life is paramount in maintaining good joint health.

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