Your Arthritis dot org

By
Alice Smellie

Last updated at 10:03 PM on 21st January 2012

Steve Hall, wearing his shoes, while carrying his son Matthew

They may look more like something a trendy teenager would wear, but a pair of custom-made, high-top trainers can offer patients relief from the crippling pain of knee arthritis.

There is no cure for the condition which accounts for one million GP appointments each year. Treatment traditionally involves painkillers, a knee replacement or other surgery. About 80,000 of these operations are carried out in the UK each year.

Osteoarthritis is damage to cartilage, the smooth surface that lines bones and allows joints to move easily. Why it happens is not fully understood but genetic predisposition and natural wear and tear are thought to  play a role. As the disease progresses, bony growths develop around the edge of the joints, causing pain and inflammation.

The trainers, known as AposTherapy, were
developed in Israel in 2004 and results of a pilot trial on 1,300
British patients were released last year. During the trial, 67 per cent
were able to reduce their need for painkillers, with 40 per cent no
longer needing any at all.

Physiotherapist Ed Butler explains: ‘The
trainers correct the way you walk, which takes pressure off the knee,
alleviating pain. You are engaging your core muscles and realigning the
body.’ As osteoarthritis progresses, the knee joint becomes more
unstable, and the muscles around it begin to be affected to compensate.

‘Sufferers often limp due to the hamstring muscles having tensed. As the condition takes hold, and before pain becomes too acute, the brain reacts and forces muscles to work in the wrong way,’ says Mr Butler.

Attached to the soles of the trainers – one at the front and one at the heel – are circular and convex Pertupods made of a rubber compound, which can be either soft or hard. ‘If someone feels a lot of pain when they put their feet down, we’d give them a softer one to lessen the impact,’ says Mr Butler.

‘For the more mobile, the harder ones make them more aware of how they are walking. The soles are like a wobble-board, forcing the wearer to balance and correct their posture.’

The Pertupods can be altered according to the patient’s therapeutic needs, determined by a physiotherapy assessment. The shoes are worn for everyday activities and no further exercises are needed.

‘People may wear them for a few hours a day initially,’ says Mr Butler. ‘As their gait is corrected, we encourage them to rely on them less.’

Three months after wearing the trainers he was nearly pain-free

One satisfied patient is Steve Hall,  49, a retired detective chief inspector who lives in Surrey with his wife Sarah, 44, a childminder, and their eight-year-old son Matthew.

‘I had a motorcycle accident at the age of 20 and broke my left tibia and fibula. In 2003 my knee started to swell up,’ he says.

Tests revealed he was suffering from osteoarthritis. ‘I was told I had the knee of a 70-year-old,’ he adds.

In 2004, Mr Hall underwent a tibial osteotomy, a surgical procedure that realigns the leg. ‘It improved things,’ he says. ‘But I was still in pain and I would have needed a knee replacement at some point.’

Three years ago he came across AposTherapy and was attracted to it because it was drug-free. Three months later, after wearing the trainers daily, he was almost pain-free.

‘I would put them on in the morning, go to work and wear them all day,’ he says. The result is that he now doesn’t need a knee replacement.

Independent clinical experts are optimistic about the treatment.

‘I have referred patients,’ says Dr Hasan Tahir, consultant physician in acute medicine and rheumatology at Whipps Cross University Hospital in London.

‘Addressing posture is an important part of the management of osteoarthritis.

‘But this is only part of the pro–cess. Losing weight is the first step and painkillers or steroid injections may still be needed.’

Three years later, Steve wears the trainers for a couple of hours a day for four or five days a week.

‘The best thing is that I can now referee my son’s football team,’ he says.

lFrom £2,100, apostherapy.co.uk. Treatment free for Bupa patients.

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Article source: http://www.dailymail.co.uk/health/article-2089947/The-wobble-board-trainers-beat-pain-knee-arthritis.html?ITO=1490

• Osteoarthritis usually develops in people aged 50 plus
• Abnormally short DNA sequences linked to painful joint disease

By
Sadie Whitelocks

Last updated at 1:33 PM on 16th January 2012

Scientists believe they are closer to pinpointing the exact cause of osteoarthritis, offering the hope of more effective treatment.

A team from the University of Southern Denmark found shortened ends of chromosomes, were linked to the onset of the degenerative disease.

Abnormally short chromosome caps, called telomeres, were seen in cells from damaged knee joints and those near the areas of severe damage were ‘ultra-short’.

