It's natural to have questions about your arthritis, whether you are newly diagnosed or an old-timer. Here are common ones
Arthritis UK says that there isn’t a single answer to the question ‘what causes arthritis?’, as there are many different forms of arthritis to be considered. Most types of arthritis are caused by several factors acting together. You may be naturally more likely to develop certain disorders as a result of your genetic make-up.
External factors may increase the risk further if you’re susceptible to a condition. These include environmental factors such as a previous injury, infection, smoking or doing an occupation which is very physically demanding. There’s also a major element of chance.
Many forms of arthritis run in families to a degree, and some conditions have a stronger tendency to be passed on through genes.
Arthritis can start suddenly without any obvious cause, and at any age. Sometimes something in your lifestyle or medical history – or a combination of these – could be responsible.
For example, if you have a physically demanding job you may be at greater risk of developing osteoarthritis, particularly if the job involves heavy repetitive activity. Also, a previous injury can increase the likelihood of osteoarthritis.
Infections can cause short-lived arthritis. One theory about the cause of rheumatoid arthritis is that it may be triggered by infections, but there’s no direct evidence for this.
We do know that rheumatoid arthritis is more common and can be more severe in people who smoke. For some people, stopping smoking might reduce the risk of developing arthritis in the future. If you’d like to stop smoking talk to your doctor, who can give you advice and information to help you quit.
Some foods may appear to make your arthritis worse, but diet and food intolerance are unlikely to cause long-term arthritis.
Research is ongoing.
It’s very hard to say how long you will be on treatment for because it depends on the kind of arthritis you have and how you respond to the treatment you’re given.
It’s safest to think in terms of years rather than months, though, because your treatment is doing at least two vital jobs; easing symptoms (for example, the pain) and tackling the cause of the symptoms (for example, inflammation), and that can take time to get right.
Advanced Rheumatology Nurse Practitioner Andrea McBride says: “We now understand that treatment isn’t just about relieving symptoms, but about gaining effective control of the cause to help protect joints in the long-term.”
It’s unlikely. Professor Helen Foster, consultant paediatric rheumatologist at the Newcastle upon Tyne Hospitals NHS Foundation Trust, says: “The answer is it might be, but the chances are very low.”
For the majority of medicines used it is essential that women don’t get pregnant, and for men taking methotrexate, leflunomide and biologics it’s vital they don’t get anybody pregnant. This is because some medicines can cause changes to the developing cells of a new baby, possibly leading to deformity, and in some circumstances may lead to miscarriage.
But, this doesn’t mean that you can’t get pregnant if you want to. You can! You just need to discuss your plans with your consultant and together create a plan for managing or temporarily withdrawing your medication for a period of time before getting pregnant, during a pregnancy, and once baby is born, especially if you choose to breastfeed.
Before you start any course of medicines your rheumatology team will advise on the importance of not getting pregnant, or getting anybody pregnant, unless planned. If you are sexually active, it is vital that you are using contraception.
For women, there are 13 different types of contraception available, including the contraceptive pill, patches, implants, injections and the intrauterine device (IUD, formerly known as a coil). A pill will depend on you remembering to take it, while the other methods do not depend on you remembering, which may prove beneficial.
For men, it is advisable that you always have a supply of condoms, in case you find yourself with a new partner who is not using an alternative method of contraception. For women having a condom in your handbag may also be helpful for any unexpected moments if you have not planned ahead.
FPA, a charity which promotes sexual health, provides a very useful guide to the 15 types of contraception available to men and women, the advantages and disadvantages of each method, and a tool to help you choose which might be the best method for you.
Younger readers may be interested to know that you don’t need parental permission to take contraception, and your GP is bound by confidentiality, so can not reveal to your parents, or anybody else, that you are using contraception. If you prefer not to go to your GP there are lots of drop-in sessions at family planning clinics. You don’t have to be planning a family or even currently in a relationship to visit a family planning clinic to seek help.
Most young people with arthritis don’t have a problem with fertility. However, Sulfasalazine can cause a fall in sperm count, and so can lead to a temporary decrease in male fertility, but this can be reversed if treatment is stopped. Read more
Methotrexate can also reduce fertility while you are taking it. Read more
You will be advised not to become pregnant or father a child if you’re taking certain drugs, like methotrexate or biological therapies, as they can affect your chances of a healthy pregnancy.
