According to the charityArthritis Care, around 10 millionpeople in the UK are living witharthritis. While often thought ofas a disease that only affectsolder people, approximately27,000 arthritis patients in theUK are under the age of 25 andsome are even children.

The term arthritis describesinflammation of the joints.There are around 200 types of the disease, although thismodule only considers the twomost common: osteoarthritis(OA) and rheumatoid arthritis(RA). Neither can be cured, sotreatment focuses on symptommanagement, slowing diseaseprogression and maintainingeveryday life for as long aspossible.

OsteoarthritisOsteoarthritis is the mostcommon form of arthritis,affecting around 8.75million people in the UK.The main symptomsinclude pain andstiffness in certainjoints of the body –most commonlythe knees, hipsand hands – as aresult of changesto the cartilage,bones andligaments. Noteverybody with OAis affected in thesame way and anindividual may notexperience the samesymptoms in different joints.

Osteoarthritis does nothave a specific cause.However, several risk factorsincrease the likelihood ofsomeone developing the

condition. These include age(OA is rare in people under 45years), gender (women aremore likely to develop OA thanmen), obesity (due to theadditional pressure puton joints), familyhistory, bonedensity andprevious jointinjury.

The firstsign of OA is usually aslightly stiffand sore joint,particularly firstthing in themorning, duringexercise and at

the end of the day. The jointmay not move as freely as itonce did, it may appear swollen,or make a creaking or crackingnoise. Some individuals find

that after a few weeks ormonths, symptoms

appear to improve.However, seeking

medical help isimportant, asreceiving a promptdiagnosis cangreatly help toprevent furtherdamage andminimise futureproblems. At the other end of

the symptom

spectrum are those who haven’tsought help and who are morelikely to experience problemssuch as muscle wasting andweakness, joint deformity,depression, and possiblyimpaired mobility.

Rheumatoid arthritisRheumatoid arthritis affectsaround one per cent of the UKpopulation, making it thesecond most common form ofarthritis. It is an inflammatorydisease that largely affectsjoints such as the hands, feetand wrists, which becomeswollen, red and painful.However, as it is an auto-immune condition, anypart of the body can beaffected, including theheart, lungs and eyes.

It is not known whattriggers RA, but factorscommonly includegenetics, gender(similar to OA, womenare affected more thanmen), smoking and age

(RA usually appearsbetween 40 and 60 years).Rheumatoid arthritis

symptoms usually developgradually over the course ofseveral weeks or months,although some people

experience a sudden onset overa few days, with the affectedjoints becoming stiff(particularly in the morning orafter a period of inactivity),painful and swollen. Thesufferer may also feel tired andunwell on a more general basis,perhaps suffering from a fever,sweating or appetite loss. As the condition is caused byinflammation, symptoms mayalso be present elsewhere in thebody. These may include dryeyes, nodule formation nearaffected joints and other issuessuch as problems with thelungs, nerves, blood vessels or even the heart.

If RA is not managedappropriately, joints maybecome permanently damagedand the individual may be at anincreased risk of other healthproblems such as osteoporosis,anaemia, infection, cardio-vascular disease, malignancyand mental health conditions,(e.g. depression and anxiety).

The costs associated with RAare high, not just because of theburden placed on the NHS, butalso to sufferers, carers, andsociety as a whole, as around athird of patients stop workingwithin two years of the diseasefirst manifesting.

The magazine for professional assistants

Contributing author: Asha Fowells MRPharmS, community pharmacist and pharmacy writer.

C P D M O D U L E

Welcome to our CPD module series for communitypharmacy technicians. Written in conjunction with thePharmacy Magazine CPD series, it will mirror the magazine’sprogramme throughout the year. The series has beendesigned for you to use as part of your continuingprofessional development. Reflection exercises have beenincluded to help start you off in the CPD learning cycle.

CURRENT THINKING ON... ARTHRITIS

MODULE NUMBER: 56AIM: To understand the symptoms and management of the two most common arthritic conditions:osteoarthritis and rheumatoid arthritis.

OBJECTIVES: After reading this module, pharmacytechnicians will:l Appreciate the differences between osteoarthritisand rheumatoid arthritis, and beaware of some of theconditions that canproduce similarsymptomsl Know the self-care steps that canhelp in themanagement ofthese conditionsl Have anunderstanding of someof the mainpharmacological treatmentsof these diseases.

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The magazine for professional assistants

Non-pharmacologicalmanagement There are many steps thatpeople with OA and RA cantake to ease symptoms andprevent the condition fromworsening:• Education, advice and accessto information about thecondition and its managementare vital. This should be offeredrepeatedly, as patients are likelyto have different concerns atdifferent times• Exercise, both strengtheningand aerobic, builds muscle andstrengthens joints, therebyimproving mobility andsymptoms. A physiotherapist isthe best person to advise onwhat is suitable and beneficial,particularly as patients witharthritic conditions may beanxious that exercising willworsen their symptoms• Weight reduction is one ofthe most beneficial measures anoverweight or obese OA or RAsufferer can take, ideallythrough exercise and dietarychanges• Pacing (interspersing physicalchores with gentler tasks andrest periods, if necessary) is animportant skill to learn• Relaxation techniques can be valuable for those who aretense and frustrated because of pain or mobility problems• Assistive devices have a rolein helping those with specificneeds – for example, wearingsupportive insoles or footwearcan be beneficial to someonewith arthritis of the feet orknees.

