patient education booklet

1. About The Author
Dr Manoj R. kandoi is the founder president of “Institute of Arthritis Care & Prevention”
an NGO involved in the field of patient education regarding arthritis. Besides providing
literature to patient & conducting symposiums, the institute is also engaged in creating
patients “Self Help Group” at every district level. The institute also conducts a certificate
course for healthcare professionals & provide fellowship to experts in the field of arthritis.
The author has many publications to his credit in various journals. He has also written a
book “ The Basics Of Arthritis” for healthcare professionals.
The author can be contacted at:
Dr manoj R. kandoi
C-202/203 Navare Arcade
Shiv Mandir Road, Opposite Dena Bank
Shiv mandir Road, Opposite Dena bank
Shivaji Chawk, Ambarnath(E) Dist: Thane Pin:421501
State: Maharashtra Ph: (0251)2602404 Country: India
Membership Application forms of the IACR for patients & healthcare professionals
can be obtained from.
Institute of Arthritis Care & Prevention
C/o Ashirwad Hospital
Almas mension, SVP Road, New Colony,
Ambarnath(W) Pin:421501 Dist: Thane
State: Maharashtra Country: India
Ph: (0251) 2681457 Fax: (0251)2680020
Mobile ;9822031683
Email: drkandoi@yahoo.co.in
Preface:
Studies have shown that people who are well informed & participate actively in
their own care experience less pain & make fewer visits to the doctor than do other
people with arthritis. Unfortunately in India & many third world countries we do not have patient education
& arthritis self management programs as well as support groups. This is an attempt to give a brief account of
various arthritis, their prevention & self management methods which can serve as useful guide to the
patients of arthritis.
It would be gratifying if the sufferers of the disease knew most of what is given in the book.
Acknowledgement
I am thankful to Dr (Mrs) Sangita Kandoi for her immense help in proofreading & for her invaluable
suggestions. The help rendered by Nisha Jaiswal is probably unrivalled. Thanks also to vidya, praveen,
rizwana and parvati for their continous support throughout the making of the book. The author is grateful to
his family for the constant inspiration they offered. The author alone is responsible for the shortcoming in
this piece of work. He welcomes suggestions for improvement from the readers.

2. CONTENTS
What is a joint?
What is arthritis ?
Do I have arthritis? How it is diagnosed?
Questions & answers about osteoarthritis
Questions & answers about rheumatoid arthritis
Questions & answers about gout
Questions & answers about ankylosing spondylitis.
Questions & answers about Juveline Rheumatoid Arthritis
Question & answers about back pain & neck pain
How can I protect my joints/ prevent arthritis?
How can I control arthritis?
How to are for onself ? Do’s and Don’t’s in arthritis.
Role of diet & nutrition.
Exercise in arthritis
Medicines in arthritis
Role of complementary therapy.
Role of surgery in arthritis
Talking to others about arthritis
Hope for the future
GLOSSARY

3. What is joint ?
A joint is where movements of one bone occurs on another. There is lack of continuity between the two
bones & the stability(holding together of the two bones) is provided by muscles & ligaments. The ligament
are elastic bands: they keep the bones in place. The muscles provide movement across the joint by
lengthening & shortening.
The bone ends at the joints are covered with a coating of cartilage which allows the joints to move smoothly
& also prevents bone ends from rubbing against each other.
The joint is surrounded by a covering known as capsule & the space within the joint is filled with fluid
known as synovial fluid. The fluid is produced by a membrane which lines the unersurface of capsule known
as synovial membrane. The fluid provides nutrition to the joint & cartilage.
Tendons are tough cords of tissue that connect muscle to bone.
What is arthritis ?
Many people over time start to feel stiffness & pain in their bodies. Sometimes they may have soreness of
hands, knees or hip & difficulty in moving the joint (stiffness). These persons may have arthritis.
Arthritis is an illness that causes pain & swelling in joints. Over a period of time joint may become severly
damaged. The word “ARTHRITIS’ literally means “ Inflammation of Joint” i.e. swelling, heat, redness, pain
& loss of function caused by tissue injury or disease in the joint.
Terminologies:
Rheumatic Disease: These are characterized by inflammation of one or more connecting or supporting
structures of the body including joints, tendons, ligaments, bones & muscles. These disease may also invole
multiple internal organs.
Arthritis: Here inflammation involves mainly joints. The different forms of arthritis form just a portion of
rheumatic disease.
Connective tissue disease: These forms of rheumatic disease affect body’s connective tissue the supporting
framework of the body & its internal organ.
Autoimmune Disease: In these form of rheumatic disease body’s own protective mechanism ( immune
systems from infection & disease harm the body’s own healthy tissue.
Types of Rheumatic Diseases:
Osteoarthritis: This commonest form of arthritis mainly affects cartilage( the cushion in between the bone
ends in a joints). There occurs wearing & tearing of cartilage which results in pain & stiffness. It is more
disability if it affects spine & weight bearing joints ( such as hip & knees).
Rheumatoid Arthritis: This is the second commonest type of arthritis characterized by autoimmune
inflammatory involvement of synovium or lining of the joint with resultant inflammatory changes.
Characterised by bilaterally equal involvement of both sides of the body, it manily involves hands, knees,
elbows & feet.
Juveline Rheumatoid Arthritis: This commonest form of childhood arthritis is associated with fever, skin
rashes, multiple internal organ involvement & inflammatory changes in joints.
Fibromyalgia: This chronic disorder is associated with pain, stiffness & localized tender points in the
muscles & tendons(that support & more bones & joints). The sites mainly involved are neck, spine, shoulder
and hips. There may be associated fatigue & sleep disturbances.
Gout: This type of arthritis caused mainly due to deposition of needle like crystals (stones) of uric acid in the
joints. The inflammation commonly involves in the big toe.

