How to weather aches and pains: managing arthritis during the winter months

The idea that the change in temperature can have an effect on people with long-term arthritis issues – and its subsequent side-effects, such as joints supposedly aching before a storm and exacerbated symptoms when the barometer falls – have frequently been dismissed as old wives tales by the scientific community, with numerous studies devoted to the subject coming up short with a solution.

But a recent study indicates that there could be something in it after all, which could lead to a weather change in the way we treat the problem.

A study conducted in Holland in 2014 was one of the first to indicate that there may be a link between the weather and increased pain in arthritis sufferers. After tracking the pain levels of osteoarthritis patients over two years, they went through the daily weather records of that period – and discovered that pain and stiffness levels tended to rise slightly (my emphasis) when humidity and pressure level rose.

Although the Dutch researchers went to great pains to hedge their bets, claiming the changes were too small to be considered ‘clinically relevant’, it was a very rare concession to what certain sufferers had been claiming all along.

A storm in a kneecap?

Another European study conducted recently to evaluate the connection between joint pain and temperature and barometric pressure (which occurs before and after a storm) has backed the Dutch claims up, to an extent: it tentatively suggested that hypersensitive stretch receptors in the affected ligaments could respond to a change in atmospheric pressure.

Of course, the bad weather-increased arthritis connection could simply be down to the power of suggestion: if you’re conditioned to believe that you’re about to feel something due to something beyond your control, you’re more inclined to become oversensitive about the part of the body you expect to become afflicted.

And it’s a fact of life that when winter approaches, a lot of people become less active and more lax in their diets, which can often be the real culprit for an increase in joint pain. So here’s a checklist of things you can do to keep yourself as pain-free as possible over the winter season:

Keep warm: Layers are your best friend in winter, as you can easily and smoothly regulate your own body temperature without veering from one extreme to another.

Keep hydrating: According to recent studies, even mild dehydration can lead to an increase in pain sensitivity. Don’t skip the fluids.

Keep up the diet: While we tend to hanker for comfort foods at this time of year, it’s a solid fact that an improved diet and the subsequent weight loss leads to a significant improvement in pain management for arthritis sufferers.

Get walking: Although the park isn’t as welcoming at this time of year as it is in the other seasons (and can be dangerous, due to frost, snow and ice), it still pays to be active.

Take vitamin D supplements: In times of decreased sunlight, you could be falling short of an element that can keep osteoarthritis at bay.

In short, you can’t change the weather, but you can change the way you deal with it.

New study links early menopause with higher fracture risk

Disheartening news for women under 40 who have experienced onset of menopause: according to a recent study by the North American Menopause Society, the idea that calcium and vitamin D supplements can fend off their heightened risk of fracture has been debunked.

The study, which evaluated data on nearly 22,000 women under 40 with menopausal symptoms, had significantly higher risks for fracture when compared with menopausal women in their 40s and 50s – even when those women take the aforementioned supplements.

How the menopause affects joint pain

Joint pain may not be seen as one of the main symptoms of the menopause – it usually gets elbowed out of the way by the earlier symptoms such as irregular periods and hot flushes. But by the time a woman’s oestrogen level starts to drop to a sufficient level, the problems begin to start for your joints, as it’s commonly believed that oestrogen plays a key role in minimising swelling around them.

The other role oestrogen plays in joint maintenance is to regulate fluid levels in the body – including reducing the build-up of uric acid, which can cause inflammation of the joints. When the levels of oestrogen subside, the levels of uric acid increase.

How calcium and Vitamin D can help

Most importantly, a decrease in oestrogen leads to an increase in bone loss. In most cases, we reach peak bone mass between 25 and 30, but the earlier the drop in oestrogen production occurs, the sooner the bone structure is put under the risk of deterioration – and one thing that can but the brakes on that deterioration is an adequate calcium intake.

