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    Lisa Bywaters
    23/Mar/2023
    Health InformationMSK articles

    Riddle me this…

    What do Lucille Ball, Kathleen Turner, Caroline Wozniacki, Pierre-Auguste Renoir, Edith Piaf, James Coburn and more than 450,000 Aussies have in common?

    They all live (or lived) with rheumatoid arthritis (RA).

    So, what is RA?

    Rheumatoid arthritis is a type of inflammatory arthritis that causes pain, swelling and stiffness in the joints.

    The most commonly affected joints are in the hands, feet and wrists.

    What causes it?

    Rheumatoid arthritis is an autoimmune disease. That means it occurs as a result of a faulty immune system.

    Your immune system is designed to look out for and attack foreign bodies – like bacteria and viruses – that can make you sick. For reasons we don’t fully understand, when you have RA, your immune system gets confused. It targets your joints and healthy tissues as if they were foreign bodies. This causes ongoing inflammation and pain.

    We don’t know why this happens, but scientists believe a complex mix of genes and environmental factors, including smoking, is involved.

    What does RA do?rheumatoid arthritis

    To understand how RA affects your body, it’s helpful to know a little about your joints.

    Joints are places where bones meet. Bones, muscles, ligaments and tendons work together so you can twist, bend and move about.

    The ends of your bones are covered in a thin layer of cartilage. It acts like a slippery cushion absorbing shock and helping your joint move smoothly.

    The joint is wrapped inside a tough capsule filled with synovial fluid. This fluid lubricates and nourishes the cartilage and other structures in the joint.

    When you have RA, and the immune system targets your joints, it causes a build-up of synovial fluid and inflammation of the tissues that line the joint (synovial membrane). This causes pain, heat and swelling.

    Cartilage becomes brittle and breaks down. Because the cartilage no longer has a smooth surface, the joint becomes stiff and painful.

    Ligaments, tendons and muscles surrounding the joint can also be affected, causing joints to become unstable.

    What are the symptoms?

    The most common symptoms of RA include:

    • joint pain
    • joint swelling, heat and redness
    • joint stiffness, especially in the morning or after sitting or being inactive for a while
    • fatigue, or tiredness that doesn’t go away, even after sleeping or resting.

    RA can affect any joints in the body, but most often affects the small joints in your hands and feet first.

    Usually, the same joints on both sides of your body are affected – but this doesn’t always happen.

    Other symptoms of RA can include:

    • fleshy lumps called rheumatoid nodules; they form under the skin around affected joints and at places where your bones are close to the skin (e.g. elbows)
    • dry eyes
    • fever
    • short-term interruption of blood flow to your extremities (e.g. fingers and toes), called Raynaud’s phenomenon.

    RA can affect other parts of your body, including the eyes, heart and lungs.

    Anyone can develop RA, but it most often appears in people aged between 30 and 60. It affects women more often than men. However, when women reach menopause, the incidence of RA becomes about the same for men and women.

    How RA develops, and its severity will differ for each person. Symptoms can develop gradually or can start with a sudden, severe attack. Your symptoms can change daily, and they can sometimes become much worse. This is called a flare or flare-up. At other times, your symptoms may go away. This is called remission.

    How is it diagnosed?

    If you’re experiencing joint pain and inflammation, discussing your symptoms with your doctor is important. Many things can cause joint pain and swelling, including injuries, infection, and arthritis.

    Getting a diagnosis as soon as possible means that treatment can start quickly. Early treatment will help you to control the inflammation, manage pain more effectively and minimise the risk of long-term joint damage and disability.

    No single test can diagnose RA, so your doctor will use a combination of tests to confirm your diagnosis. They may include:

    • Your medical history. Your doctor will ask about your symptoms, family history and other health issues.
    • A physical examination to assess joint tenderness, flexibility, and stiffness.
    • Blood tests to check for inflammation and antibodies associated with RA.

    Scans such as an x-ray or MRI (magnetic resonance imaging) may be used to exclude other conditions or to look for joint inflammation or damage.

    Your GP will refer you to a rheumatologist if they think you have RA. Rheumatologists are doctors who specialise in diagnosing and treating problems with joints, muscles, bones and the immune system.

    How is RA treated?

    While there’s no cure for RA, there are many treatments to help you manage the condition and its symptoms so you can continue to lead a healthy and active life. The ultimate goal is to reach a stage where you have very low or no disease activity – or remission. This can take trial and error, but some people can achieve remission or low disease activity once they start treatment.

    Medicines

    Your rheumatologist will recommend and prescribe medicines for your RA. Most people need to take more than one medicine because different medicines work differently.

    The types of medicines used to treat RA and manage its symptoms include:

    • disease-modifying anti-rheumatic drugs (DMARDs), which reduce the activity of your immune system. There are different categories of DMARD:
      • conventional synthetic DMARDs or csDMARDs – e.g. methotrexate. Your rheumatologist will prescribe one of these medicines when you’re first diagnosed. They’ve been used for many years to treat RA and are very effective for most people. They’re called first-line medicine because they’re tried first. They may be used on their own or along with other DMARDs.
      • biological DMARDs or bDMARDs – e.g. adalimumab. bDMARDs are used if the csDMARD hasn’t worked well enough to control your RA or stops working. They’re called second-line medicines.
      • targeted synthetic DMARDs (tsDMARDS) – e.g. tofacitinib. They’re also a second-line medicine.

    All DMARDs reduce the activity of your overactive immune system; however, the biological and targeted synthetic DMARDs are both more targeted to specific immune cells or processes.

    • corticosteroids (or steroids) – e.g. prednisolone, act quickly to control or reduce inflammation and may be used in the short-term while you’re waiting for the DMARDs to take effect. They aren’t used for long periods as they’re associated with serious side effects.
    • pain relievers (also called analgesics) for temporary pain relief
    • non-steroidal anti-inflammatories drugs (NSAIDs) for temporary pain relief.

    The medicines that your rheumatologist prescribes will depend on your particular symptoms and how much pain and inflammation you have.

    Your medicines may also change over time. Your rheumatologist might try different medicines to find out which will work best for you, or you may need an additional medicine if your condition or symptoms worsen.

    Usually, you need to have tried a certain number of medicines before another is recommended for you. For example, bDMARDs are only prescribed if your RA is active and you haven’t had success with standard treatments.

    You’ll need to see your doctor regularly for blood tests to see if the medicines are working for you and to monitor for side effects.

    Exercise

    This is one of the most important things you can do to manage your RA. Exercise can improve symptoms, including stiffness, pain, and fatigue, and reduce inflammation. It helps increase your flexibility and range of movement, so it’s easier to do many everyday activities.

    Being active is also essential for your overall health and wellbeing. It helps keep your muscles, bones and joints strong so that you can keep moving. It reduces your risk of developing other conditions such as heart disease, osteoporosis, and diabetes. It boosts your mood, benefits your mental health, helps with weight control and improves sleep.

    Low-impact aerobic activities like exercising in warm water, cycling and walking can be a good place to start. Activities like strength training and tai chi are also beneficial. A physiotherapist or an exercise physiologist can give you information and support if you need help starting. They’ll also ensure you exercise safely to avoid injuring or straining your joints.

    Self-care

    There are other things you can do to manage your RA.

    Learn about your condition. Understanding RA allows you to make informed decisions about your healthcare and actively manage it.

    Manage your weight. Being overweight or obese increases inflammation throughout your body. This inflammation affects not only your joints but also your blood vessels and insulin levels. This can increase your risk of other chronic health conditions, including heart disease and diabetes. People with RA already have a higher risk of developing these conditions, so losing weight is an important thing you can do to reduce this risk. Being overweight or obese also limits the effectiveness of some medicines used to treat RA. Losing weight can be challenging, especially when pain impacts your ability to participate in physical activity. But it may help you to know that even a small amount of weight loss can help to improve your symptoms.

    Learn ways to manage your pain. Pain is the most common symptom of RA, so it’s crucial to learn ways to manage it effectively. Read our A-Z guide for managing pain for more information.