Scientists believe they are closer to finding the exact cause of osteoarthritis

These latest findings show that that these lengths of DNA play an integral role in the development of the condition which leads to stiffness and pain in different joints – most commonly in the hands.

It is hoped that this will prompt more effective treatment for osteoarthritis (OA), the most common
form of arthritis, for which there is no cure.

Commenting on the findings lead researcher Dr Maria Harbo said: ‘We see both a reduced mean
telomere length and an increase in the number of cells with ultra-short
telomeres associated with increased severity of OA.’

Researchers studied telomere length in cells taken from the knees of three women with osteoarthritis.

They found that average telomere
length was shortened in the affected joints, and telomeres became
shorter near the areas of worst damage.

Biological ageing causes the gradual shortening of telomeres – DNA sequences which protect the ends of chromosomes – but a host of other factors can make them shorten
over time, including damage caused by oxygen
free radicals (oxidative stress).

Oxygen free radicals are the unstable molecules produced as a by-product of normal bodily processes, as well as external factors, such as tobacco, alcohol, and sunlight.

The shortening of telomeres is linked to reduced lifespan, heart disease and osteoarthritis and previous research has shown that preserving the length of these chromosomal ‘bookends’ can increase life expectancy.

People with very long life
spans have also been shown to possess longer telomeres.

On the other hand there is evidence that out-of-control telomere recovery may be linked to cancer.

The findings are published in the online journal Arthritis Research Therapy.

Each year more than 140,000 hip and knee replacement operations are performed on the NHS in England and Wales.

Osteoarthritis usually develops in people over 50 years of age and can be accelerated by previous injury or repetitive stress to joints.

There is no cure for the disease but there is a range of treatments to relieve discomfort.

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Article source: http://www.dailymail.co.uk/health/article-2087258/DNA-breakthrough-gives-vital-clue-cause-osteoarthritis.html?ITO=1490

Rheumatoid arthritis (RA) could be included in England’s Quality Outcome Framework (QOF). Arthritis Care has long campaigned for arthritis to be covered by the QOF to ensure the condition is prioritised and those living with it get the best outcomes from their healthcare service.

There are 20 potential new QOF indicators across nine areas currently being consulted on – RA is one of the areas being proposed. NICE is now consulting on whether to include RA and the five indicators they have chosen for the condition.

‘This is potentially great news for those living with RA in England,’ said Federico Moscogiuri, head of policy and campaigns at Arthritis Care. ‘Arthritis Care will be responding to the consultation to ensure we push for the most appropriate indicators to be included.’

Dr Fergus Macbeth, director of the Centre for Clinical Practice at NICE, said: ‘This consultation on potential new indicators is an integral part of NICE’s process for QOF. The final menu of indicators, to be published on the NICE website in August, will support healthcare professionals to deliver good quality patient care, based on the best available evidence.’

Introduced in 2004, the QOF is a voluntary incentive scheme for GP practices in England, rewarding them for how well they care for patients. Arthritis Care continues to campaign for osteoarthritis to be included in the QOF.

Article source: http://www.arthritiscare.org.uk/NewsRoom/Latestnewsstories/rheumatoid-arthritis-in-quality-outcome-framework-consultation

In a statement issued by the Board of Trustees on 22 September, the chair of Arthritis Care, Rosemary Blair, has announced that chief executive, Neil Betteridge, is moving on to pursue new career options.

‘Neil has brought enormous strengths to Arthritis Care over 11 years, for the past seven as chief executive. He has succeeded in raising the needs of people with arthritis up the political agenda at national and local levels and has built strong relationships with leading health professionals.

‘He has also provided great personal and professional knowledge and expertise to Arthritis Care. Under his leadership, Arthritis Care has become a leading and respected voice of people with arthritis and he leaves a legacy of policy change and service delivery that we will continue to build on. We will be very sad to see him go.

‘The Board join with me in expressing our warmest thanks to Neil and in wishing him every success in the future.

‘The Board will shortly start the search for a new chief executive to lead the organisation at a time of new challenges facing so many of us in the voluntary sector.’

Commenting on his move, Neil Betteridge said:

‘Having grown up with arthritis as a child, being chief executive of Arthritis Care has been a dream come true for me. But I believe that now is the right time for me to be seeking new opportunities at a personal level. It also means Arthritis Care can appoint a successor who will have time to develop and deliver the next long term strategy, as we approach the final year of the current plan.

‘I will miss the many people who make Arthritis Care unique. Our members, volunteers and other supporters are passionate about their work for Arthritis Care and, supported by our dedicated staff around the UK, they make a huge difference to people’s lives on a daily basis.