4. Spondyloarthropathies: This group of rheumatic disease are characterized by sacroiliac joint involvement &
associated multisystemic complaints. These are discussed later in details.
Systemic Lupus Erythematosus also known as SLE or lupus): It is an auto immune disease that results in
inflammation of & damage to the joint, kidney, heart, skin, lungs, blood vessels & brain.
Scleroderma (Systemic Sclerosis): It literally means “Hard skin”. In this condition, there is an abnormal &
excessive production of collagen ( a fiber like protein) in the skin, blood vessels, lungs, kidney & joints.
Infectitious Arthritis: It includes arthritis caused by infectitious agents (such as parvovirus arthritis,
gonococcal arthritis, lyme disease ( a bacterial infection caused by tick bite). Here early diagnosis, antibiotic
therapy & mechanical drainage of pus (by aspiration or open surgery) is very important to prevent joint
damage.
Polymyalgia Rheumatica: This rheumatic disease affects the supporting & moving structure around the
joints with resultant morning stiffness, pain and aching involving shoulders, hips, neck & lower back. It may
be followed characterized by inflammation , fever weightloss & weakness.
Polumyositis: It causes inflammation & weakness in the muscles affecting whole body with resultant
disability.
Bursitis: Bursal are small fluid filled sacs that help reduces friction between bones & other moving
structures around the joints. Inflammation of bursa is known as bursitis is known as bursitis which may be
idiopathic (without any known cause) or secondary ( to arthritis, trauma or infection). Bursitis is associated
with pain & tenderness & sometimes restriction of motion of nearby joints.
Tendinitis (Tendonitis): Tendons are tough cord of tissue that connect muscle to bone. Tendinitis is
inflammation of tendon with resultant pain, tenderness & sometimes restricted motion of nearby joint. It
may occur due to overuse. Trauma or due to underlying systemic(multiple organ) rheumatic disease.
Do I have Arthritis ? (How it is Diagnosed ? )
Pain is the way your body tells you that somethings wrong. Pain is defines as an unpleasant experience
associated with actual or potential tissue damage to a person’s body. There are specialized nervous system
cells (neurons) that transmit pain signals are found throughout the skin & other body tissue. These cells
respond to tissue damage due to trauma or inflammation. Most kinds of arthritis cause pain the joints. The
pain may be acute (temporary lasting for a few seconds or longer but wanes as healing occurs) or chronic
(for examples as seen in OA & RA which last for months to years).
Warning Signs of Arthritis:
Joints pains & stiffness
Fever
Loss of Weight
Difficult breathing
Skin rashes or itching.
Causes of Arthritic Pain: The causes of pain in arthritis may vary depending upon type of arthritis. The
causes include:
Inflammation of synovial membrane, tendons or ligament.
Muscles starin & fatigue.
Stretching of capsules.
Increased tension inside the bone (raised intraosseous pressure).
Rubbing of bone ends with each other due to wearing of cartilage.