    Work closely with your healthcare team. The best way to live well with RA is by working closely with the people in your healthcare team (e.g. GP, rheumatologist, physio). Keep them informed about how you’re doing and if you’ve experienced any changes in your symptoms or tried new medicines, complementary therapies, supplements or other treatments.

    Use aids and equipment. Supports such as long-handled shoehorns, reachers and canes can reduce joint strain and make life easier, especially if your condition has reduced your flexibility and mobility. An occupational therapist can advise you on aids, equipment and home modifications. You can also check out our range of aids in our online shop.

    Protect your joints. Splints, orthotics and other supports may help reduce pain and prevent joint damage or inflammation. A physiotherapist or podiatrist can advise you on whether these strategies could be helpful for you.

    Talk to an OT. An occupational therapist can advise on pacing yourself and managing fatigue, and how to modify your daily activities at home and work to reduce strain and pain on affected joints.

    Sleep well. Not getting enough quality sleep can worsen your symptoms; however, getting a good night’s sleep when you have RA and chronic pain can be difficult. If you’re having problems sleeping, talk with your doctor about ways to deal with this. There are many options available to help you sleep better.

    Manage stress. Stress can also aggravate your symptoms, so learning to deal with stress is extremely helpful. Things you can do to manage stress include planning your day and setting priorities, using relaxation techniques such as going for a walk, getting a massage or listening to music, and, where possible, avoiding people and situations that cause you stress.

    Practise mindfulness. Regularly practising mindfulness meditation can improve your mood, relieve stress, improve sleep, improve mental health and reduce pain.

    Eat a healthy, balanced diet. While there’s no specific diet for RA, it’s important to have a healthy, balanced diet to maintain general health and prevent weight gain and other health problems, such as diabetes and heart disease.

    Quit smoking. Smoking cigarettes harms your general health, negatively affects your bone health, and increases inflammation. Smokers also have a greater risk of developing more severe RA, may be less likely to have remissions, and are more likely to have RA-associated lung disease. Smoking can make it more difficult to manage your pain. It causes fatigue and slower healing, which can make your pain worse. And it can make some of your RA medicines less effective. If you’re a smoker, you may be less likely to be as active, and less physical activity can increase your pain too.

    What about surgery?

    Surgery may be needed in some cases. Your doctor may suggest surgery as an option to:

    • improve your joint movement
    • improve your mobility and independence
    • correct the position of joints that have become misaligned
    • relieve pain that’s no longer controlled with treatments such as medicines, heat and cold, massage or exercise
    • improve health and wellbeing if joint pain affects your sleep, mental health, and ability to work or participate in other important activities or events.

    If your doctor thinks surgery might be a good option, they’ll refer you to an orthopaedic surgeon. Together, you can discuss the benefits and risks of surgery, alternatives and what will happen if you do nothing. You can then decide if it’s right for you. For more information, read Choosing Wisely Australia’s 5 questions to ask your doctor or other healthcare provider before you get any test, treatment, or procedure.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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    Lisa Bywaters
    23/Mar/2023
    Health InformationMSK articles

    The power of a good nap

    And how to do it right

    “Let’s begin by taking a smallish nap or two.” – Winnie the Pooh

    Ever had one of those days when you wake up feeling like you need a nap??

    Days like that make me want to be just like Winnie the Pooh. He has it all worked out. Lots of honey, good friends and naps. I’m sure my spirit animal is a small, round-ish teddy bear who lives in the Hundred Acre Wood 🧸.

    However, unlike Pooh Bear, many people with chronic pain crave a nap during the day because of poor sleep quality, not because they’re relaxed and full of honey. Chronic pain and sleep issues often go hand in hand.

    In our report: Making the invisible visible: Australians share the impact of musculoskeletal conditions on their lives almost three-quarters (72%) of the people who took part in our survey said their sleep was affected by their condition. One person said: “I sleep very little due to pain, so find myself very tired during the day, which makes it harder to manage the pain.” 

    So should we follow Pooh’s advice and “when all else fails, take a nap”?

    It depends.

    Sleeping is a complicated business. There’s so much we still don’t know about it.

    However, we do know that sleeping too long or too often during the day can make getting a good night’s sleep even harder. And it can exacerbate your pain and make you feel stiff and sore.

    But sometimes, when you’re battling pain and fatigue, a nap is exactly what you need. So what can you do? How do you find the right balance?

    Tips for napping

    First, listen to your body. You know it better than anyone else. So if you’re exhausted and know you won’t make it through the day, or the commute home without falling asleep, listen to your body and take a nap.

    That being said, sleep experts recommend that you:

    Limit your nap to 20 minutes or less – aka a power nap. Any longer and your body enters a deeper state of sleep from which it’s harder to wake – and when you do wake, you’ll most likely feel groggy. Limiting your nap to less than 20 minutes reduces this risk, and you’ll wake up feeling rested.

    Nap in the early afternoon. After lunch, most of us tend to feel a bit fuzzy and unfocused, but when you combine that with fatigue or sleep problems, it can be tough to keep your eyes open. This is the perfect time to lay your head down for a short time. But avoid late afternoon napping, as this will interfere with your overnight sleep.

    Maintain good sleep habits. That means going to sleep at the same time each night and getting up at the same time each morning. This helps your body clock find a rhythm that works best for you. Read our information on sleep to find out more.

    Only nap occasionally, not as a daily practice. Experts recommend that you only take a nap when you really need one so it doesn’t start affecting your night time sleeping patterns. An exception is when you’re going through a flare, or you’re unwell, as naps may be required more often to help you recover. But once you’re better, go back to your usual sleep routine.

    Set an alarm. This is important because once you’ve nodded off, you’ll need help to wake up, especially if you’re exhausted. But 20 minutes is the sweet spot for napping, and you need to stick to it. So set your alarm.

    Find a comfy place to nap – preferably not your bed. If you’re in bed, sleeping longer than planned is far too easy (trust me) 😴. Even with an alarm set, it’s too easy to hit snooze (it’s so comfy and you’re so tired). So nap on the couch, in a supportive armchair or at your desk if you have some supports to keep you comfortable and not put a crick in your neck or back or aggravate your condition.

    Turn off your TV, radio, computer etc. Put on an eye mask and/or earplugs if you need to block out light or noise. If your phone is your alarm, set it to airplane mode so you only get the alarm and nothing else. Because if you’re going to nap and enjoy the benefits, you need to block out all other distractions.

    When you wake up, take some time to stretch or do some gentle exercises to help you loosen up. After being still for a while, your muscles and joints may become stiff and painful. So take a little time to get yourself going again. And drink a glass of water to rehydrate.

    Talk with your doctor if you find you need a nap every day. It may indicate that your musculoskeletal condition, medicines or another health condition is interfering with your sleep or causing drowsiness. Together you can explore these possibilities so that you can come up with a plan to get it under control.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

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    yellow-strength-training.jpg
    Lisa Bywaters
    22/Feb/2023
    Health InformationMSK articles

    Strength training

    It’s 6.30am, and I’m at the gym. There’s the waft of sanitiser and sweat in the air. I’m wearing Lycra, grunting, and questioning all the decisions that led me to this point 😣.

    OK, I’m being overly dramatic. But after almost four years away from the gym, I’m a little flustered and overwhelmed. I’m also at a gym with complicated-looking machines that have QR codes to show you how to use them properly! What was I thinking?!?

    Oh, that’s right. It’s time to get serious about strength training again. Walking and LOTS of podcasts have gotten me through the worst of the pandemic and saved my physical and mental health. But I now need to step it up and add strength training back into my routine.

    Why?

    Because we all need to be doing some strength training every week. The Australian physical activity guidelines say adults should do at least two sessions of strength training every week. So, on with the active gear and off to the gym 😐.

    So what exactly is strength training?

    Strength training is any exercise that uses resistance or weights to strengthen your muscles by working them a little harder than you do in everyday life. It’s also called resistance or weight training.