‘I wish my successor well and if I can offer any support to him or her, I would be happy to do so.’

Arthritis Care contacts

Alba Lewis, director of fundraising and communications AlbaL@arthritiscare.org.uk
Clare Mills, executive assistant  ClareM@arthritiscare.org.uk Tel: 020 7380 6558

Article source: http://www.arthritiscare.org.uk/NewsRoom/Latestnewsstories/arthritis-care-announces-departure-of-chief-executive

Arthritis Care has announced the appointment of Susie Parsons as interim chief executive. She takes over from Neil Betteridge, who resigned in September.

Susie Parsons said ‘Like all voluntary organisations, Arthritis Care is operating in a difficult funding climate and I am looking forward to working with the Trustees and staff to secure a sustainable future for the services and campaigns which are so tremendously important to people living with arthritis.’

Having spent all her working life in the public and voluntary sectors, including as chief executive of the Commission for Racial Equality, London Lighthouse and the National Campaign for Learning, Susie set up an interim management and consultancy business in 2005, specialising both in turning round organisations in difficulty and supporting successful ones to become even better.  She has served as Interim chief executive of the Refugee Arrivals Project, the Barrow Cadbury Trust and the Novas Scarman Group.

Article source: http://www.arthritiscare.org.uk/NewsRoom/Statementsandpressreleases/UXpW

Arthritis
Care has welcomed today’s publication of NICE’s preliminary guidance on the use
of tocilizumab (RoActemra) for rheumatoid arthritis.

Federico Moscogiuri, head of policy
campaigns, said: ‘The appraisal consultation document published today
recommends making tocilizumab more easily available to people with rheumatoid
arthritis. This is the first time that a drug other than an anti-TNF has been
recommended for second-line treatment of this often debilitating disease. 

Although it must be stressed that this guidance
is only preliminary, it represents a is a very encouraging development in terms
of improving treatment options for people with rheumatoid arthritis. Arthritis
Care will be preparing a full response to the consultation in due course, and
will continue calling for greater choice in treatment options for people with
all forms of arthritis.’

Should the NICE
recommendations become final guidance following consultation,
tocilizumab will become available for people with rheumatoid arthritis
following the use of
disease-modifying anti-rheumatic drugs (DMARDs), without having to
try rituximab first.

Anyone with questions about
arthritis can call Arthritis Care’s helplines free on 0808 800 4050 or
email Helplines@arthritiscare.org.uk 

Article source: http://www.arthritiscare.org.uk/NewsRoom/Latestnewsstories/G5Pp

Arthritis Care is today launching a consultation on the state of services for patients with rheumatoid arthritis in England.

The consultation, launched on World Arthritis Day is aimed at patients, clinicians and commissioners and seeks to assess the progress that has been made in improving services for patients with rheumatoid arthritis since the publication of the 2009 National Audit Office report Services for people with rheumatoid arthritis which outlined a number of concerns about the provision and quality of services for patients.

The consultation asks participants for feedback on the state of services in their area, the information and support available to patients and whether patients are getting access to the treatment and care they need to manage their condition.

Upon launching the consultation Federico Moscogiuri, Head of Policy and Public Affairs for Arthritis Care said: “Over two years since the National Audit Office published its findings into the state of services for people with rheumatoid arthritis, Arthritis Care remains concerned at the current quality of these services in England, particularly against the current backdrop of NHS ‘efficiency savings’. That is why this World Arthritis Day we are launching this survey with clinicians, commissioners and people with rheumatoid arthritis across England, to determine how services have changed over the past two years and get an understanding of where further progress is needed to improve services for people with rheumatoid arthritis. This survey will feed into our newly-launched ArthritisWatch project, which will gather evidence of changes and cuts to services for all people with arthritis in England. For too long musculoskeletal conditions such as rheumatoid arthritis have not been a priority for the NHS: we hope this initiative can help to change that.”

You are not obliged to answer any of the questions, but the more information you are able to provide, the stronger our evidence will be. We will not contact you and your answers will remain anonymous.

Survey for people with rheumatoid arthritis

Survey for doctors and comissioners

Article source: http://www.arthritiscare.org.uk/NewsRoom/Latestnewsstories/2011-quality-of-rheumatoid-arthritis-services-in-the-nhs-survey

Northern Ireland Executive’s Draft Programme for Government was revealed on November 17, and it included two important commitments which will make a difference for people with arthritis and for which Arthritis Care has been campaigning hard.

