NHS treatment

jooms

I find GPs have been of no help. Each and every can only suggest physiotherapy and harmful pain killing drugs.

Are there any GPs who actually have osteoarthritis? I think that those who have may have a better understanding of what patients are trying to explain as well as current research. I am fed up with the terms "wear and tear" and "progressive untreatable condition",

It is duty for physicians to keep knowledge updated and continuous referrals to outdated medical text books are of no use. Research indicates that Osteoarthritis is an autoimmune condition, perhaps even systemic, and the inflammatory response is the cause of cartilage catabolism.

Will whole joint replacement be necessary if there is earlier physiological intervention to stop progression and even reverse the condition ?

In more than 3 years of non treatment or ineffective treatment I observe nothing knew in NHS treatment of osteoarthritis.

Time to rethink osteoarthritis?

Mike1

GPs are GENERAL Practitioners who know a bit about everything that is why there are SPECIALISTS so in the first instance a referral to a Pain Clinic should be sought as they are the experts in pain and can refer to other Specialists such as Neurosurgeons and so forth. Osteoarthritis is not an autoimmune disease, and although the exact causes are not known, multiple risk factors have been identified. In a healthy joint, cartilage provides cushioning and a smooth joint surface for motion. In an osteoarthritic joint, as cartilage is irreversibly destroyed and bone abnormalities develop, movement becomes painful and more difficult. As for stopping progression or reversing the condition this is merely a pipe dream that has no bearing on fact, regrettably once you have OA you have OA!

Crookesey

If folk would start using their GP practice with an element of respect then it might just be able to return similar. No matter how many times GP practices ask their patients not to request say, Paracetamol on prescription, because of costs, and they carry on demanding them for free it is not surprising that staff can be less caring than they could be, if they had far less time wasters to deal with.

Well that’s my daily rant over, have a nice day guys. 😄

Mike1

I have tremendous respect for my GP, even though I may not like the way he deals with my conditions, and refer to him as “Sir” during the appointment. It takes 10 years to become a GP, a 5-year degree in medicine, recognised by the General Medical Council; a 2-year foundation course of general training; followed by a 3-year specialist training course in general practice. However, like every other qualification some people are better than others. In medical degrees there is no level of pass like in other degrees (i.e. 1.1, 2.1 etc) just either pass or fail; the surprising fact is that the pass mark is 50% and in other degrees generally 40%! 

General practitioners (GPs) treat all common medical conditions and refer patients to hospitals and other medical services for urgent and specialist treatment. They focus on the health of the whole person combining physical, psychological and social aspects of care based on their knowledge and experience. Remember though that the average GP appointment is only 10 minutes and with the best will in the World they can only diagnose on the basis of what the patient tells them and what they can see or determine through examination, therefore it is important to get the salient points over to the GP during the 10 minute appointment. Writing down how you feel, what your pain levels are like, what if anything affects your pain and so forth can be very useful. It is quite possible that you may have omitted something or the GP may have overlooked something bearing in mind the length of the appointment and the workload he/she has, in such cases it is perfectly acceptable to politely ask for a second opinion or a referral. If you are uncomfortable challenging your GP there is nothing wrong in making an appointment with a different GP for the same problem.  For some services, such as Physio or Podiatry, it is also possible to self-refer so it is worth checking out your own Health Authority's website.

jooms

Research suggests that progression of osteoarthritis ie cartilage catabolism is immunopathogenic ie an immune response.. Although described as innate immune response the fact that it progresses to cartilage degradation suggests that the immune response is disregulated and has become an auto immune disease.

The initial cause of joint damage is something else.

Reversing osteoarthritis. Research shows that by removing senescent cells the remaining chondrocytes can produce the ingredients for cartilage repair.

The focus on treatment should move away from the wear and tear explanations and mechanical replacements towards a physiological therapy that stops the inflammatory products progressing the damage.

helpline_team

Hi Jooms

Thank you for your message. I am sorry you are feeling let down by your GPs. We agree that it is very important that patients and GPs work in partnership using the latest evidence-based information to help manage arthritis.

It’s worth asking if there is a GP in the practice that takes an interest in arthritis and musculoskeletal (MSK) conditions.  We are keen to transform care for people with arthritis and any health care professional with an interest in improving MSK health can join our professional network. More than 5,000 GPs and primary care professionals have now participated in our core skills e-learning package.

Thanks for the comments from Mike1 and Crookesey. You may find the information here on the causes, treatments and help self-options for managing osteoarthritis helpful. I have also included a link about other types of arthritis.

Although there’s no cure for osteoarthritis yet, there are treatments that can provide relief from the symptoms and allow you to get on with your life. These include lifestyle changes, pain relief medications, physical therapies and supplements and complementary treatments.

You are very welcome to call us on our freephone helpline: 0800 5200 520 so you can talk things through with one of our helpline team. 

I hope this is helpful.

Best wishes

Mags

Helpline Team

https://www.versusarthritis.org/about-arthritis/conditions/osteoarthritis/

https://www.versusarthritis.org/about-arthritis/conditions/arthritis/

jooms

Thanks Mags for reply.

But nothing new.

I would be interested to know what Versus Arthritis thinks about the following.

