A wave of the hand, a turn of the head, a bend of the knees: simple, everyday actions, and yet a source of agony for the millions of Canadians who experience joint disorders. Some suffer in silence, others complain to a spouse or a good friend, but most don’t seek medical attention until the pain and discomfort become too much to bear.
“Joint pain gets trivialized because it’s so common,” says Dr. Zoë Hayes, a retired St. Francis Xavier University psychology professor, and president of the Arthritis Society’s Antigonish, NS, branch. “People have the attitude that there’s no point in seeing a doctor because there’s nothing that can be done.”
After suffering from joint pain for 35 years, Hayes finally fought back about eight years ago by losing 50 pounds and becoming involved in an aquatic exercise program, first as a participant and then as a teacher. Three joint replacements later—two for her knees and one for a hip—Hayes continues to teach aquafit classes and is a strong advocate for physical activity as a treatment for joint pain.
“You can’t just sit in a rocking chair,” she says. “You have to keep moving or you stiffen up.”
Joint disorders may arise from congenital problems, trauma or infection, but according to Melanie Nolan, communications coordinator for the Arthritis Society in Atlantic Canada, the main culprit is usually arthritis. Although often perceived as one specific illness, arthritis is actually a broad category that comprises more than 100 different conditions, and ranges from mild forms of bursitis (inflammation of the fluid-filled sac that lies between a tendon and skin, or between a tendon and bone) to debilitating inflammatory diseases such as rheumatoid arthritis and lupus.
“Arthritis comes from the Greek words arthro, meaning joint, and itis, meaning inflammation,” says Dr. Evelyn Sutton, a professor at Dalhousie University’s medical school and director of the Arthritis Centre of Nova Scotia.
The most prevalent type of arthritis is osteoarthritis (OA), a progressive disease that affects more than four million Canadians, about 180,000 of them in Nova Scotia—the province with the highest incidence in the country. Commonly targeting the hands, hips, feet, knees and spine, OA breaks down the shock-absorbing cartilage that cushions our joints. As well, it dries out our synovial fluid, a natural joint lubricant that keeps things moving. Pain is intermittent at the onset, but worsens over time, gradually limiting the range of motion in joints and sometimes resulting in permanent disability.
Although it can strike at any time, OA usually occurs after the age of 45, with the highest incidence in individuals over the age of 65. The odds may seem stacked against seniors, but the good news is that OA is not inevitable. “The risk for osteoarthritis increases with age,” says Dr. Sutton, “but normal aging is not synonymous with arthritis.”
According to Christine James, former executive director of the Nova Scotia Physiotherapy Association, the loss of cartilage and stiffening of joints, often attributed to age, may be related to factors such as obesity, repetitive strain injuries, bad posture, physical inactivity, degenerative diseases and wear and tear from participating in sports without proper stretching or conditioning.
Relief from symptoms
Once arthritis sets in, there is no cure, but there is relief from the symptoms. Current treatment options include physical therapy to strengthen the muscles that support the joints, weight reduction to minimize the load we place on them, and complementary therapies like acupuncture and massage therapy. Pain management ranges from non-prescription painkillers and anti-inflammatories to prescription medications that alleviate more severe symptoms.
Surgical options include arthroplasty (the rebuilding of joints by resurfacing or relining the ends of bones when cartilage has worn away and bone has been destroyed; the term also refers to total joint replacement); arthroscopy (in which a very thin tube with a light is used to see directly into the joint through a small incision in the skin—this allows the physician to see how much damage there is, and to treat what may be causing pain); resection (the removal of part or all of a bone) and arthrodesis (the two bones forming a joint are joined together so that the resulting fused joint loses flexibility—usually done to relieve pain).
The really good news is that it’s never too late to take positive action, and Zoë Hayes, quite literally, is walking proof of that. Losing weight in preparation for knee surgery was just the kick-start she needed to change the course of her osteoarthritis. “I was at the point where I couldn’t walk across campus anymore,” she recalls. “I couldn’t stand in front of my class. I had to sit on my desk while I taught.
“It’s unwise to ignore joint pain,” she continues. “Forty years ago, I was told that I had osteoarthritis and advised to take two aspirins, four times a day. Then, two years ago, my orthopedic surgeon recommended a rheumatologist who told me that I have an inflammatory form of osteoarthritis, which explains the involvement of so many joints.”
A prescription medication helped for a while, but Hayes had an adverse reaction and had to stop taking it. “There’s nothing else that’s available at this time,” she says, “and progress is slow.”
Still, at 79, Hayes remains hopeful that something can be done for those who suffer from arthritis. Even if it gets more difficult to do so, she’ll do everything she can to manage her own condition and to help others manage theirs. “I don’t intend to stop,” she says determinedly. “I can’t.”
Rheumatoid arthritis (RA)
A form of autoimmune inflammatory arthritis, RA targets about one per cent of Canadians, and while it touches all age groups, onset is usually between the ages of 25 and 50; women are affected two to three times more frequently than men. Symptoms include unusual tiredness and stiffness that lasts for longer than 30 minutes each morning and the loss of movement in the affected joints.
There is no cure for RA, but early recognition and intervention improves the chances of controlling the disease, and can often prevent severe joint damage and disability.
Risk factors for developing osteoarthritis
- Advancing age
- Family history of osteoarthritis
- Sports and work-related injuries to the joints
- Excess body weight or obesity
- Having other forms of arthritis
Symptoms of osteoarthritis
- Pain and stiffness in the joints—typically the knees, hips, hands and spine
- Less than 30 minutes of joint stiffness after periods of inactivity
- Swelling of joints
- Enlarged finger joints
- Loss of joint flexibility
Arthritis Society: Provides arthritis education and information, patient care and support, and funding for arthritis research. Offers the Arthritis Self-Management Pain Program and the Lifestyle Makeover Challenge.
Just Diagnosed Toolkit: A guide from the Arthritis Society to understanding and managing arthritis. The “Types of Arthritis” section has fact sheets for the most common forms of the disease. Tips also cover topics such as living well, dealing with emotions, communicating your needs, managing daily activities and exercising. Go to arthritis.ca and click on the “newly diagnosed” link, then select “Just Diagnosed Toolkit.”
My Joint Replacement: A website developed to support the thousands of Canadians who undergo joint replacement surgery, 90 per cent of whom have joint damage caused by arthritis. Videos, photos, articles and checklists provide a comprehensive guide that covers everything from the pre-operative visit and subsequent surgery to recovery and rehabilitation. myjointreplacement.ca.
Joints In Motion: Offers participants the opportunity to take part in marathons, half marathons or 10 kilometre races, or multi-day trek and cycling events around the world—all to raise funds and awareness about arthritis.
Canadian Physiotherapists Association: Offers advice about what to look for in a physiotherapist; provides help with finding a physiotherapist in your area. thesehands.ca.
Arthritis Consumer Experts: Provides current, research-based information about all aspects of arthritis and encourages empowerment through education. jointhealth.org.
ArthritisID: A free smartphone app that offers current, evidence-based information to help detect, treat and manage arthritis. arthritisiscured.org.