Vitamin D has long been seen as a cure-all for a range of mid-life symptoms. A fat-soluble vitamin that aids in the absorption of phosphorus and calcium from the intestine and helps to build and maintain bone mass, it also plays a key role in the reduction of inflammation. The jury is still out as to how much Vitamin D a body needs, but it’s generally agreed that there is a correlation between a great many mid-life ailments and a low level of Vitamin D.

There are plenty of foods that are rich in natural calcium and Vitamin D – dairy products and oily fish are the two that are most highly touted in both instances. Access to sunlight on a regular basis is also a key source of Vitamin D.

So what can we draw from the recent conclusions? Well, when it comes to fractures and osteoarthritis, it appears that calcium and Vitamin D supplements may not be the miracle cure for potential fractures that we once thought it was – but, as statics bear out, 80% of hip fracture patients have a vitamin D deficiency.

And in any case, there are still plenty of reasons to keep taking them – such as fighting off seasonal depression, boosting your attempts to lose weight, maintaining the health of bones and teeth, supporting the immune system and regulating insulin levels.

High cholesterol could cause arthritis

With winter well and truly kicking in, a lot of us are beginning to feel the annual aches and pains brought on by arthritis a little bit more than usual, and taking steps to fend it off. But while you blame your current situation on the weather, you might want to take a look at another factor that raises its ugly head at this time of year: comfort eating and lifestyle choices that bring on high cholesterol.

We all know that a high cholesterol level can be responsible for serious health conditions such as heart attacks and strokes. But now a series of studies conducted in Australia and China are claiming that the wrong diet and a sedentary lifestyle can also trigger the development of osteoarthritis as well.

What is the link between poor diet and arthritis?

As any medical expert will tell you, our joints constantly undergo low-level stress and damage from the simple activities we undergo on a daily basis. In most cases, this isn’t a problem – our body has the ability to naturally repair any damage on the fly. There are a welter of issues that can prevent this from happening, including obesity, family history, overexertion after a joint injury, and simple old age. And now there appears to be another factor.

According to the studies, conducted on mice, the research teams found that high cholesterol levels induce mitochondrial oxidative stress on cartilage cells. In laypersons terms, that’s a severe genetic imbalance which can damage the body’s ability to repair itself. In the case of our joints, it can cause cartilage cells to die – which ultimately speeds up the onset of osteoarthritis.

As we know, there is no complete cure to osteoarthritis, but it can be managed and even alleviated to the point of minimal suffering. Regular exercise, the wearing of braces and suitable footwear can help, but – as always – prevention is better than cure.

Go Mediterranean this winter

One dietary solution that has been championed for years now and refuses to go away is the Med Diet – foods based around the Mediterranean region that is largely based on vegetables, fruits, nuts, beans, olive oil and fish. A recent study claims that switching to the Med Diet lowers your risk of heart disease by as much as 30% – but new research published in the Journal of Nutrition, Health and Aging claims that the Med Diet can not only help you manage your osteoarthritis, but prevent it.

One hundred and twenty-four sufferers of osteoarthritis were split into two, with half put on the Med Diet and half on a control diet. Sixteen weeks later, the group on the Med Diet showed a significant decrease in IL-1a, a pro-inflammatory molecule which influences the progression of osteoarthritis. They also saw an improvement in knee flexion and hip rotation.

Whilst this isn’t claiming a miracle cure, there is obviously a lot to be said for a controlled diet as a tool to avoid arthritis, and another reason to think seriously about what you eat this winter.

When the menopause becomes a pain: menopausal arthralgia

As any woman of a certain age already knows, the menopause brings a plethora of issues, none of them welcome. Hot flushes and night sweats. Irregular periods and a loss of libido. Mood swings, dryness, weight gain, bloating, irritability and anxiety. In extreme cases, even gum problems, panic disorder, dizziness and irregular heartbeat.

However, there’s one particular symptom of the menopause that tends to get lost in the mass of maladies: menopausal arthralgia.

What is menopausal arthralgia?

