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What is Arthritis?

An estimated 1 in 5 British Columbian adults has some form of arthritis, and many don’t even know it.

There are more than 100 different types of arthritis, a disease that affects people of all ages, from babies, prime of life, to older people. Contrary to popular belief, it is not a disease of the elderly; in fact, more than 3 in 5 people diagnosed with arthritis are under the age of 65. The disease affects all people, though some people — like women and Aboriginal Canadians — are more likely to get arthritis than others.

More than 5 million Canadians live with arthritis that falls into two major groups:

Osteoarthritis - Caused by a breakdown of cartilage in joints causing bones to rub together resulting in pain, stiffness and eventual loss of use. There are some forms of osteoarthritis that appear to be genetically driven, and others that are a result of injury, overuse or advanced age.

In British Columbia, approximately 615,000 people – or 1 in 7 – are living with osteoarthritis (OA). Within one generation (30 years) it is anticipated that 1 in 4 or 1.49 million British Columbians will be living with OA and one person in British Columbia will be diagnosed every 8.8 minutes.

Inflammatory arthritis - is a general term used to describe autoimmune forms of the disease. In inflammatory arthritis, the body's own immune system attacks healthy joints and tissues, causing inflammation and joint damage. Rheumatoid arthritis is the most common form of inflammatory arthritis. Other forms include ankylosing spondylitis, psoriatic arthritis, lupus and many others.

Unlike OA, rheumatoid arthritis (RA) can occur at any age. In 2010, approximately 40,000 people in British Columbia were living with RA. The prevalence of RA is expected to rise by 80 per cent by 2030. In 2040, more than 80,000 people– or 1 in 71 people in British Columbia – will be living with RA; one person in British Columbia will be diagnosed with RA every 2.6 hours.


Treatment Options

British Columbians living with arthritis have a variety of therapy options to treat their disease. Medication treatments can be divided into two categories: 1) those that control symptoms; and 2) those that control the disease itself. Non-medication treatments, such as healthy eating, exercise and physical therapy, should also be considered with your healthcare provider.

Medication Treatments

For many people living with arthritis, medications are a critical part of their treatment plan. While there are no known cures for arthritis, many effective treatments exist, especially for inflammatory forms of arthritis. These medications can, in some cases, actually stop the disease process that causes joint damage and disability. With the advent of new medication treatments, arthritis patients and their health care providers have an expanded range of options available to them when making decisions about a treatment plan.

Until the mid 1980s, arthritis treatment options (both medication and non-medication) were scarce. Often, doctors would take a slow approach to treatment, putting patients on pain-relievers like acetaminophen (Tylenol) or non-steroidal anti-inflammatory drugs (NSAIDs) for long periods of time before trying more aggressive treatments.

We now know that in many forms of inflammatory arthritis, there is a "window of opportunity" at the beginning of the disease process when appropriate treatment can actually stop the progression of the disease and prevent joint damage and disability.

Today, the approach to the treatment of arthritis, particularly for inflammatory arthritis, has changed. Instead of having patients struggle on a medication that simply provides pain relief, doctors, backed by scientific evidence, have started to treat patients early and aggressively, with the goal to reduce medications if the patient goes into remission.

Essentially, there are two categories of medications. It should be noted that the medications in the second category, those that treat the underlying disease process, are used only in some forms of inflammatory arthritis.

1

Medications to treat symptoms

  • non-steroidal anti-inflammatories ("NSAIDs") like naproxen (Naprosyn), diclofenac (Voltaren), celecoxib (Celebrex), ibuprofen (Motrin)
  • pain relievers, like acetaminophen (Tylenol)
  • steroids
  • opioids
2

Medications to treat the underlying disease

  • disease modifying anti-rheumatic drugs ("DMARDs") like methotrexate, sulfasalazine, hydroxychloroquine, leflunomide
  • biologics (“boDMARDs”), also known as biologic response modifiers
  • biosimilars (“bsDMARDs”)
  • targeted small molecules (“tsDMARDs”)

Medication Guides

Medication guides enable people living with arthritis to have a meaningful conversation with their rheumatologist and pharmacist about available therapy options and route of administration...

