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Managing Arthritis
The panelists answering queries at the Q&A session.

Arthritis, which means joint inflammation, is an increasing common problem in Singapore due to an aging population and urban stressful lifestyle. There are more than 120 kinds of arthritis but the three most common ones are osteoarthritis, rheumatoid arthritis and gout. Following a popular Malay public forum on gout last year, Changi General Hospital organised another rheumatology forum, “Managing Arthritis” in English at the CGH Auditorium on 26 July 2003.

Osteoarthritis is the most common type of arthritis. It is caused by wear and tear due to excessive use over the years or to old injuries in affected joints. It usually affects people over 60 years old. Osteoarthritis mostly affects the large weight bearing joints like the knees, hips and spine, causing pain and stiffness which is worst at the end of the day.

Rheumatoid Arthritis is due to an abnormal reaction of the body’s immune system to the joints. It is most commonly seen in people between the ages of 40 and 60, especially in women. Small joints especially the wrists, hands and feet are affected. Later, other joints like the shoulders, elbows, hips, knees and ankles may also be involved. Pain, stiffness and swelling is worst in the morning.

Gout is a type of arthritis caused by uric acid. Uric acid is a waste product formed from the breakdown of an amino acid called purine. It is usually removed from the body by the kidneys. In gout, uric acid builds up and forms crystals which are deposited inside the joints. The base of the big toe is usually affected. It also affects other joints like the ankle, knee, wrist and fingers.

Arthritis affects about 15 per cent of the population in United States and United Kingdom. According to Prof Feng Pao Hsii, Chairman, National Arthritic Foundation, a local study was done at Whampoa housing estate involving 3505 people. Of those surveyed, nearly 6 per cent of respondents had significant aches and pains that lasted more than 6 weeks. “More females than males had joint complaints, and these joint symptoms also increase with age,” said Prof Feng.

10 Myths about Arthritis
  • Only old people have arthritis.
  • Arthritis is a single disease.
  • Arthritis is caused by cold, wet weather.
  • Certain diets can cause arthritis.
  • Arthritis is a minor physical inconvenience.
  • Patients with arthritis should rest as much as possible.
  • Glucosamine and chondroitin can cure arthritis.
  • There is no cure for arthritis.
  • There is nothing I can do about my arthritis.
  • Every day is the same for arthritic patients.

MANAGING ARTHRITIS WELL
– ROLE OF NUTRISUPPLEMENTS
Dr Yoon Kam Hon, Consultant Physician & Rheumatologist, CGH/Gleneagles Medical Centre
Mr Yoon Kam Hon

Arthritis can be treated using non-drug methods eg. patient education, dietary control, weight control, physiotherapy and programmed exercise. Doctors can also prescribe antiinflammatory drugs and disease modifying antirheumatic drugs. Steroid and hyaluronic acid joint injections may be used. For serious arthritic conditions, joint surgery or replacement may be necessary.

Nutritional supplements can be used as a complementary part of the overall treatment for arthritis, especially osteoarthritis. Generally, they have some effect on analgesic/pain relief, disease modification and are useful for osteoarthritis or damaged joints. Examples of nutritional supplements include Glucosamine, Chondriotin, Seatone and ginger extracts.

The body naturally produces glucosamine and uses it to form and repair cartilage. Glucosamine supplements, extracted from the shells of crabs, lobsters and shrimp, work by reducing inflammation and increasing the production of cartilage components. After 3 to 4 weeks, 50 to 60 per cent of patients see some improvement in joint pain and motion. A recent study in Europe found that patients who took 1,500mg of glucosamine sulfate every day for three years reported significantly less pain, less restriction of movement and less lost joint space, an indication of disease progression, than people who took placebos. Side effects of Glucosamine include abdominal pain and diarrhoea which occur in 6 to 12 per cent of patients.

Chondriotin is an extract of animal cartilage. It reduces inflammation and cartilage breakdown, and protects cartilage. 13 studies done in more than 300 patients. At least 50% of patients report improvement in pain and movement of joints. It can be used together with Glucosamine. Side effects of Glucosamine include abdominal discomfort and constipation in 10 per cent of patients.

EXERCISE AND ARTHRITIS
Mr Kelvin Wong, Physiotherapist

Contrary to the belief that exercise is bad for arthritic patients, exercise is good because it maintains muscle strength, reduces the stiffness in the affected joints by keeping the joints lubricated, improves pain tolerance and maintains the range of motion.

The following exercises are recommended for arthritic patients.
  Mr Kelvin Wong

Stretching Exercises

  • For all joints
  • Slow and sustained
  • No jerking movements

Gym Exercises

  • Free weights
  • Weights machine
  • Start with low loads first

Aerobic Exercises

  • 30 minutes (continuous)
  • 3 - 5 Times per Week
  • Low Impact Exercise eg. cycling, aerobics, swimming, brisk walking

HEALTHY EATING IN THE MANAGEMENT OF ARTHRITIS & GOUT
Ms Patsy Soh, Dietitian
Ms Patsy Soh

Avoiding cer tain foods completely or elimination diets are not encouraged as research has not shown conclusive results. Elimination diets do not help everyone and nutritional difficulties may arise. They can also be socially disruptive and become extreme if not properly supervised. Instead, take well balanced meals but bear in mind the following:

Rheumatoid Arthritis

  • Eat a variety of foods for a well-balanced diet.
  • Use a high calorie diet if the patient is malnourished.
  • Restrict saturated fats and sodium intake if hypercholesterolaemia and hypertension is present.
  • Include fatty fish such as salmon, tuna, herring, cod and mackerel.
  • Eat plenty of vegetables, fruits and wholegrain products.
  • Ensure adequate fluid intake.
  • During acute flare-ups, prepare simple meals.

Osteoarthritis

  • Lose weight if overweight or obese.
  • Limit intake of fat and refined carbohydrates.
  • Eat more folic acid rich vegetables such as spinach, bak choy, cabbage, cauliflower and legumes eg. black eye peas.
  • Eat fish more often instead of fatty meat/poultry.

Gout

  • Avoid foods high in purine eg. internal organs, ikan bilis, sardines, soya bean products, chicken essence, alcoholic drinks etc.
  • Limit consumption of foods with moderate levels of purine eg. meat, salmon, broccoli, spinach, dry lentils, peanuts, banana, to once or twice a week.
  • Eat a balanced diet. Avoid crash diets.
  • Drink plenty of water.
  • Reduce your weight if you are overweight.