Commonly known as ‘menopausal joint pain’, menopausal arthralgia occurs when the menopause triggers swollen, stiff or painful joints – usually the back, hips and knees, but it can also flare up amongst the extremities, such as the neck, shoulders, jaw and elbows.

Medical experts are still struggling to pinpoint the exact causes of this malady, but they’re in general agreement that the reduction of oestrogen – which has been proven to keep the inflammation of joints down – plays a major part.

The symptoms can change from woman to woman: some experience shooting pains down the arms, legs and back. Others experience stiffness in the affected areas in the morning, or swelling at the end of the day. In extreme cases, as women try to manage the pain by over-relying on other areas of the body, it can lead to weight gain, depression and even isolation.

What can you do to fend off menopausal arthralgia?

As with all forms of arthritis, there is no sure-fire cure – it’s one of the facts of life when it comes to the ageing process. However, there are many steps one can take to make the transition into post-menopausal life as smooth as possible, and the first one is a no-brainer: consult your doctor and spell out everything you’re currently experiencing.

When you know exactly what the problem areas are, you can then counter them with a targeted exercise plan. Obviously, you’ll be looking for a low-impact regime that’ll keep your joints flexible and strong, and swimming, tai chi and yoga are excellent activities for this purpose. Complimentary therapy such as osteopathy could help, too.

It goes without saying that achieving and maintaining a healthy body weight is key – after all, the heavier you are, the more strain you put on your joints. It’s also very important to start reducing your intake of carbs and sugar, as chronic inflammation of the joints can be caused by a diet that’s top-heavy with refined carbohydrates and sugars and low in essential fatty acids.

Replace the artificially sweet treats with fruits bursting with natural anti-inflammatories, such as blueberries, cherries and blackberries, and supplement your diet with Vitamin D, Omega 3 and multivitamins.

Finally, it makes sense to manage your stress levels. Although keeping calm seems a lofty goal when our bodies seem to be acting of their own accord, it’s a proven fact that elevated stress releases amounts of cortisol, which works as an inflammatory agent and makes matters worse.

Remember: you’re not alone in this, and it happens to all women.

Why sitting could be the new smoking

After reading this article you may want to sit down, and then stand up again: it’s becoming clear that sedentary lifestyles – a lifestyle with irregular or no physical activity – has more of a bearing on a range of health conditions than first thought.

As Cambridge Sport & Medicine Specialist Cathy Speed knows, the prime culprit when it comes to inactive lifestyles is sitting, something that takes up as much of 70% of the average day for a huge amount of people. For many people, it’s an unavoidable fact of life: our working lives have moved away from the physical grind of the factory and towards the mental grind of the office. When you spend your spare time doing more of the same – be it in front of a television or laptop – that’s where the problems begin.

Time to stand up and fight

The list of ailments that a sedentary lifestyle can help being on is manifold, and frightening. Cardiovascular disease and its offshoots – heart disease, circulation and blood pressure – are the most obvious consequences of an unhealthy lifestyle, and the risks of them occurring can increase with as little as two hours of sitting time per day. Even worse, a sedentary lifestyle has been linked to an increase in the risk of contracting cancer.

Need more bad news? People who watch TV for more than two hours a day gives you a 20% increase in the chances of contracting Type 2 diabetes. High amounts of sitting have been linked to an increase in the chances of contracting depressive symptoms. Older adults who spend over six hours of their day sitting are more likely to develop muscle degeneration than those who don’t. And overall, sedentary lifestyles have been associated with an increase of all-cause mortality by up to 49%.

What you can do

So what can we do to combat a sedentary lifestyle when it seems like the world we live in is pushing us towards it? The first thing you need to do is review your lifestyle – honestly and unflinchingly – and make plans to improve it. You’re not being asked to throw away your armchair: rather, you need to pick out moments in your week when you know you’re wallowing for no real reason, and work out what you could be doing instead that will do your body some good.