"Human osteoarthritis is a systemic musculoskeletal disorder involving activation of innate and adaptive immune systems accompanied by inflammation exemplified by the elevated production of pro-inflammatory cytokines which play a significant role in the progression of the disease. The future of novel therapies for osteoarthritis should consider developing drug development strategies designed to inhibit pro-inflammatory cytokine-induced signal transduction. These strategies have been successful in the development of drugs for the treatment of rheumatoid arthritis."

Malemud CJ. Biologic basis of osteoarthritis: state of the evidence. Curr Opin Rheumatol. 2015;27(3):289-294.

It seems to me that there may be a danger that any exercise that causes joint pain promotes inflammation and further degradation of cartilage of cartilage.

There are several other research studies that explain the disease much better than the outdated "wear and tear" explanation.

Possibly now is the time to consider the systemic and auto-immune effects of the disease ?

helpline_team

Hi Jooms

I have passed your query on to our health information team. I will get back to you with a response as soon as possible. This may take a few days.

Best wishes

Mags

Helpline Team

helpline_team

Hi Jooms

Our health information and research liaison teams have come back to me with the following information:

The phrase 'wear and tear' is now generally accepted as outdated. ‘Wear and repair’ is a more accurate term. Recent research has shown that there is a range of factors contributing to the development of the osteoarthritis. Some of these causes are listed on the NHS website https://www.nhs.uk/conditions/osteoarthritis/.

Our Centre for Osteogenesis Pathogenesis was set up to better understand these causes and improve diagnosis and treatment. There is currently no strong evidence to suggest osteoarthritis is an autoimmune condition.

There is increasing evidence that inflammation plays a role in the onset and progression of osteoarthritis. We are funding research to further explore this, including trying to identify biomarkers of inflammation in the blood that may contribute to later OA development. Our research is also looking to target the molecules involved in inflammation to develop new treatments for osteoarthritis.

We are also funding research to explore the connection between exercise, inflammation and osteoarthritis. The general consensus of the research in this area is that there is no clear link between exercise and worsening symptoms of osteoarthritis. Indeed, exercise is one of the best things you can do to improve your symptoms of arthritis, and can provide addition benefits for both physical and mental health.

Last week Dr Benjamin Ellis, Consultant Rheumatologist and Clinical Policy Advisor at Versus Arthritis co-hosted an exercise & arthritis Q & A session. You can find it here:

https://www.facebook.com/VersusArthritis/videos/2633127477003751

I hope this helps.

Best wishes

Mags

Helpline Team

jooms

Thank you for reply Mags

Pleased that there is a realization (among some) that the vague term "wear and tear" is outdated and uninformative. The fact that many in NHS still use it suggests that their knowledge of the illness should be updated. We need to advance rather than sticking with old ideas and practices.

The new term "wear and repair" is perhaps a misnomer since the current NHS treatment, for osteoarthritis at least, is not repair but, instead, replace or pain alleviation. I am not totally persuaded by NHS descriptions and explanations knowing its very conservative views and financial limitations to implementing new ideas and practices.

On the subject of osteoarthritis being an auto immune disease is perhaps symantic. Research indicates that while the immune system might not the initiator it is the innate immunity that progresses the disease through cartilage catabolic proinflammatory products.

So very pleased that versusarthritis funding research into identifying proinflammatory biomarkers because the theory being that blocking this specific immune response might allow the chondrocytes to repair the cartilage. Hopefully osteoarthritis treatment will actually become repair and not replace. The focus for treatment has to be on reversal of the immunopathogenesis of the disease regardless of whether we categorise the biological process as auto immunity, innate immunity, adaptive immunity, etc.

On exercise:

Metadata research (mostly knee osteoarthritis) shows only moderate short-term improvement from exercise. Undoubtedly good for muscle strength, cardiovascular system, and possibly mental health it is research that is full of subjective variables that seems to have made conclusions 'scientific' through statistics. Studies did not seem to measure over time radiographic changes in joints or pro-inflammatory markers but rather on patient physical performance which could be effected by many factors and could, therefore, be subjective

On a personal note my knee osteoarthritis presented unexpectedly and suddenly ( 1 day) while exercising (walking) and it now takes only a small amount of walking (even standing) to cause a great degree of pain. If pain is a symptom of inflammation then one has to ask what degree of damage is being caused on the joint for the sake of exercising the cardiovascular and musculoskeletal system?

If exercise is supposed to help then perhaps it needs to be more patient-specific or is any exercise better than none?

If normal treatment for a swollen non arthritic joint is rest it seems logical to assume that exercise might not be giving the joint sufficient opportunity to repair itself and might even be causing low-grade and damaging inflammation?

helpline_team

Hi Jooms

I'm glad you've found our team's previous answers helpful. We'd suggest you explore your further questions with someone medically qualified such as a physiotherapist.

Best wishes

Guy Helpline Team

Ellandrhia

Please help,

I have severe arthritis in my left hip and both knees and x-rays have shown that I need joint replacement surgery. However, on seeing my consultant I was told that my BMI was too high and that he would not do any surgery unless I lost weight. I have been large my whole life and it is almost impossible for me to lose such a large amount of weight when I am unable to walk. The health authority have put a BMI restriction of 25 which is very low and I know I can never reach this goal. I know that there are health authorities out there that do joint replacements without weight restrictions, do you know how I can find this out. At the moment I am crawling to the bathroom and spend all day in a chair so any help would be greatly appreciated,

Elaine

helpline_team

Hi Elaine

Thank you for posting on the forum, we have sent a reply to your other post (BMI restrictions).

Best wishes

Lynda

Helpline team