    Strength training uses equipment like free weights (e.g. dumbbells, leg cuffs), gym machines and elastic resistance bands or your body weight (e.g. push-ups, squats).

    When you exercise, you’ll do reps, sets and rests.

    A rep, or repetition, is the completion of one exercise. For example, one bicep curl or one lunge.

    A set is a specific number of reps performed in a row. This is generally between 8 and 15 reps depending on the person and the exercise. So, a set may be 10 bicep curls or 12 lunges.

    Rests are – you guessed it – rests from the weights or resistance. You give your muscles a short break to recover. Then you do your next set. So you may do 3 sets of 10 bicep curls or 2 sets of 12 lunges.

    Breaking it up into reps, sets and rests allows your strength training program to be tailored to your specific needs and abilities. It also makes it easy to track how much you’re exercising and when you need to progress and add more weight, resistance, reps or sets.

    Why should we be doing strength training?

    No matter your age or fitness level, regular exercise is essential for good physical and mental health and wellbeing. A good exercise program should incorporate activities that help maintain or improve your flexibility, balance, overall fitness and endurance, and of course, your strength.

    Strength training:

    • Strengthens the muscles that support your joints. This is particularly important if you have arthritis or joint problems.
    • Helps you maintain a healthy weight or lose weight when combined with a weight-loss diet.
    • Helps improve your balance and flexibility.
    • Increases your stamina, meaning you won’t get tired so quickly.
    • Increases your bone density, essential for reducing your risk of osteoporosis.
    • Improves sleep quality.
    • Makes you feel good. Exercise releases chemicals such as endorphins, serotonin and dopamine into your bloodstream. These chemicals can boost your mood, improve your sense of wellbeing and relieve pain.

    Who should be doing strength training?

    EVERYONE! Wow, that was shouty 😁. The serotonin must still be buzzing around my body 😂.

    But everyone should be able to do some strength training each week.

    If you haven’t exercised in a while or you’re new to strength training, it’s a good idea to talk with your doctor and get advice from a physiotherapist, exercise physiologist, or a qualified exercise professional before you start. That’s because the amount you do and the weights involved will differ for each person. There’s no ‘one size fits all’.

    But won’t it aggravate my condition?

    No, not if you get the right advice before you begin and follow some simple precautions.

    • Warm up first. Before you grab the weights or start lunging, you need to warm your muscles and get your blood pumping. So take some time to walk briskly, climb stairs, or ride a stationary bike.
    • Focus on your form. Ideally, when you’re starting out you’ll be under the supervision of a professional who can ensure your form is correct and safe.If you’re doing it on your own take it slowly and position yourself in front of a mirror so you can watch your form. Or work out with a friend and help each other.
      To avoid injury, make sure your movements are smooth and even, not jerky. Pay attention to how your muscles control the movements; don’t let the weights control you. If they are, they may be too heavy for you. Try not to hunch your shoulders or hold tension in your neck.
    • If you have hot, swollen joints, avoid exercising those joints. Instead, concentrate on areas that aren’t actively inflamed. For example, exercise your arms and shoulders if your knees are inflamed.
    • Strength training exercises shouldn’t cause pain if you’re doing the exercises correctly and using the appropriate weight or resistance. If your joints start to hurt more than usual, stop that exercise. Get advice to ensure you’re doing everything properly. And talk with your doctor or exercise professional about what pain is normal to feel when exercising and what isn’t.
    • To get the most out of your strength training program, you need to do it two to three times per week. Your program should also increase in intensity over time to continue strengthening your muscles. Generally, a strength training program will take between 45 and 60 minutes to complete. This includes warming up and cooling down.
    • Listen to your body. If you’re experiencing a flare, or you’re really not up for a strength training session, take a break. You know your body better than anyone else. But exercise is an important management strategy and something we need to do most days. So, instead of strength training, try some gentle exercises in water or range of motion exercises at home. This will help reduce pain and stiffness.
    • Exercise when you’re feeling the most flexible. If you’re really stiff first thing in the morning, it’s probably not the best time to do your strength training. Wait until your body has loosened up, and then do your exercises. Taking a warm shower may also help.
    • Don’t overdo it. Start with weights that challenge you a bit, but not too much. Again, support from a professional will help you find the right weights and exercises for you.
    • But also remember to challenge yourself. When your program becomes easy to complete and is no longer challenging, it’s time to increase the intensity. This may involve increasing the number of sets, repetitions, weight or resistance. Or it may be time to add new exercises that work your body differently.
    • Give your muscles a break between strength training sessions. Don’t do strength training sessions on consecutive days unless you work different muscle groups in each session. For example, arms on Monday; legs on Tuesday.
    • Dress the part. No, you don’t need to buy a whole new wardrobe for strength training 😏. But you do need comfortable, stretchy clothes that allow you to move easily without getting caught on equipment. And you’ll need good shoes that provide support and comfort while providing a good grip on the floor or equipment.
    • Remember to breathe. When you’re concentrating on form and technique, it’s easy to forget to breathe. But that can raise your blood pressure and make you feel faint. So make sure you breathe.
    • Stay hydrated. Exercise is thirsty work, so keep your water bottle close by and keep your fluids up.
    • Don’t rush your cool down. It’s important to take time to wind down physically and mentally after your exercise session. This gives your body a chance to cool down and your heart rate to return to normal. It’s as easy as taking a walk around the gym or your house or doing some stretches. Talk with your doctor, or exercise professional for some guidance.

    Argh! But I don’t want to go to a gym!

    That’s fair enough. They can be intimidating and costly. But there are other options.

    • Work out at home. You can follow online videos or have an exercise program created for you by a physio or exercise physiologist. You may need to purchase some weights or resistance bands and use your body weight for exercises. Another option is to rent or buy a home gym.
    • Go to the park. Lots of them have strength training stations you can use for free.
    • Get a personal trainer. They can bring all the necessary gear to your home or a local park. You can join a small group or hire them on your own, though it’s generally cheaper to be part of a small group.
    • Go swimming. Although it’s generally considered a cardio exercise because it raises your heart rate and works your heart and lungs, swimming can also increase muscle strength. When you move through the water, you’re pushing against its resistance. You won’t see the same results as using weights or other equipment, but it’s a good option.

    “Good things come to those who sweat.”

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
    disco.jpg
    Lisa Bywaters
    22/Feb/2023
    Health InformationMSK articles

    Let’s dance!

    Note: I’ve been listening to great music while writing this article. I’ve embedded some links so you can share the love 💛.

    Bored with your usual exercise program? Why not follow David Bowie’s advice and “put on your red shoes and dance the blues”?

    Dancing is a fun, expressive and social form of exercise. It’s also a great way to meet new people.

    There are many dance styles to try – from salsa to hip hop, ballroom or belly dancing. Or you can shake your tail feather around the house when a great song comes on the radio.

    Why you should be dancing

    If you’re like me, the idea of dancing, especially in public, is terrifying. I’m uncoordinated, clumsy and have never felt comfortable or natural moving to music. My partner is changing that, one ‘box step’ at a time. Not the unco, clumsy part – he’s not a miracle worker 😂. But becoming more comfortable just dancing. You see, he’ll literally dance at the drop of a hat. At home, in his coffee shop, in the supermarket. It makes him happy.

    And when he’s happy, I want to join in on that happiness.

    So that’s a key reason to dance – happiness 😊.

    It’s also a very social activity. Joining a dance class or going to clubs is an opportunity for you and your friends to have a fun, physical outing. And you may make new friends. What’s not to love about that? 💜

    Gonna make you sweat (Everybody dance now): Dancing is exercise

    The Australian physical activity guidelines recommend that adults be active most days of the week, preferably every day.

    That means that each week, adults should do either:

    • 2.5 to 5 hours of moderate intensity physical activity – e.g. a brisk walk, golf, mowing the lawn or swimming. Moderate intensity means you can talk comfortably but not sing.
    • 1.25 to 2.5 hours of vigorous intensity physical activity – e.g. jogging, aerobics, fast cycling, soccer or netball. Vigorous intensity means you can only say a few words without gasping for breath.
    • an equivalent combination of moderate and vigorous activities. (1)

    So dancing – at a moderate or vigorous intensity – is a fun and creative way to contribute to your weekly dose of exercise.