The next plan of action is to set realistic short-term goals that can spur you on to greater things in the long term. Aiming to lose a pound of weight per week…going on a 30-minute walk at least three times a week…completing one major job in the house, from tidying the garden to finally putting up that bookcase…all of these things are infinitely preferable than finishing off a box set that you’re not really into.

From there, you can start to think about making the move into a truly healthy lifestyle. The walk around the park can turn into a jog around it if you put yourself in the right frame of mind. That pound you’re losing every week can be magnified with a few regular gym sessions. And if you want to spend a chunk of time sitting, you can always do that on a bike.

We all know that sedentary lifestyles are very easy to slip into, especially when the weather starts to worsen, but it’s just as easy to slip into good habits too.

As Cambridge Sport & Medicine Specialist Professor Cathy Speed explains: “Physical activity for health-related benefit can be the most effective prescription ever written.” To arrange a consultation at her Cambridge clinic, call 01223 200 595 or 01223 200 594.

Why bones don’t heal: researchers identify risk factors for fracture nonunions

We all know the science behind the way bones heal, or at least the layperson’s version of it: the displaced halves of the bone are reset by a trained practitioner, they’re held in place with one contraption or another, and the patient is advised to keep that area as still as possible while the body does its business and naturally knits the two ends back together.

As anyone unfortunate enough to undergo such a trauma already knows, however, it’s not always as simple as that. And according to a recent study by the Louisiana State University Health Sciences Center,there are a raft of different factors that can determine whether a fractured bone will successfully be reunited, or not.

The study, which analysed the data of a mind-boggling 90.1 million patients, eventually honed in on 309,330 different cases of bone fracture.

The results: 4.93% of them resulted in fracture nonunions. The most successful reunion rates were found in the bones in the hand (with a 1.47% rate of failure) and radius bone in the forearm (2.10% rate of failure). The most problematic areas were the scaphoid bone (below the thumb – 15.46% rate of failure), the tibia and fibula (13.95%) and femur (13.86%).

The bare bones: lifestyle is key

Unsurprisingly, the study concluded that there are many factors that can determine fracture nonunions. Other ailments in the body are a prime factor: osteoarthritis, rheumatoid arthritis, and diabetes increased the odds of nonunion by at least 40%. Medications also play a part: if painkillers or insulin is a day-to-day part of your life, the risk of non-union is increased (although if you’re on anti-diabetic medication that isn’t insulin, or oral contraception, the risk is decreased).

Other factors that can have a detrimental effect on your odds of a successful reunion of a fracture are myriad, and include anticoagulant use, osteoarthritis with or without rheumatoid arthritis, anticonvulsant use with or without benzodiazepine, opioid use, diabetes, osteoporosis, smoking, obesity, antibiotic use, and Vitamin D deficiency. And if you’re male, the chances of nonunion are greater than if you’re female.

Why Vitamin D is essential for healthy bones

Obviously, doctors can put into practice a range of procedures to correct nonunion fractures, including electrical stimulation and specialised braces. In most cases, however, surgery is required – which is the last thing anyone needs, particularly if physical activity is part of your career or quality time.

While fractures can be an unavoidable fact of life, the message is obvious: your lifestyle is a huge factor in determining the success rate of the healing process, and one key factor – the correct intake of Vitamin D – is the quickest and best solution. It’s an established fact that Vitamin D helps calcium absorption in the gut, which allows for normal levels of bone growth and remodelling. Furthermore, a lack of Vitamin D can lead to brittle bones.

For more information on bone health, you can find it here. To arrange a consultation at Cathy’s Cambridge clinic, call 01223 200 595.

The menopause and benefits of exercise

Women who are going through the menopause, whether they are keen athletes or just wish to keep the pounds off, often start to experience an increase in joint pain or soft tissue injuries that threaten to derail their exercise efforts. However, the menopausal transition is one of the key stage in a woman’s life where keeping fit and well is essential, so we take a look at the menopause and exercise benefits.