The two commitments are to provide better access to anti-TNF (biologic) treatments for people with severe rheumatoid arthritis and to ensure that people with long term conditions have access to self management training and other education, information and support programmes to help them manage their conditions effectively.

Arthritis Care has campaigned long and hard, with the active participation of members and others with arthritis, for better access to anti-TNF’s, which can be life transforming for people with severe RA, and which are much more readily available in other parts of the UK than in NI. The Programme for Government now pledges to ‘enhance access to life-enhancing drugs for conditions such as rheumatoid arthritis, cancer, inflammatory bowel disease and psoriasis…’. Minister for Health Edwin Poots MLA has said that he hopes to reduce the waiting time for access to anti TNF’s from 9 months to 3 months.

Arthritis Care has also pressed hard, though the Long Term Conditions Alliance Northern Ireland, for recognition of the value of the self management training and information work which the organisation and other groups in the Alliance carry out. The programme for Government now makes the commitment to make such training and information available for those who want it, and to work with stakeholders to secure appropriate support programmes to help people manage their long term condition effectively.

Steve McBride, Arthritis Care’s Policy Adviser for Scotland and Northern Ireland, said ‘These proposals are a big step forward, and will have real benefits for many people with arthritis. There is still work to be done in ensuring the full and effective implementation of these policies, but the Programme for Government pledges are a real success and everyone who has taken part in helping to bring them about can take real satisfaction in this very positive outcome.’

The full Programme for Govenment document can be read at:
http://www.northernireland.gov.uk/draft-pfg-2011-2015.pdf
The draft document is now open for consultation until February 22, 2012.

Article source: http://www.arthritiscare.org.uk/NewsRoom/Latestnewsstories/ni-executive-adopts-arthritis-care-goals

By
Roger Dobson

Last updated at 10:43 PM on 26th December 2011

The pain was innocuous enough at first, says Melanie Hutt.

‘It started with slight swellings in my ankles and knees, and a little pain occasionally,’ recalls the 31-year-old charity fundraiser from London.

‘I mentioned it to my GP, and was told that people have all sorts of aches and pains, and it was probably nothing to worry about.’

‘I was getting a lot of stiffness, especially in the morning, and it had spread to my toes, fingers and elbows,’ said Melanie Hutt

But as time went on, Melanie’s symptoms worsened.

‘I was getting a lot of stiffness, especially in the morning, and it had spread to my toes, fingers and elbows.’

Melanie had to live with this crippling pain for two years before a GP spotted it might be rheumatoid arthritis.

‘She referred me to a rheumatologist, and it was finally diagnosed,’ says  Melanie.

‘I was put on to an anti-inflammatory drug and had a general steroid injection for the pain. There were improvements straight away.’

Rheumatoid arthritis, in which the body’s immune system over-reacts, causing inflammation, heat, pain and swelling in the joints, affects more than half a million people in Britain, with women and the over-40s most at risk.

Yet according to leading arthritis charities, thousands of people may be living with the condition without knowing it, because both patients and GPs are ignorant of the symptoms.

Worryingly, they warn that if the condition is not treated within three months of the symptoms starting, patients are at risk of joint damage and long-term disability and pain.

Without prompt action, the chronic inflammation also increases the risk of other health problems, including heart disease.

As a result, patients with rheumatoid arthritis are at risk of dying five to ten years earlier than average.

A new survey by Arthritis Research UK and the National Rheumatoid Arthritis Society found that nearly six out of ten people had experienced some of the symptoms associated with rheumatoid arthritis.

However, many ignored them, with almost half assuming  pain, stiffness and swelling in the joints was a normal part of ageing, and a third putting it down to overdoing it in the gym or garden.

It’s not known what causes rheumatoid arthritis, although genetic susceptibility and environmental factors, such as a viral or bacterial infection may trigger it

‘There are too many people in the UK with the symptoms of inflammatory and rheumatoid arthritis who are not seeking treatment,’ says Professor Alan Silman, medical director at Arthritis Research UK.

‘The first 12 weeks of symptoms developing are critical — if arthritis is caught in this time and treated aggressively, there is less joint damage and reduced chance of long-term disability.’

It’s not known what causes rheumatoid arthritis, although genetic susceptibility and environmental factors, such as a viral or bacterial infection may trigger it.

Symptoms include stiffness first thing in the morning that lasts for at least an hour and swelling and pain in the affected joints which are usually warm and swollen.