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Non-medication treatments:

In addition to medications, a well-rounded treatment plan for arthritis includes several important components. Taking control of your disease means making sure your body is as healthy and strong as possible. This means eating well, making sure you get enough of the right vitamins and minerals, maintaining a healthy body weight, quitting smoking, doing the right kinds of exercise, and making your home and work environments as supportive and accessible as possible.

  • Physiotherapy
  • Occupational therapy
  • Exercise
  • Diet and nutrition
  • Vitamins and minerals
  • Smoking cessation
  • Sleep and fatigue
  • Stress reduction

Resources

The ArthritisBC+Me portal provides a list of websites on a wide variety of arthritis topics. We have selected and evaluated these websites and apps, but cannot guarantee the function...

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FAQ

As a patient, care giver or healthcare professional, you may have questions about how to find help for people living with arthritis in BC. This FAQ section contains questions frequently asked by BC arthritis patients.

1   How do you recognize symptoms of arthritis?

There are more than 100 different types of arthritis and symptoms vary widely between each type. For example, primary symptoms range from pain, stiffness and swelling in joints for rheumatoid arthritis, to dryness of the eyes and mouth for Sjögren’s Syndrome, to spiking fevers and a faint, salmon coloured rash over certain areas of the body for adult-onset Stills disease.

For many types of arthritis, however, there are common signs (things your doctor can see, like a swollen joint) and symptoms (things patients feel, like fatigue, pain, etc.) that point the way towards a specific arthritis diagnosis. While these symptoms may differ among types of arthritis, there are several which are commonly associated with inflammatory arthritis and osteoarthritis. For a full list of disease-specific signs and symptoms, see disease spotlights here:

Arthritis Consumer Experts
http://jointhealth.org/aboutarthritis-diseasespotlights.cfm?locale=en-CA

The BC Lupus Society
http://www.bclupus.org

Canadian Spondylitis Association
http://www.spondylitis.ca

The Arthritis Society
http://arthritis.ca/understand-arthritis/types-of-arthritis

2   What do you do if you recognize symptoms of arthritis?

If you are experiencing symptoms such as joint stiffness and pain or fatigue, it is important to speak with your doctor about them. Early detection, diagnosis and treatment are vitally important when dealing with almost every type of arthritis. A correct diagnosis is the first step a person with arthritis can make towards taking control of their disease and taking action in building a treatment plan. Click here to access a system assessor:

ArthritisID

Arthritis Symptom Checker

3   How do you get a referral to an arthritis specialist?

If your family doctor suspects you have osteoarthritis, in all but serious cases, your osteoarthritis will be managed by your family doctor. The Osteoarthritis (OA) Tool  will be a helpful resource. The OA Tool has been developed for primary care providers who are managing patients with new or recurrent joint pain consistent with OA in the hip, knee or hand.

A rheumatologist is a doctor who specializes in treating arthritis. In British Columbia, a referral from a family doctor is required to see a rheumatologist.

Rheumatologists specialize in the management of inflammatory types of arthritis such as rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. These specialists have at least five years of additional training, on top of their regular medical schooling.

It can be challenging to get a referral from a family doctor to a rheumatologist. This may be because there are so many forms of arthritis, and general practitioners may not be familiar with many of the symptoms of the more than 100 different types of arthritis.

There are some things you can do to make it easier to get a referral to a rheumatologist. First, tell your doctor if you have the hallmark symptoms of inflammatory arthritis. These are:

  • Ongoing joint pain and swelling
  • Ongoing morning stiffness, lasting more than an hour after rising
  • Inability to continue daily work and living activities.

Also, tell your doctor about any history of inflammatory arthritis in your family, as some forms of the disease may have a genetic component.

Once your family doctor suspects inflammatory arthritis, he or she will need to write you a referral letter. This letter should include the following:

  • The suspected diagnosis of inflammatory arthritis.
  • A brief history and clinical findings. These may include morning stiffness, weight changes, fever patterns, and number and types of joints affected.
  • Copies of all reports, including MRIs, x-rays, and letters from any other specialists consulted.