    Everybody dance: Other health benefits

    Chic put it so well in their song, “Dancing helps relieve the pain, soothes your mind, makes you happy again. Listen to those dancing feet. Close your eyes and let go.“ But don’t just take the word of those disco legends… dancing:

    • improves the health of your heart and lungs
    • improves circulation of blood and synovial fluid through joints
    • relieves pain and stiffness
    • reduces fatigue
    • helps you sleep better
    • improves strength, endurance and stamina
    • improves balance, coordination and flexibility
    • helps keep bones strong and prevent falls
    • lowers stress levels and improves your mood
    • helps you maintain a healthy body weight or lose weight when combined with a weight-loss eating plan
    • builds self-confidence
    • improves brain health and cognitive functions
    • nurtures your creative side and allows you to express yourself
    • improves overall health and fitness.

    Dance, dance: Getting started

    OK, if I’ve sold you on dancing, it’s time to get started. And a good way to do that is to think about the different dancing styles and ask yourself…

    • What style appeals to me?
    • What do I want to get out of dancing? For example, do I want to:
      • meet new people?
      • get fit?
      • improve my balance and coordination?
      • get involved in competitions?
    • Do I want to dance on my own or with a partner?

    Thinking about these things can help you choose the style that best meets your needs.

    You also need to be conscious of the physical demands of the dance style. For example, if there’s a lot of jumping or moves that put significant pressure on joints, it may not be suitable if you have arthritis in your hips, knees or feet. That being said, there are so many styles to choose from, including:

    Once you’ve picked a style, as you would before starting any new exercise program, you need to consider your fitness level and other health issues. If it’s been a while since you’ve been active, talk with your doctor before you start.

    Flashdance: What to wear?

    Your clothing needs to be comfortable and allow you to move freely. But you don’t want any trailing sleeves and long skirts. They’ll be a trip hazard. So leave your inner Stevie Nicks at home, at least until you’re a more proficient dancer 😁.

    As far as shoes go, some dance styles, like tap, require special shoes. But for the most part, when starting out, you can generally wear shoes you already have. Just make sure they’re flexible, comfortable and provide good support. And it’s best to start in low shoes that allow you to move smoothly and safely across the floor.

    Other tips for a safe(ty) dance

    Dancing is exercise, so start slowly and learn good technique. You should also:

    • Consider getting family or friends involved. It’s fun to explore new experiences, like dance classes or groups with others, especially if you’re a little nervous or find it difficult to get motivated on your own.
    • Warm up before you start. Don’t just ‘lose yourself to dance’. Give your body time to loosen up and get ready for some exertion.
    • Drink enough water and stay hydrated – before, during and after dancing.
    • Take breaks, and rest when you need to. It’s easy to get caught up and overdo it, especially when you’re having a good time. So listen to your body and take regular breaks.
    • If you feel unusual pain, stop that move or dance sequence, and get advice from your dance instructor, physiotherapist or exercise physiologist. You may be overextending a joint or moving in a way that’s not great for your musculoskeletal condition. So safety first.
    • Cool down when you finish.
    • Have a wonderful time!

    Dance hall days: Finding a place to dance

    • Start at home if you’re nervous about going public with your dance moves. Put some music on, and go for it. Make sure you have plenty of space and there are no slip or trip hazards (e.g. rugs, pets). Other safety issues such as talking with your doc, wearing appropriate clothing and footwear, warming up, cooling down and hydrating still apply.
    • Check out some online groups and classes. There’s so much available online. This has been a positive of the pandemic – an enormous growth in good online resources. You’re sure to find something that suits you. If you’re looking for inspiration, YouTube and TikTok have some great dance content. Just watch them carefully and evaluate them as you would any other online health content. Our article Online exercise – look before you leap provides a list of things to consider before starting any online exercise (including dance).
    • Visit websites of local community houses and clubs as they often provide dance classes as part of their exercise offerings.
    • Dance schools and studios often provide more formal dance training. This may be of particular interest if you want to perfect your dance technique, enter competitions or learn a style unavailable in your local community.
    • Hit a club or pub. And if you’re groaning about a late night (which I do regularly), many venues have afternoon music and dance sessions or dinner dances. You just have to keep an eye on local venues.
    • No Lights, No Lycra. This a place for people to come and dance freely in a friendly, non-threatening, drug and alcohol-free atmosphere. It happens in a dimly lit room with the lights low so people can truly dance without worrying about what they look like. No Lights, No Lycra events happen all over the world. You can find your closest venue here.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    More dance tunes to get you in the mood!

    These songs will have you cutting the sleeves off your jumpers to make leg warmers (à la Flashdance) in no time 😅.

    Reference

    1. Australian Government, Department of Health and Aged Care. Physical activity guidelines: For adults (18-64 years) 
    CONTINUE READING
    lupus.jpg
    Lisa Bywaters
    22/Feb/2023
    Health InformationMSK articles

    Sometimes it’s lupus

    Do you remember the TV show House? Hugh Laurie played the brilliant but grumpy, antisocial doctor addicted to pain meds who secretly has a heart of gold. Yep, it had all the tropes 😂.

    The show created a lupus meme – where a diagnosis of lupus was often mentioned on the show to which House’s reply would always be, ‘it’s not lupus’. And most of the time, he was right.

    The meme highlights the fact that lupus is rare, complex, and difficult to diagnose.

    And sometimes, it is lupus (as was the case in an episode in season 4).

    So what is lupus?

    Lupus (systemic lupus erythematosus) is a chronic condition that can cause inflammation and pain in any part of your body. Symptoms vary from person to person and can range from mild to severe.

    Anyone can get lupus; however, women are more likely to develop it than men. It’s usually diagnosed in people aged between 15-45.

    Certain ethnic groups are also more likely to develop lupus, such as Indigenous Australians, Africans, Hispanics, Asians and Native Americans.

    Causes

    Lupus is an autoimmune disease. That means it occurs as a result of a faulty immune system.

    Your immune system is designed to identify foreign bodies (e.g. bacteria, viruses) and attack them to keep you healthy. But in the case of lupus, your immune system mistakenly targets healthy tissue.

    This causes pain and inflammation in parts of the body such as the skin, joints, and internal organs (e.g. kidneys, heart and lungs).

    We don’t know why this happens. Scientists believe a complex mix of genes and environmental factors may be involved.

    Symptoms

    Symptoms can vary greatly between people and may include:

    • skin rashes
    • joint and muscle pain
    • sensitivity to light
    • hair loss
    • fatigue
    • fever
    • mouth ulcers
    • weight changes
    • organ involvement (e.g. kidneys, heart, lungs)
    • pale, blue, or red fingers or toes triggered by cold or stress (Raynaud’s phenomenon)

    It’s unlikely that one person will experience all of these symptoms. At times the symptoms you experience as a result of your lupus (e.g. rash, pain, fatigue) will become more intense. This is a flare.

    Flares are unpredictable and can seem to come out of nowhere. They’re often triggered by stress or exposure to ultraviolet light.

    Diagnosis

    Lupus can be a difficult condition to diagnose. Symptoms vary significantly from one person to another and are similar to those of other conditions. They can also change or fluctuate. So, it may take months or years to get a definitive diagnosis of lupus.

    No single test can diagnose lupus, so your doctor will use a combination of tests to confirm your diagnosis. They may include:

    • Your medical history. Your doctor will ask about your symptoms, family history and other health issues.
    • A physical examination – including your joints and skin to look for any signs of change, inflammation and rashes.
    • Blood and urine tests.
    • Tissue biopsies of the skin or kidneys.

    Test results also help rule out other conditions that may have similar symptoms.

    Your GP should refer you to a rheumatologist if they think you have lupus. Rheumatologists are doctors who specialise in diagnosing and treating problems with joints, muscles, bones and the immune system.