Although it mostly develops in the wrists and knuckles, the knees and joints of the ball of the foot, shoulders and elbows are often affected as well. The condition is usually diagnosed with a blood test.

There is no cure, but there are a number of treatments, including painkillers and anti-rheumatic drugs, which slow down the progression of the disease and ease symptoms.

In some cases surgery, including joint replacements or synovectomy — removal of the lining of an inflamed joint — may be necessary.

However, drugs work properly only in 50 to 70 per cent of patients.

In an effort to overcome this problem, scientists have recently announced that they are developing a new treatment for the condition — a type of vaccine that ‘re-sets’ the immune system in rheumatoid arthritis sufferers so it doesn’t overreact.

This injectable treatment requires doctors to first take a blood sample from the patient. They then extract a type of white blood cell called dendritic cells — these form part of the immune system and their job is to switch other immune cells into ‘fight’ mode when the body is under attack.

For some reason, in rheumatoid arthritis these cells fire-up the immune system and it begins to mistakenly attack healthy tissue.

Scientists at the University of Queensland have found if they add an existing anti-inflammatory drug called Bay11-7082 to the dendritic cells before injecting them back into the body, it seems to stop the immune system from overreacting.

The results of a trial on 29 patients showed those with the worst symptoms had the greatest benefit.

Six months after receiving a jab, patients reported reduced pain and better mobility. Blood tests also revealed a significant drop in levels of inflammatory chemicals circulating in the body.

British experts believe this kind of therapy could be the key to controlling the disease in the future.

Arthritis Research UK spokesman Professor John Isaacs, who is carrying out similar research into rheumatoid arthritis vaccines at Newcastle University, said: ‘This area of research is all about trying to switch off the disease. If we can do that, it would be hugely significant. The research is in its early stages, but it looks very encouraging.’

But until these treatments become widely available, early diagnosis and treatment is vital, says consultant rheumatologist Dr Karim Raza, of Birmingham University.

‘Drugs like methotrexate, which control rheumatoid arthritis by suppressing the immune system response, work best if used early and can, in many patients, lead to ‘remission’ — a state where there is virtually no evidence of ongoing joint inflammation.’

He adds, ‘It takes, on average, six months from the onset of symptoms before a patient sees a rheumatologist.

‘Much of this is because patients delay seeing their GP. There are, of course, also cases where the delay is on the part of the healthcare system — for example, delays by GPs in referring patients to specialists.’

The charities behind the new survey have now launched a campaign to highlight the three key symptoms to look out for: early morning joint stiffness lasting more than 30 minutes; persistent swelling of one joint or more, especially hand joints; and pain when joints are squeezed.

For more information, visit arthritisresearchuk.org.

Additional reporting: PAT HAGAN.

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• Potential treatment proved successful in animal studies
• Could help tackle range of conditions including cancer

By
Sadie Whitelocks

Last updated at 11:55 AM on 26th December 2011

A simple vaccine could prevent the onset for autoimmune diseases such as rheumatoid arthritis and Chrohn’s

A simple vaccine could stop the onset of autoimmune diseases such as rheumatoid arthritis and Chrohn’s, say scientists.

The potential treatment has proved successful in animal studies and it is hoped the breakthrough could lead to new ways of tackling a range of conditions including cancer.

Autoimmune diseases occur when the immune system mistakes some parts of the body as a pathogen and starts attacking its own cells.

But the new vaccine, based on nanotechnology, stops this process without causing severe side effects.

Lead researcher Professor Irit Sagi, from the Weizmann
Institute in Rehovot, Israel, hailed the discovery and believes it could prompt more effective treatments.

He said: ‘We are excited not only by the
potential of this method to treat Crohn’s, but by the potential of using
this approach to explore novel treatments for many other diseases.’

Professor Sagi and his team treated mice with a rodent version of Crohn’s, which is a chronic condition that causes inflammation in the gut.

Results showed that untreated mice suffered severe damage
to their colons while those injected with the vaccine experienced only ‘limited’ symptoms.

Authors highlight in the journal Nature Medicine. that the new approach is
extremely precise, and more effective than previous attempts.

Yeda, the technology transfer arm of the
Weizmann Institute, has already applied for patents on the vaccine.

However further testing is now needed before experts can be sure the therapy is safe for humans.

Rheumatoid arthritis is estimated to affect 400,000 people in England and Wales while there are currently 90,000 people living with Crohn’s disease in the UK.

Currently there is no cure for either autoimmune disease and the exact trigger of the condition remains unknown.

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