If your family doctor suspects you have osteoarthritis, in all but serious cases, your osteoarthritis will be managed by your family doctor. The Osteoarthritis (OA) Tool will be a helpful resource. The OA Tool has been developed for primary care providers who are managing patients with new or recurrent joint pain consistent with OA in the hip, knee or hand.

4   How important are diet and nutrition in managing my arthritis?

What you eat can help you manage your arthritis or make your pain worse. Certain foods have been shown to provide some inflammation relief, strengthen bones and boost the immune system. The most important role diet and nutrition plays is helping attain or maintain ideal body weight, achieve good heart health, and promote or manage diabetes and osteoporosis. As a potential member of your healthcare team, a registered dietician can help you design and follow an “arthritis friendly” diet. You can find information about dietitian services in BC here: https://www.healthlinkbc.ca/dietitian-services

5   What lifestyle changes should I consider to help manage my arthritis?

Once arthritis is diagnosed, finding the right medication is often key. Once the right treatment has been identified and started, many people living with arthritis will often regain enough of their health to make lifestyle changes to reduce the pain and disability associated with their disease.

In addition to diet and nutrition, exercising at this point in a treatment program is crucial, as it helps to prevent weight-gain and muscle loss. Even moderate physical activity can help to improve health outcomes. Light cardiovascular and weight-bearing exercise, as well as low-impact water-aerobics are examples of exercises to help you regain fitness and keep your muscles toned to support healthy joints. Even periods of high intensity exercise can be beneficial as long as joints are protected and rest periods are included.

Studies show that smoking is one of the strongest environmental risk factors for developing rheumatoid arthritis. For those diagnosed with rheumatoid arthritis, smoking decreases the effectiveness of drugs prescribed to treat the disease and can be a barrier to engaging in activities that may relieve symptoms of rheumatoid arthritis, such as exercise.

6   Who provides arthritis programs and services in your community?

These are some of the services and service providers you might interact with to practice prevention and treatment strategies.

Publicly-funded arthritis treatment programs

The following are publicly-funded arthritis treatment programs that offer clinics and classes free of charge to help people with osteoarthritis and inflammatory arthritis manage their disease. All of these programs require a physician referral, so talk to your doctor if you would like to be referred:

Additional programs located in your community may be found on the Health Link BC website: www.Healthlinkbc.ca

Arthritis Consumer Experts

Arthritis Consumer Experts provides free, science-based information and education programs to people with arthritis. ACE serves people living with all forms of arthritis by helping them take control of their disease and improve their quality of life through education and empowerment.

Physiotherapy Association of British Columbia

The Physiotherapy Association of British Columbia “Find a Physio” tool allows the public to search for physiotherapists who are registered with the Association by name, location, clinic type, area of practice or keywords.

Self Management BC Program

The Self Management BC program offers a menu of self-management programs available throughout BC. Programs are for adults and there is no cost to attend.

The Arthritis Society

The Arthritis Society offers online self-learning resources and workshops on various topics related to arthritis. The Arthritis Society also operates an Arthritis Answers Line, offering toll-free telephone information, support, and assistance.

HealthLink BC

HealthLink BC provides access to non-emergency health information and advice in British Columbia. Information and advice is available by telephone, a website, a mobile app, and a collection of print resources, including the BC HealthGuide Handbook.

The Physical Activity Line (PAL) is now Physical Activity Services at HealthLink BC, where you can find physical activity information and tools.

HealthLink BC’s registered dietitians offer telephone, email and web-based based food and nutrition services to support the information, education and counselling needs of B.C. residents and health professionals.

QuitNow

QuitNow is the free, quit-smoking program of the Government of British Columbia, delivered by the BC Lung Association.

8   How can I donate to arthritis in BC?

Your donation is important to those affected by arthritis and to Canadian researchers who continue to look for a cure. Please go to these organizations to find out how you can support British Columbians living with arthritis:

Arthritis Research Canada

http://www.arthritisresearch.ca/donate

BC Lupus Society

https://www.canadahelps.org/services/wa/dnm/en/#/page/3848

Cassie + Friends

http://cassieandfriends.ca/support/make-a-donation/

The Arthritis Society

http://arthritis.ca/support-us