    Treatments

    While there’s no cure for lupus, treatments are available to help control disease activity and improve symptoms. They include medicines and self-care.

    Medicines

    Medicine can help manage your symptoms and assist in controlling your immune system.

    Because people with lupus experience different symptoms, and to varying degrees, there’s no ‘one size fits all’ treatment. You might need to take a combination of medicines.

    • Hydroxychloroquine is very effective at reducing inflammation and reducing flares. It’s the first-line medicine for most people with lupus.
    • Non-steroidal anti-inflammatory drugs or NSAIDs may temporarily relieve pain and inflammation. NSAIDS should be avoided by people with kidney disease.
    • Corticosteroids (or steroids) are used to quickly control or reduce inflammation. They come in different forms: tablets, injections, or a cream to apply to skin rashes.
    • Disease-modifying drugs may be needed to suppress your immune system and control symptoms if you don’t respond to hydroxychloroquine and/or steroids.
    • Biological disease-modifying medicines (biologics and biosimilars) also suppress the immune system. They may be used in more severe cases of lupus that aren’t responding to treatment. These medicines target the specific cells and proteins that cause inflammation and tissue damage rather than suppressing your entire immune system.

    All medicines can have side effects. It’s important you discuss these with your doctor and know what to do if you experience any. Your doctor will also monitor your response to the medicines closely. You may need regular blood tests depending on the medicines you’re taking.

    You should also inform your doctor of any other medicines or complementary therapies you take. They can potentially affect your lupus medicines.

    Self-care

    There are many things you can do to manage your lupus.

    • Learn about your condition. Understanding lupus allows you to make informed decisions about your healthcare and actively manage it.
    • Manage your exposure to ultraviolet (UV) light. UV light, especially sunlight, can cause a flare. This can include skin rashes in sun-exposed areas. Remember to wear 50+ UVA and B sunscreen every day (even if it’s cloudy). You should also cover your skin and wear a hat and sunglasses outdoors. Less commonly, UV light from fluorescent lights, including low-energy light bulbs, may cause rashes in some people with lupus.
    • Stay active. Regular physical activity has many health benefits, including helping you to manage your symptoms. When you start exercising regularly, you should notice an improvement in the quality of your sleep, an increase in energy levels, a reduction in fatigue, and improvements in your overall strength and fitness. Exercise can also help prevent long-term consequences of lupus, such as heart disease and osteoporosis.
    • Learn ways to manage your pain. Pain is one of the most common symptoms of lupus, so it’s crucial to learn ways to manage it effectively. Read our A-Z guide for managing pain for more information.
    • Manage stress. Stress can aggravate your symptoms, so learning to deal with stress is very helpful. Things you can do to manage stress include planning your day and setting priorities, using relaxation techniques, getting a massage or listening to music. And, where possible, avoiding people and situations that cause you stress.
    • Quit smoking. Smoking cigarettes can worsen your lupus symptoms and reduce the effectiveness of particular lupus medicines. It can also affect your bone health and increase inflammation.
    • Ask your GP about your vitamin D, calcium and cholesterol levels. Lupus can affect them all, and you may need to take supplements or medicines to correct any problems.
    • Sleep well. Not getting enough quality sleep can worsen your symptoms; however, getting a good night’s sleep when you have chronic pain can be difficult. If you’re having problems sleeping, talk with your doctor about ways you can address this.
    • Eat a healthy, balanced diet. While there’s no specific diet for lupus, it’s important to have a healthy, balanced diet to maintain general good health and prevent other health problems, such as diabetes and heart disease. Lupus can also cause weight loss or gain depending on how it affects your body and the medicines you take. A healthy balanced diet may help prevent this. Talk with your doctor if you’re concerned about your diet or weight.
    • Pace yourself. Pacing is an effective strategy to help you do the things you want to do by finding the right balance between rest and activity (both physical and mental). This will help reduce your risk of flares and fatigue.
    • Get support from others. Research has shown that people with positive social support cope better with pain. Family, friends, colleagues, and health professionals can help you manage. A peer support group may be another option.

    Pregnancy

    Most women with lupus can have children. However, there’s an increased risk of complications such as premature labour, high blood pressure, blood clots and miscarriage.

    For these reasons, it’s essential that you plan your pregnancy carefully.

    The healthier you are before you get pregnant, the greater the chance you’ll have a healthy pregnancy and baby. Aim to have your condition under control and be in the best possible health.

    Talk with your doctor and specialist before you get pregnant. They may need to change your medicines to ensure a safe pregnancy.

    Complications

    Lupus is an unpredictable condition that can affect any part of your body, including your internal organs. Working closely with your healthcare team, following your treatment plan, and staying informed about lupus is the best thing you can do to reduce your risk of complications.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
    kids-with-coloured-shoes.jpg
    Lisa Bywaters
    21/Feb/2023
    Health InformationMSK Kids Blogs

    Choosing the right footwear

    To manage foot and lower limb pain in children

    Guest blog written by podiatrist Daniel van Hoof-Harkin, B. Pod (Hons)

    When a child starts to complain of pain in their legs or feet for whatever reason – after activity, ‘growing pains’ at night, or joint inflammation caused by a condition like juvenile arthritis (JIA) – often the first thing I’ll look at is their footwear. Specifically, what footwear they wear and when and how they wear them. I’ll then spend time discussing and trying to recommend footwear. That’s because good shoes can be a first-line treatment in relieving pain.

    To help you choose the best footwear for your child, here are my suggestions for things to look for.

    Getting the right support

    To a large extent, you get what you pay for with shoes. Cheaper shoes are usually made with lower quality materials and have less support than more expensive footwear. This is why quality shoes can cost significantly more.

    When I look at a pair of shoes for someone in pain, I’m looking primarily at four things:

    • Heel pitch – Also known as drop or offset, it is the difference in height between the heel and forefoot within the shoe. Ideally, shoes should have approximately 10mm, as this helps to reduce the effects of reduced ankle range of motion, or for high arched people whose forefoot sits lower than their heel.
    • Torsional rigid shank – This is the stiffness of a shoe between the heel and the forefoot and helps to stabilise mobile feet, especially on graded surfaces.
    • Heel counter – This is usually a piece of plastic that wraps around the heel in shoes and helps to reduce inversion and eversion of the rearfoot during lower impact activities.
    • Upper fixation – This will normally be achieved with either Velcro or laces, but also aided by the upper of a shoe.

    Most brand-name sneakers will have all of these qualities, which will help support the feet and legs of children, whether they’re walking or running. However, if a shoe lacks any of these qualities, it’ll provide less support for your child’s feet.

    For example, Mary Jane style school shoes don’t have as much upper, and only a single strap to secure them. That means they’ll offer less support than a pair of laced shoes.

    Mary Jane school shoesLaced school shoes

    Orthotics – Yes or no?

    Orthotics can often be a controversial subject, but just like any form of therapy, if used correctly, they can make a big difference for a child with leg or foot pain. And there’s evidence that they have a place in managing JIA and hypermobility-related disorders.

    But when should they be considered? Sometimes I’ll recommend foot orthotics immediately, and other times I’ll let people know they’re unlikely to help their symptoms. As a general rule of thumb, if your child has good quality footwear and wears them appropriately, but they’re still experiencing ongoing pain, they may require some form of in-shoe support. In this case, visiting a podiatrist for an assessment would be worthwhile.

    School shoes vs trainers

    A good quality trainer is usually a more comfortable and better option for most active kids. This is because trainers have thicker midsoles that provide a good balance between structure and cushioning, especially when kids play on hard graded surfaces like concrete. School shoes are usually more of a dress shoe, which means they have less cushioning and generally don’t tolerate as much punishment as trainers.
    At the end of the day, school shoes are often determined by the uniform requirements of the school, and if dress shoes are required, then fit and comfort when wearing need to be the most important factors.