If you’ve taken these drugs in the past, that won’t stop you from being able to have a child, though doctors are likely to advise that you don’t try for a pregnancy until six months after stopping these medicines. Speak to your GP, Nurse Specialist or Consultant Rheumatologist.
Many people with childhood arthritis will find that their symptoms go into remission as they grow older. However, in around a third of cases, arthritis can remain active into adult life and will be managed with treatment, and in rarer cases, surgery.
If your arthritis remains active into adult life, the truth is that your future will have lots of good times, when you’re barely aware of your symptoms, and some less fun times too, when you’re symptoms are painful and get in the way of day-to-day life. Sometimes every single day will be different.
But know two things; you will have a team of professionals to lean on for support, and you will always be more than your arthritis. The world is still your oyster.
Alcohol intake may need to be limited depending on the type, or combination of medicines you are taking. And, as the combination of medicines and alcohol may harm your liver, the safest advice is to seek advice on safe unit levels for you specifically. It’s not a ‘one size fits all’ scenario.
Your doctor can give individual guidance as to how many units of alcohol may be suitable for your individual circumstances per week, though this can’t be splurged on just one event (binge drinking gets messy). This is especially important if you’re taking methotrexate or leflunomide because of the possibility of an increased risk of liver damage with this drug. But, the same advice can apply for other medicines, not just methotrexate.
For those on weekly methotrexate, if you are a “weekend social animal” take it midweek, rather than at the weekend, to keep the medicine and alcohol as far apart as possible. And being conscientious with your regular blood tests can also be a sensible precaution. Your GP is responsible for checking the results regularly and can reassure you that your liver function is within the safe zone, and if not help is at hand.
If complications should arise because of excessive alcohol consumption it may be a medical decision to temporarily stop your medicines to allow your liver to recover. But remember, a break in positive treatment may be enough to lose good control of your arthritis.
You may think that limiting your alcohol intake will limit your social life, but often the reality is the opposite. If you are able to stay on your prescribed treatment without complications, you get greater control of your arthritis. Greater control means fewer flares, fewer tired days, less pain and less restriction. This will lead to happier, more active days and nights all round, making the lack of booze a small price to pay.
Read the latest NHS guidelines for all adults here.
Don’t forget to look at our Apps Hub to find ways to keep track of your drinking.
Side effects vary depending on which drugs you are taking, and can also vary from person to person.
For more information on specific side effects for drugs ask your Consultant, GP or Pharmacist. Or, go to Arthritis Research UK.
The vast majority of young people with arthritis don’t need a wheelchair. If you keep on track with taking your medicines to give the best chance for your disease to be well controlled, it’s very likely you’ll never need one.
In a few cases, the arthritis is so severe that, through no fault of your own, you will need a wheelchair to get around. But this only happens rarely, and often only for limited periods at a time.
With current research and knowledge scientists and medics are far more knowledgeable and sophisticated about how they get the best from the medication to give you the very best chance to continue with an active, productive and positive life.
In a few cases finding what works best may prove a little tricky. On rare occasions this may mean that using a wheelchair briefly may actually be a positive move, to give a bit more freedom and independence on sore days. As symptoms settle your usual physical activity will once again be actively encouraged.
Of course you can. You might think you’re “different”, but, well, everyone’s different in some way. Just try out online dating if you don’t believe us!
It’s not easy to discuss these issues sometimes, but try to talk to your rheumatology nurse if you have any emotional or physical concerns – they will have heard it all before. Or, if a face to face chat isn’t your thing, you could write a letter. Just remember, you won’t be the first person to ask that question, or the last!
You might have practical worries about how joint pain will affect your love life – but there is advice available about comfortable positions to use during sex, for example.
You can find some useful advice here.
Many people with arthritis are able to have the career they want, and many employers are understanding and supportive if you need adjustments in the workplace or time off for appointments.
There is plenty of help out there for you to find work and stay in work, not least at all from the Government, which is desperate for you to get a job! Read our Workplace Survival Guide.
Occupational Therapists, careers advisers and your medical team can all help you, too.