Benefits of exercise during the menopause

Preventing weight gain: the hormonal changes that occur during the menopause mean you’re more likely to put weight on in the abdomen area. There are also other factors at play; muscle mass starts to diminish as you get older and this means your body is less efficient at using up calories. Even not getting enough sleep as a result of night-time hot flushes can contribute to weight gain as you are less likely to exercise and more likely to snack when tired.

Reducing the risk of serious health concerns: another menopause and exercise benefit is that it helps to keep the weight off during this period which can offer protection against diseases, such as cancer, heart disease and diabetes.

Strengthening your bones: losing bone density is a natural part of the ageing process, but the menopause greatly speeds up bone loss. Women can lose up to 20% of bone density in the first few years after the menopause and studies have shown that bone mineral density can be maintained or increased with exercise, which means you’re at less risk of developing osteoporosis or suffering from bone fractures.

Improving your mood: the menopause can be a very challenging time for a woman and the associated mood swings have long been fodder for menopausal jokes. The hormones that trigger ovulation and menstruations are also responsible for releasing serotonin, a chemical that regulates our moods, so as hormone levels fluctuate, so does the amount of serotonin in our system. Other symptoms of the menopause such as hot flushes, insomnia and lack of concentration can all exacerbate your mood. Physical activity has been proven in numerous studies to increase production and release of serotonin and other mood-enhancing chemicals.

Maintaining musculoskeletal health: in a Chinese study published in 2013, 743 women, between the ages of 35 and 64 years were studied and post-menopausal women experienced significantly higher prevalence of musculoskeletal symptoms, such as neck pain, frequent knee pain and joint pain, compared to younger, pre-menopausal women.

Exercise is the best way to keep all the parts of our musculoskeletal system – bones, joints, tendons, ligaments and muscles – in good working order.

As Professor Cathy Speed explains: “Exercise is an important part of menopausal management, enhancing wellbeing, bone and muscle strength and reducing many health risks.” If you’re experiencing problems that are undermining your exercise routine or keen to take charge of your health to aid you through the menopause, call 01223 200 595 to arrange a consultation at her Cambridge menopause clinic.

Cathy Speed to speak at Spire Cambridge GP conference

This Saturday, Cambridge Sport & Exercise Specialist Professor Cathy Speed has been invited to speak at the Duxford Annual GP Conference run by Spire Cambridge Hospital.

She will be teaching on a variety of musculoskeletal conditions and then giving a Keynote Speech on High Performance Sports Medicine, reflecting on the development of high performance sport and medical care of elite athletes over the past few decades.

The conference will be held at Imperial War Museum, Duxford, and the all-day event will consist of a series of lectures and workshops with the opportunity to network and will provide GP’s with six hours of CPD.

Google takes aim at arthritis

The prevalence of rheumatic and musculoskeletal conditions are a growing concern, with their implications for healthcare expenditure and the impact on the economy through loss of workdays. Now, arthritis is in Google’s sights as it joins with global pharmaceutical GlaxoSmithKline to develop bioelectronic medicines that could tackle a whole host of ageing concerns.

Statistics from the World Health Organisation show that the prevalence of rheumatoid arthritis in developed countries varies between 0.3% and 1% of the population and osteoarthritis affects nearly 10% of men and 18% of women over the age of 60. With a rising ageing population, the impact of these conditions should not be overestimated.

Last month it was announced that Google’s parent company Alphabet had teamed up with GSK, the largest drug company based in the UK, to form Galvani Bioelectronics. With two research hubs, one in San Francisco and one just outside of the London, and a potential investment of up to £540million over seven years, this development sees Google continue its foray into the lucrative healthcare market.

What is bioelectronic medicine?

Battery-powered implants are used to correct misfiring electrical signals between our nervous system and our organs. These implants are the size of a grain of rice or even smaller and are attached to individual nerves that are not functioning optimally. GSK believe that many health conditions could be treated with bioelectronic medicine; they could open up the airways of asthma sufferers or reduce inflammation that is the cause of many chronic diseases, including arthritis.