    Alleviating foot pain

    When recommending shoes to parents, I’ll often ask how active their child is. I’ll then ask, ‘if you were going to be doing the same things as your child, which shoes would you choose to wear?’ Imagining yourself in your child’s place means you’ll have a better understanding of what’s most appropriate.

    The other aspect we don’t often realise is how hard graded surfaces can be on our feet and ankles. If your child is susceptible to experiencing pain, then I’d recommend they wear structured sneakers more often. It’s also important they wear them on outings to places like shopping centres, theme parks, or on days with lots of walking. Less structured footwear like thongs, or ballet flats, should only be used for short outings, where there won’t be much walking involved.

    Leg length discrepancy and heel lifts

    Differences in the length of legs, or leg length discrepancies, happen more frequently than we think. It’s been reported between 40-70% of the population have a difference in leg length, and one in every 1000 people can have a difference of greater than 20mm.

    Leg length discrepancies can be difficult to assess clinically and almost impossible to measure accurately without performing scans to assess bone lengths and joint alignment. Also, kids can often grow asymmetrically, meaning one leg may grow faster than another. However, I often see these leg length differences have disappeared 6 months later.

    So I’m usually not too concerned when I come across a leg length discrepancy unless the child has pain I believe is being influenced by it or the leg length difference is such that I see significant postural problems occurring. Once again, if there’s concern about the presence of a leg length discrepancy, it’s worth having it assessed by a health professional, and whether it is indicated to include a heel lift under the shorter leg.

    Finding the right fit

    Ultimately, the most important thing when it comes to footwear for any child is fit. Given how quickly children can grow, keeping up with their shoe size can become a frequent and sometimes costly exercise. However, it’s vital for growing feet.

    Making sure that shoes aren’t too small is essential, as small footwear can cause pain, injury, and difficulty with movement. When checking shoe fit, try and establish their size when they’re standing. This is because feet may become longer when standing, changing the shoe size compared to sitting. It’s also important that the footwear isn’t too big, as this can cause increased movement within the footwear that can affect stability. If shoes are too long, they can also pose a trip hazard to a child.

    This advice is, of course, very general, and individual needs will vary. But as a starting point for parents of children with lower limb pain, this advice can be a useful for reducing symptoms.

    Contact our free national Help Line

    Call our nurses if you have questions about juvenile arthritis, managing pain, treatment options, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    CONTINUE READING
    stem-cell.jpg
    Lisa Bywaters
    25/Jan/2023
    Health InformationMSK articles

    Stem cell treatments and osteoarthritis

    In October 2022, the Albanese Government announced that they would invest almost $7 million in stem cell research. The ARISTOCRAT project, led by MSKs Director Emeritus, and orthopaedic surgeon Professor Peter Choong, will allow researchers to develop new therapies to improve the lives of people with conditions like osteoarthritis.

    So what does this mean? What are stem cells? And, will they be the miracle treatment we’ve been waiting for?

    Let’s take a look.

    But first, what’s osteoarthritis?

    Osteoarthritis, or OA, is the most common form of arthritis. It most frequently affects the joints in the knees, hips, feet, spine and hands.

    OA was once thought to be a natural part of ageing or a lifetime of ‘wear and tear’ on joints. But we now know it’s much more complex than that and may occur due to many factors.

    With OA, the cartilage that lines the ends of bones in a joint, enabling them to move smoothly over each other, becomes brittle and breaks down. Because the cartilage no longer has a smooth surface, the joint becomes stiff and painful. Eventually, the cartilage can break down so much that it no longer cushions the two bones.

    There are currently no treatments, including medicines, that can affect the underlying disease process of OA. Instead, symptoms (e.g. pain and stiffness) are managed using exercise, weight management and medicines that provide temporary relief.

    The lack of targeted treatments to prevent OA from worsening or reversing the damage it causes makes the promise of new and innovative treatments, such as stem cells, very exciting.

    So what are stem cells?

    Cells are the basic building blocks of all living things. They provide structure for the body, take in nutrients from food, convert those nutrients into energy, and carry out specialised functions. Cells also contain the body’s hereditary material and can make copies of themselves. We have many different types of cells, such as nerve, bone, fat, blood, and stem cells.

    Stem cells differ from other cells in the body in three ways:

    1.  they can divide and renew themselves over a long time
    2.  they’re unspecialised, so they can’t do specific functions in the body
    3.  they can become specialised cells, such as muscle cells, blood cells, and brain cells.

    There are many types of stem cells. However, the type of stem cell most often promoted as a treatment for osteoarthritis is the mesenchymal stem cell or stromal cell. They’re generally referred to as MSCs (because no one can say mesenchymal 😉). These cells can be obtained from many parts of the body, including bone marrow and fat.

    MSCs can become bone cells (osteoblasts), cartilage cells (chondrocytes), muscle cells (myocytes), or fat cells (adipocytes). They can also release substances that may alter how the immune system responds to injury and encourage other cells to grow.

    This has led scientists and doctors to explore whether MSCs can restore function to damaged joints and tendons.

    EuroStemCell has an interesting article that explains MSCs – what they are, what researchers are investigating when it comes to MSCs, and the challenges they face.

    More research is needed

    For most conditions, stem cell treatments are still considered experimental. They have yet to prove safe or effective in clinical trials for osteoarthritis.

    While there’s a lot of excitement about the future, we need more research to understand how to best obtain, handle and administer stem cells or the cells made from them.

    We need to know some of these answers to ensure that new stem cell treatments don’t cause more harm than good.

    We also need more information about potential side effects and the long-term safety of stem cell treatments.

    Be wary

    Unfortunately, despite the lack of reliable evidence that stem cell treatments work and are safe to use, they’re actively promoted for osteoarthritis and many other health conditions by clinics in Australia and overseas.

    Some clinics use cells obtained from the person on the same day they’re collected, while others may grow the person’s or donor cells in the lab over several weeks before returning them to the person. It’s important to know that even when the cells are taken from a person and returned to the same person, there’s still risk involved. Even though they’re your own cells, the fact that they’ve been removed means there’s the risk that they may have become contaminated.

    Most clinics charge substantial fees (thousands of dollars). They encourage multiple treatments and may imply they’re doing research but aren’t usually part of a registered clinical trial. They also often use celebrity patients’ testimonials or endorsements to support their claims of success.

    That’s why participating in a clinical trial is currently the safest way to access stem cell treatments. Researchers must follow strict rules to ensure that participants are safe. Each clinical trial also follows a careful study plan or protocol that describes what the researchers will do.

    Before joining a clinical trial, you’ll be told what to expect as a participant and all the things that might happen. For example, someone from the research team will explain possible side effects or other risks of the treatment. You’ll also have a chance to ask questions about the trial. In most cases, you won’t be required to pay any costs involved in participating in a clinical trial. There may be out-of-pocket expenses, such as travel, which may be reimbursed to you.

    Ask questions

    If you’re considering trying a stem cell treatment, you need to be well-informed – so ask lots of questions. For example:

    • Is this treatment part of a registered clinical trial listed on the Australian New Zealand Clinical Trial Registry (ANZCTR), ClinicalTrials.gov, or elsewhere?
    • Was ethics review and approval obtained, and by whom?
      Note – All clinical research projects in Australia must be approved by a Human Research Ethics Committee (HREC), which checks that the research conforms to the National Statement on Ethical Conduct in Human Research requirements.
    • Does the doctor, or any of the researchers involved, have any conflicts of interest, including financial?
    • What are the total costs of the treatment, and how much will I be expected to pay? Remember, if you’re taking part in a clinical trial, no costs should be involved.
    • Will you use my own cells, or are they from a donor or other source?
    • How does this treatment compare to other treatments?
    • Is there any scientific evidence (not testimonials or anecdotes) that the treatment improves my health condition?
    • What are the potential side effects or risks involved?
    • How many treatments are required?
    • How long do you monitor the effects of my treatment?

    Stem cell treatments are still considered experimental for osteoarthritis, so don’t be embarrassed to ask lots of questions. Learn as much as possible about the treatment and how it might affect you. You should also have a chat with doctor or specialist about your intentions and get their input.