5. Why Pain Varies from persons to persons ?
There are various factors which influence the severity of pain. These include:
Swelling within the joint.
Severity of inflammation.
Severity of joint damage.
Individual patient thresold & tolerance for the pain.
Social support network like “Institute of Arthritis Care & Prevention” can make an important contribution to
pain management.
What are the symptoms of Arthritis?
These depends upon the type & severity of arthritis commonly occurying symptoms include:
Swelling in joint/ joints.
Stiffness in the joint which may last for more than on ehours.
Warmth & redness in a joint.
Difficulty in moving or using the joint.
Pain (which may be constant or recurring & tenderness (pain on manual pressure) in a joint.
What Can I Do?
You must consult a doctor as early as possible. Only a doctor can tell if you are suffering from arthritis or
related condition & what you can do about it. The earlier you consult, the better; as prognosis (long term
outcome) may vary depending upon early or late medical intervention.
You will need to tell the doctor hoe you feel & where it hurts.
If you are using any herbs or over the counter medical preparation you should tell your doctor about them.
What will happen during your first visit to the doctor?
The doctor will usually do the following:
Take your medical history.
Review the medication which you are already using.
Conduct a clinical examination to determine the cause & severity of arthritis.
Doctor may take x-rays (pictures) of bones & joint. X-rays don’t hurt & are not dangerous except in
pregnancy. If you are pregnant, inform your doctor before x-rays.
Doctor may request blood and/ or urine samples to decide which kind arthritis you have & also the severity
of arthritis.
What Medical History Doctor Will Ask?
These are certain questions doctor is like to ask:
When did you first notice the pain?
When does the pain occur: Morning, night or throughout day?
How long does the pain last?
Is the pain is one or more joints?
What is the type of pain dull aching or throbbing or otherwise?
Whether there is stiffness in the morning lasting for more that 30 minutes.
Does activity make the pain better or worse?
Does rest make the pain better or worse?
Have you had any previous injury or disease that may account for the pain?
Is there any family history of any rheumatic disease.
Any medication which you are taking?
How does medical history help?
Medical history helps in differentiating between inflammatory & non inflammatory arthritis. It not helps in
attaining diagnosis but also an indication of severity of disease & determines the treatment protocol.

6. Difference Between Inflammatory & Non Inflammatory arthritis
Index 3.1
Inflammatory Arthritis Non Inflammatory Arthritis
Morning Stiffness + -
Spontaneous Exacerbations + -
Night Pains + -
Constitutional Symptoms + -
Exacerbated by use of joint - +
Improvement with use of joints + -
Elevated ESR/ CRP + -
How physical examination helps?
During the examination, the doctor looks for redness, warmth, damage, ease of movements & tenderness.
This helps in determining the diagnosis & severity of disease.
The examination also includes examination of heart, lungs, abdomen, nervous system, eyes, ears & throat as
may be necessary as some forms of arthritis have multiple system involvement.
What are the common investment done?
These include blood investigations, urine & x-rays
Blood Investigations:
Complete Blood Count: This test determines the number of different types of cells in the sample of blood.
Some rheumatic conditions & drug therapy are associated with a low white blood count (leukopenia), low
red cell count (anaemia), or platlet count (thrombocytopenia). Periodic examinations may be required if
some drugs known to cause these have been prescribed to you.
Erythrocyte Sedimentation Rate (ESR): This blood test is used to detect inflammation in the body. Higher
ESR rate indicate presence of inflammation. It also helps determining the response to medication. Reduction
in ESR following medication is suggestive of favourable response.
Rheumatoid factor: Rheumatoid factor is an anti-body (Protein Molecule) found in most people (but not all)
rheumatoid arthritis. This test detects the presence of this protein molecule. This factor may be found in
many disease besides rheumatoid arthritis & sometimes in normal healthy individuals.
E-Reactive Protein Test: This nonspecific test detects presence of inflammation in body. It helps in
monitoring response to medication as levels reduce when anti-inflammatory medications are used.
Urine Examinations: Here urine sample is tested for pressure of proteins, red blood cells, pus & bacteria.
There may indicate kidney disease in rheumatological syndrome & also may suggest any untoward side
effect of drugs being used for treatment.
Complement: This test measures a group of proteins which help destroy foreign substances like germs
entering into the body. The group of protein known as complement is characteristically low in active lupus
disease.
Antinuclear Antibody (ANA): This tests detect levels of antibodies that are often present in autoimmune
disorders. They are referred as antinuclear antibodies as these react with material in the cells nucleus

7. (control center). There are different individual types of ANs that are specific to certain autoimmune
disorders. These may sometimes found in normal healthy individuals.
Synovial Fluid Examinations: Here the fluid is collected from the joint itself using a local anaesthesia
injection. The fluid is examined for white blood cells (found in RA & infection), pus cells (found in
infection), bacteria or virus (found in infection), or crystals (found in gout & pseudogout).
X-rays & Other Imaging Procedures:
Xrays provide an image of the bones & doctor can get a fair idea of how the joint looks like inside. But x-
rays donot shows cartilage, muscles & ligament.
Other imaging methods which show the whole joint include CT Scan, MRI & arthropathy.
Alternatively doctor may use arthroscope to visualize inside of the joint. Arthroscope is a small, flexible
tube which when inserted in the joint through a small incision transmits the image of the inside of a joint to
video screen.
What can treat arthritis pain?
A number of different specialists are usually involved. Often a team approach is use. The team essentially
comprises of a physician (rheumatologists) surgeons (orthropaedists), & physical & occupational therapists.
The health professional team, and you, the patient all play a vital role in achieving