Furthermore, bioelectronic medicine can help manage or reverse these health concerns with no side effects, an often significant downside to many of the very costly drugs that have been developed to treat these diseases.

Bioelectronic medicine and rheumatoid arthritis

Recently, scientists at the University of Amsterdam and the Feinstein Institute of Medical Research in New York released clinical trial results that demonstrated that stimulating the vagus nerve, which extends from the brain to the abdomen, with a bioelectronic implant improved disease activity in rheumatoid arthritis patients.

Previously, tests had been performed in animal and in vitro models with very encouraging results, but this was the first human study that showed that stimulating the vagus nerve suppressed production of key cytokines that create inflammation. As well as rheumatoid arthritis, this technology could significantly improve the experience of those suffering from other inflammatory conditions, such as Crohn’s, Alzheimer’s, Parkinson’s.

So, will this be the future of arthritis treatment? Kris Famm, GSK’s head of bioelectronics, said: “Hopefully in 10 years there will be a treatment option where your doctor will say ‘Why don’t you go for bioelectronic?’, and a surgeon will do a little procedure and it will help the organ to do what it should be doing.”

Professor Cathy Speed offers a customised arthritis service at her London and Cambridge clinics. Arthritis doesn’t have to mean lifelong pain and immobility; seek treatment early for effective management. Call 01223 200 595 to arrange a consultation.

The future of hip replacements: cartilage grown from stem cells in your fat

There are around 80,000 hip replacements performed every year in the UK to address the pain and lack of mobility that results from cartilage and bone degeneration, yet hip replacements fashioned from metal, polyethylene or ceramic have an expiry date. Now, new research is focused on regenerating cartilage using stem cells.

Why do you need a hip replacement?

The hip is one of the largest, most flexible and weight-bearing joints in the body and, after the knee and hand, is the third most likely joint in the body to be affected by osteoarthritis. Our bones are covered with a tough, flexible substance called cartilage that allows them to move smoothly against each other, but over time this cartilage can wear down, causing the bones to rub against each other. Pain, stiffness and lack of mobility result and eventually this can severely limit your ability to perform normal, daily activities.

During joint replacement surgery, any or all of the joint can be replaced with artificial parts that are composed of metal, plastic or ceramic. However, an alternative approach is to regenerate the damaged cartilage, avoiding the need for joint replacement surgery.

Recently, scientists at Washington University in the US, led by Professor Farshid Guilak have extracted stem cells from adipose or fat tissue left over from liposuction. These stem cells are known as master cells because they are able to turn into different types of tissue as required by the body. The stem cells were placed on a circular frame which could fit over the ball of a hip joint. A cocktail of proteins was used to transform the stem cells into cartilage cells and, over a period of just six weeks, a thin layer of living, healthy cartilage tissue grew over the frame.

The cartilage is grown in a ‘weaving pattern’ that ensures the implant is strong enough to bear ten times the body’s own weight. Furthermore, gene therapy was utilised, causing the cells to release anti-inflammatory molecules which can help fight arthritis. At the moment, the living tissue implants are being tested on animals, with human trials expected in three to five years’ time.

Hip replacements and the young

A dodgy hip is seen as one of the costs of getting older, but figures released by the NHS earlier this year found that the number of hip replacements in the under-60s has risen by 76% over the last decade.

Partly this is due to improvements in surgical techniques that makes the procedure and recovery less arduous and technological advances in the prosthetic materials used. Previously, replacement joints had an expected lifetime of 15 years meaning revision surgery would be a must if performed at a young age. Newer prosthetics can now expect to last 20 years or more.

The figures from the NHS showed that the increase in hip replacements in the younger age group only reflected an overall increase across all age groups. With an ageing population, joint replacement surgery will only continue to rise, but as this new research indicates the future could be joint repair rather than replacement.

Professor Cathy Speed’s academic interests include regenerative medicine in joint disease. To arrange a consultation at her Arthritis Clinic at the Progress Clinic in Cambridge, call 01223 200 595.