    Stem cells and cell therapy are an exciting new frontier in medicine, but it’s still early days. So watch this space.

    And watch our video, Stem cells and muscle, bone and joint health: Hope, hype and reality, presented by Professor Megan Munsie, Deputy Director – Centre for Stem Cell Systems, The University of Melbourne; Head – Education, Ethics, Law & Community Awareness Unit, Stem Cells Australia.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    Peak bodies
    Research registries
    CONTINUE READING
    bacteria-in-kitchen.jpg
    Lisa Bywaters
    25/Jan/2023
    Health InformationMSK articles

    Reactive arthritis

    Did you know that there’s a link between certain bacteria and a type of arthritis? It’s strange but true. Find out how a case of food poisoning, or a sexually transmitted infection, can sometimes cause arthritis.

    Reactive arthritis (ReA) is a relatively uncommon form of arthritis that occurs as a ‘reaction’ to a bacterial infection in another part of your body.

    Usually, when you have an infection, your immune system fights the foreign body (e.g. the bacteria) and then settles down. However, with reactive arthritis, the immune system stays active after the infection has cleared and targets healthy parts of the body, causing pain and inflammation.

    Although it’s caused by bacteria, it’s not contagious. However, the bacteria can be passed on to others through sexual activity or contaminated food.

    The types of bacteria that cause reactive arthritis are:

    • salmonella, shigella, yersinia or campylobacter bacteria – they cause food poisoning and bowel infections
    • chlamydia bacteria causes genital infections (though some people may not have any symptoms) and is spread through sexual contact.

    Most people who become infected with these bacteria won’t develop reactive arthritis. So the big question is why some people develop arthritis and others don’t 🤔.

    Researchers believe that your genes may play a role. You’re more likely to develop reactive arthritis If you have the gene HLA-B27. However, lots of people have this gene and never develop reactive arthritis.

    Reactive arthritis can occur at any age, but it tends to affect people aged between 20 and 50.

    The good news is that for the majority of people, their condition disappears within 6 months. However, some people experience symptoms for a longer period.

    Symptoms

    The symptoms of reactive arthritis develop some weeks after the infection and may include:

    • pain, swelling or stiffness in a joint (arthritis), most commonly the knees, feet and ankles
    • pain in the lower back and buttocks
    • pain and inflammation of tendons, such as the Achilles tendon at the back of your heel
    • pain and redness in your eyes – some people may develop conjunctivitis (inflammation of the outer layer of the eye) or uveitis (inflammation of the middle layer of the eye)
    • extreme tiredness, or fatigue
    • rash on the palms of your hands or soles of your feet
    • mouth ulcers
    • diarrhoea.

    The good news is most people won’t experience all of these symptoms.

    Diagnosing ReA

    There’s no specific test for diagnosing reactive arthritis, so your doctor will use a combination of tests to confirm your diagnosis. They may include:

    • discussing your medical history – e.g. your current symptoms, as well as any recent illness, infections or other health problems
    • a physical examination of your joints, spine, eyes and skin to check for inflammation and other changes (e.g. changes to joint movement, rashes)
    • lab tests – e.g. blood, urine or stool (poo) samples may be taken to check for the presence of infection, look for signs of inflammation and to rule out other conditions
    • swabs of your throat, penis or vagina to check for signs of infection
    • x-rays – may be used to look for signs of arthritis
    • arthrocentesis – a sample of fluid is taken from your joint and tested in a lab (this is done to rule out conditions such as gout that may cause similar symptoms).

    Treating ReA

    Treatment aims to manage the symptoms until you get better and may include:

    • Antibiotics to treat the infection. Antibiotics don’t treat the symptoms of reactive arthritis, just the bacterial infection. If you developed reactive arthritis due to a sexually transmitted infection, your sexual partner/s will also need antibiotics.
    • Non-steroidal anti-inflammatory drugs (NSAIDs) are the main medicine used to treat reactive arthritis because they quickly reduce joint inflammation and pain. But they do have the risk of side effects, so you’ll be given the lowest effective dose for as short a time as possible to reduce this risk.
    • Corticosteroids may be necessary if you have severe joint pain and inflammation. They can be taken as tablets or injected directly into a joint, muscle or other soft tissue.
    • Disease-modifying anti-rheumatic drugs (DMARDs) may be given if your condition doesn’t respond well to other treatments. DMARDs suppress your overactive immune system. They help relieve pain and inflammation and reduce or prevent joint damage. It can take several weeks to months before you begin to notice any effect, so you may also need to take other medicines to help control pain and inflammation until then.
    • Eye drops to treat conjunctivitis or steroid eye drops to treat uveitis.
    • Physiotherapy can help keep affected joints mobile and strengthen the surrounding ligaments, tendons and muscles.

    Uveitis requires specialist treatment. If you develop uveitis, your doctor may refer you to an ophthalmologist, a specialist who deals with eye diseases.

    Your doctor may also refer you to a rheumatologist, a specialist who treats problems with joints, muscles, bones and the immune system.

    Self-care

    As well as following the treatment plan your healthcare team has given you, there are many things you can do to manage your reactive arthritis.

    Become more informed about your condition. Understanding reactive arthritis allows you to make informed decisions about your healthcare and actively manage it.

    Stay physically active. We know that regular physical activity has many health benefits. But it can also help you manage the symptoms of your condition. When you start exercising regularly, you should notice an improvement in your pain levels, the quality of your sleep and an increase in energy levels. However, when your joints are very swollen or painful, avoid strenuous activity or straining the joint. Gentle exercise or movement is best and will help prevent the joint from becoming stiff.

    Pace yourself. Pacing is an effective strategy to help you do the things you want to do by finding the right balance between rest and activity (both physical and mental). This will help reduce your risk of flares and fatigue.

    Eat a healthy, balanced diet to improve your energy levels, help maintain your weight, and give you a greater sense of wellbeing. And ensure you handle and store your food safely to avoid any contamination.

    Learn ways to manage your pain. Pain is a common symptom of reactive arthritis, so it’s important you learn ways to manage it effectively. Read our A-Z guide for managing pain for more information.

    Practise good hygiene and safe sex.

    Preventing ReA

    You can reduce your risk of getting reactive arthritis by avoiding sexually transmitted infections and food-borne bacteria. So:

    • Wear a condom during sex with new partners.
    • Wash your hands regularly or use hand sanitiser if you don’t have access to water and soap (we’re experts at this now!) 😉
    • Make sure your food is prepared and stored correctly.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

    More to explore

    CONTINUE READING
    driver.jpg
    Lisa Bywaters
    25/Jan/2023
    Health InformationMSK articles

    Taking the stress out of getting to medical appointments

    Travelling into the city for medical appointments – either from the ‘burbs or a more rural or regional area – can often be stressful, time-consuming, costly and difficult. Planning your journey, becoming familiar with different types of transport, and potential forms of assistance can make it easier.

    We’ve got some info, tips and tricks to help you get to your appointments safely and calmly – no matter what transport you use.

    I’m travelling by car…

    If you’re travelling to your appointment by car – either as the driver or passenger – it’s important to plan and be prepared.

    Get comfortable in the car
    If you’re the driver, make sure you can reach and operate all of the controls, pedals, steering wheel etc. comfortably, and you have good visibility through your windows and mirrors. Whether you’re the driver or passenger, remember to pack your supports (e.g. lumbar cushion), water, and any other necessities you need for a road trip.

    Take breaks
    Avoid driving for more than an hour without a break. Stop, get out of your car, and stretch or massage tight muscles. Build these breaks into your overall trip time so that you have plenty of time to get from point A to point B safely and comfortably.

    Know your route
    Have a map or set your GPS to your destination. It’s easy to get confused or take a wrong turn if you’re anxious or worried about an appointment.

    Be prepared for public works and road closures
    Nothing can disrupt your trip and add to your stress like road works, especially when you weren’t expecting them 😤.

