Arthritis in older people
Dr Huw Beynon, consultant physician and rheumatologist
It was comedian George Burns who said: “You can’t help getting older, but you don’t have to get old.” As a rheumatologist, I’d agree: it’s not necessarily your chronological age, but your biological age that matters. Arthritis, which is an inflammation of the joints, can be caused by around 100 disorders. Not all of them are associated with advancing age, but some are, including the most common joint problem, osteoarthritis.
Eight million people in the UK are affected by osteoarthritis, which causes pain and decreased mobility. It is a wear and tear disorder of the major joints including the hips, knees, spine and fingers. The most commonly affected joint is the hip. If you perform X-rays on people over 65, you’ll find around 1 in 20 has evidence of wear and tear in their hip joint and it’s a significant cause of disability in older people. The second most common problem area is the knee, and the fingers and thumb joints are often affected too, making it painful and difficult to do simple household tasks.
So, how likely are you to develop osteoarthritis? As it’s caused by wear and tear, as the cartilage between the joints is worn away, your risks do increase the older you get. But we also know that there’s a genetic predisposition, with the condition often running in families. Weight is a factor in osteoarthritis of the knees and, interestingly, the fingers, but not the hips. It’s more common if you’ve damaged the joints in certain sports and there’s also a link with jobs involving a great deal of heavy lifting or prolonged standing.
Once you’ve developed osteoarthritis it’s not necessarily always downhill. Some patients can see an improvement while others might remain stable for years. But in a substantial number of cases, the joints will deteriorate to the point at which orthopaedic surgery becomes the best option. For the right patient - with the right surgeon - surgery can give fantastic results.
But for some with osteoarthritis, pain relief is the immediate priority and there are a number of options, including analgesics, such as paracetamol and codeine, and non-steroidal anti-inflammatories. Some people find capsaicin, which comes from chill peppers, helps. Others find relief in heat, but they need to be careful not to cause serious damage to the skin or blood vessels by, for example, sitting too close to a fire for hours on end. There is also a wide range of preventative remedies on the market such as glucosamine. For most, there’s no evidence that they work - but some people swear by them and as they do no harm I’m happy for patients to take them. There is evidence, however, that taking regular doses of vitamin D is important, especially in London, where in the winter 70% of people are vitamin-D deficient, potentially causing muscle and joint pain. There is no ‘wonder drug’ on the market for osteoarthritis. Great claims have been made for some which have offered short-term improvements in pain levels, only for them to turn out to destroy the joints.
Other causes of arthritis, though, can be successfully controlled with drugs. Rheumatoid arthritis, an inflammatory arthritis, can affect any organ of the body, although the joints take the main hit. With early diagnosis and treatment, drugs can “turn the disease off”, preventing destruction of the joints. There are also successful treatments which can be used in another big cause of arthritis among older people - gout. It’s a condition often associated with over-indulgence, and although you don’t have to be a big eater or drinker too get gout, if you are predisposed to it, cutting down on red meat or beer and spirits will reduce your chances of an attack. There are also effective drugs both to tackle acute attacks and to keep it at bay in the longer term.
For older people, one of the biggest risks to their health are falls, especially as many are more vulnerable to fractures because of osteoporosis (lower bone density). Every year, about one-third of over 65-year-olds and more than half of over-80-year-olds fall. Falls are the leading cause of injury and death for older people. That’s why it’s so important to keep your fitness up in later life. The fitter you are, the stronger your muscles are and the less likely you are to fall and so the less likely you are to develop fractures. And more widely, that’s the message for so many of the conditions that cause arthritis. Keeping your weight down, staying fit and taking exercise to build muscle tone really help, taking the pressure off the joints and helping to prevent further decline. You’re never too old or too infirm to take some sort of exercise and it really is a positive way forward to help you stop getting “old” as you get older.
Arthritis: what it is and who’s affected
• Arthritis refers to an inflammation of the joints and can be caused by some 100 different diseases
• The commonest include osteoarthritis or wear and tear arthritis, inflammatory arthritis, like rheumatoid arthritis or arthritis associated with psoriasis; and crystal-induced arthritis such as gout (caused by uric acid deposits) and pseudo-gout (caused by calcium pyrophosphate deposits)
• Osteoarthritis causes joint pain, stiffness and decreased mobility and is more common in older age.
• Rheumatoid arthritis is most often diagnosed between the ages of 30 and 40 but can affect any age.
• Gout most often begins in men aged between 40 and 50 and women older than 60.