Pharmacy technicians have awealth of knowledge on manyof the above measures and areideally placed to highlight thosethat arthritis sufferers may haveoverlooked, such as eligibilityfor winter vaccinations.Community pharmacy teamscan also signpost patients to

local support groups, and offer afamiliar face and a sympatheticear for patients and carers whomay at times feel isolated.

Pharmacologicalmanagement ofosteoarthritisPain relief is the main treatmentaim of OA. Paracetamol, takenregularly if required, and/ortopical non-steroidal anti-inflammatory drugs (NSAIDs)should be used first-line, as wellas topical capsaicin for knees orhands that continue to be

painful. If these measures proveineffective, opioids may beconsidered, or an oral NSAID orCOX-2 inhibitor may be addedor used as a substitute, althoughonly at the lowest effective dosefor the shortest possible timeperiod and with a proton pumpinhibitor taken concurrently. Formoderate to severe pain,injectable corticosteroids orsurgical options may be used.

Treatments that are notrecommended on the NHSinclude rubefacients,glucosamine, chondroitin andacupuncture, although patientsmay choose to fund one ormore of these themselves.Transcutaneous electrical nervestimulation (TENS) and/orthermotherapy may bebeneficial to some patientsalongside other treatments.

All patients withsymptomatic OA should be

reviewed regularly to monitorsymptoms, the effectiveness andtolerability of treatments, andany concerns or questions thesufferer has about theircondition, as well as to highlightany relevant services they couldaccess. Patients should also beaware that they can seek helpat a time earlier than the nextallotted appointment if theyexperience any problems withtheir condition or treatments, or have any other concerns.

Pharmacologicalmanagement ofrheumatoid arthritis The main treatment aim of RA is to reduce joint inflammationand slow down or preventfurther damage to enablesufferers to live as full a life aspossible. Disease-modifyingantirheumatic drugs (DMARDs),usually methotrexate plus atleast one other (eg. leflunomide,hydroxychloroquine and

sulfasalazine), should be tried assoon as possible after active RAis diagnosed. If DMARDs proveineffective or have side effectsthat the patient cannot tolerate,a cytokine modulator such asetanercept or infliximab may beused either in combination withmethotrexate or on its own.

It can take weeks or monthsfor DMARD or cytokinemodulator therapy to take fulleffect (although cytokinemodulator therapy tends towork a little quicker thanDMARD), during which time thepatient should be regularlymonitored for side effects andefficacy. Short termcorticosteroids may also be usedto combat inflammation rapidly.Disease-modifying medicationshould only be continued for aslong as the benefits are felt andat the lowest dose possible toprevent flare-ups.

Pain relief – paracetamol,codeine or a compoundanalgesic, replaced if necessaryby an oral NSAID or COX-2inhibitor at the lowest effectivedose for the shortest possibletime, plus a PPI – may be usedduring flare-ups of RA.

Surgery is usually onlyrecommended when a joint has been damaged to such an extent that it is no longerfunctional or has becomedeformed, or if pain is notreduced despite tryingalternative measures.

Medication is just part ofthe management plan for apatient with RA, who willrequire a multidisciplinary team(ideally through one namedcontact) to enable life tocontinue as normally aspossible. Podiatry is particularlyimportant for RA patients.

There is little or no evidencesupporting long-term use ofcomplementary therapies, such

as acupuncture or chiropractic,although some patients mayfind them effective in the short-term. Use of such alternativeapproaches should not affect or replace conventionaltreatments.

Patients with RA shouldhave a check-up at least once ayear – and considerably moreoften if they experience a flare-up or require therapeutic drugmonitoring. Blood tests andimaging should be repeated tomeasure disease progression.

Patients should know howand when to access specialistcare rapidly if they experiencea flare-up and, as with all long-term conditions, they shouldbe given all of the informationand time they require tounderstand their disease andhow it is managed. They shouldalso be involved in treatmentdecisions.

MAY 2015 T R A I N I N G M AT T E R S 45

C P D M O D U L E

reflectionexercise

Go to www.tmmagazine.co.uk to answer the CPD questions. When you pass, you’ll be able to print out a certificate to showcase your learning.You can also add this to your online, personalised learning log.

What support is available in your local area for arthritissufferers and their carers? Make sure you have an up todate list so that you can signpost those who ask or whoyou feel might benefit.

USEFUL WEBSITES:

8

l NHS Choices: www.nhs.uk/conditions/osteoarthritisand www.nhs.uk/conditions/rheumatoid-arthritis is agood starting point for anyone looking for moreinformation on osteoporosis and rheumatoid arthritisl Patient groups have a wealth of information ondiseases and treatments, and often have advice lines andonline forums. Arthritis Research UK:www.arthritisresearchuk.org/arthritis-information/conditions and Arthritis Care:www.arthritiscare.org.uk/AboutArthritis/Conditions/have a broad offering, with the National Rheumatoid Arthritis Society: www.nras.org.uk being more specialised.

Next month: We focus on eye conditions.

Osteoarthritis is the most common

form of arthritis, affecting around

8.75 million people in the UK

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