    Allow extra time in your journey so that you don’t feel rushed or stressed if you encounter any public works and have to change your route. If you don’t experience any delays, you can use the extra time before your appointment to grab a coffee, read a book or just relax.

    You also need to be mindful of damage to our road networks caused by storms and floods. Before you head out, check the traffic websites in your state/territory for information about roadworks, road closures and other traffic alerts.

    Tolls
    Be aware of any tollways you may need to go on. If you have an electronic tag, the toll will automatically be added to your account. If you don’t have a tag, you’ll need to purchase a pass before you set out on your journey or pay soon after you use the tollway.

    Parking
    Is there parking at the medical centre or hospital you’re going to? If you’re not sure, call them before you leave. If there’s parking available, is it free or do you have to pay a fee to use it? And if so, do you need coins, or can you pay with your debit/credit card?

    I’m travelling by public transport…

    When travelling by public transport, many factors, like cancellations and delays, are out of your control. So being proactive and prepared will give you some control over your trip.

    Plan your trip
    Your state/territory government website has tools to help you find the best way to get from point A to point B (and back).

    Simply enter the place you’re departing from (e.g. Wodonga) and where you’re going to (e.g. Royal Melbourne Hospital). You then choose the time you want to depart or arrive by and your journey date. You’ll be given several journey options to choose from. It’s a good idea to plan to arrive much earlier than your appointment so that if something does go wrong (a cancelled train or you get a little lost 😐), you have time up your sleeve. You won’t be rushing or worrying about running late.

    Mobility aids
    The experience of travelling with mobility aids will vary between trains, trams, cabs, ferries, buses and coaches, as each form of transport is different. It will also depend on the mobility aid – scooter, wheelchair, walker, crutches etc. – as they can vary significantly in size and space required to safely transport them. Before you set out on your journey, contact the relevant operator and let them know you’re travelling with a mobility aid. This gives you a chance to provide them with the details of your mobility aid and ask any questions.

    I need help to get to my appointment…

    Sometimes travelling by car or public transport isn’t an option, or you may need extra help.

    Community transport
    Community transport services are run by not-for-profit organisations and some local councils. The service is often operated by volunteers who take people to medical appointments, shopping centres and social outings if they can’t use other transport. Eligibility requirements and costs vary from place to place and with different operators. Search online for ‘community transport’ or contact your local council to find out about options in your area.

    Subsidised taxi fares
    All states and territories have subsidised taxi schemes for people with disability and health issues. They all vary in the concessions offered and eligibility criteria. Contact your relevant government department to determine if you’re eligible to participate in this scheme.

    Patient transport assistance schemes
    If you need financial support with travel and/or accommodation to receive your medical treatment or care because the services are unavailable locally, patient travel assistance schemes may be an option. These services are generally available for people who travel large distances or interstate to access necessary health care. Again, they vary in the support provided and eligibility criteria.

    Red Cross Patient Transport Service
    If public transport isn’t an option for you, the Red Cross operates a transport service for medical appointments. Cars are driven by volunteers, not medical staff, so you may need a carer if you’re unwell.

    Angel Flight Australia
    This volunteer-run charity operates non-emergency flights to help rural and remote Australians get to medical appointments in other parts of the country. All flights are free, and people are transported to medical facilities across Australia. Find out more.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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    bursitis.jpg
    Lisa Bywaters
    07/Dec/2022
    Health InformationMSK articles

    What’s the deal with bursitis?

    If you’ve ever had bursitis, you know how painful it can be. I had the displeasure of experiencing it several years ago when I slipped in the bathroom and fell heavily. Unfortunately, my shoulder took the full brunt of the fall 😫. I honestly thought I’d broken a bone; it was so painful! But after seeing my doctor, it turns out I had bursitis. And so began several weeks of ice packs, rest and gentle exercise. The good news is that my shoulder recovered completely. But I realised that although I’d heard of bursitis, I didn’t know what this common, painful condition was.

    So let’s look at bursitis – what it is, what causes it (apart from falls 😉) and what are the treatment options.

    What is bursitis?

    Simply put, bursitis is the inflammation of a bursa. A bursa (plural bursae) is a small fluid-filled sac that cushions your bones and soft tissues (muscles, tendons and skin) in and around your joint.

    They reduce friction between moving parts (e.g. between a bone and a tendon), enabling them to move smoothly over each other.

    When a bursa becomes irritated or inflamed, it fills up with excess fluid. This causes pain and restricts movement.

    What causes bursitis?

    Bursitis can develop quickly (acute bursitis) or more slowly (chronic bursitis). Common causes include:

    • injury, e.g. having a fall and landing hard on your shoulder or hip
    • overusing a joint, especially if the movements are repetitive, e.g. typing, playing tennis
    • prolonged pressure, e.g. kneeling for long periods while laying carpet or scrubbing floors
    • joint stress, e.g. from being overweight or having an uneven walk (gait)
    • other health conditions, e.g. rheumatoid arthritis, gout, diabetes
    • infection, e.g. if a joint is injured and bacteria enter the bursa.

    What are the symptoms of bursitis?

    The signs and symptoms of bursitis include:

    • pain, especially when moving the joint
    • joint stiffness and swelling
    • restricted movement of the joint
    • warmth and reddening of the skin in the affected area.

    The joints most commonly affected are the shoulder, elbow, hip, knee and heel.

    How is it diagnosed?

    If you have a painful, swollen joint or you’re finding it difficult to move a joint, it’s important that you discuss your symptoms with your doctor. Getting a diagnosis as soon as possible means that treatment can begin immediately.

    To diagnose your condition, your doctor will:

    • Take your medical history and ask about your symptoms, recent injuries, the work you do, and other health issues.
    • Do a physical examination and look for redness and swelling in and around the joint, and test your joint’s range of movement.

    If your doctor thinks your bursa is infected, they may remove a sample of fluid from your bursa. This will be examined under a microscope for signs of infection.

    Scans such as x-rays and ultrasounds are usually unnecessary; however, your doctor may send you for a scan to rule out the possibility of another condition.

    How is bursitis treated?

    Some people can manage the pain, inflammation and stiffness of bursitis with self-care, such as cold packs, rest and gentle exercise. However, other people will require medical treatment to manage.

    In this case, your doctor may recommend using over-the-counter non-steroidal anti-inflammatories (NSAIDs). They can be taken as a tablet (orally) or applied directly to the skin (topically) as a cream or gel. In cases of severe pain, your doctor may prescribe stronger anti-inflammatory medicines or inject a corticosteroid into the bursa.

    You may also see a physiotherapist or exercise physiologist who can recommend exercises to help your joints move more easily and prevent bursitis from occurring again.

    If your bursitis is caused by an infection, your doctor will prescribe antibiotics to treat the infection. In some cases, a needle is inserted into the bursa to remove the infected fluid. This may happen several times until the infection has cleared.

    If the bursitis was triggered by a particular form of overuse, it‘s important to avoid that activity or modify how you perform it. An occupational therapist or physiotherapist can help you find solutions to this problem.

    What can I do to control my symptoms?

    You can do many things to relieve your pain and inflammation.

    • Protect and rest the joint to help the bursa recover. Your doctor or physiotherapist will advise you on how to rest the joint and for how long. This could include using cushions or pads when sitting or kneeling for long periods, using a sling or walking stick, modifying your activities etc.
    • Ice packs can help soothe red, inflamed joints, and heat packs and rubs can relax tense, painful muscles.
    • Maintain a healthy weight to reduce the pressure and stress on weight-bearing joints such as hips and knees.
    • Continue to stay active as much as you can while following any instructions provided by your healthcare team to protect your bursa.
    • Your doctor, physiotherapist and/or occupational therapist can offer other suggestions and strategies to reduce your risk of developing bursitis again.

    Contact our free national Help Line

    Call our nurses if you have questions about managing your pain, musculoskeletal condition, treatment options, mental health issues, telehealth, or accessing services. They’re available weekdays between 9am-5pm on 1800 263 265; email (helpline@msk.org.au) or via Messenger.

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