As requested by readers, this week we are focussing on the subject of rheumatoid arthritis (RA). The term arthritis' is a general one, that covers 200 specific forms of the condition.

Most well known is osteoarthritis, but also covered by the term arthritis are: rheumatoid arthritis, juvenile arthritis, ankylosing spondylitis, gout and systemic lupus erythematosus (SLE), as well as many more.

Arthritis refers to inflammation in a joint. The problem of arthritis in general, affects seven million people in the UK.

These are people who have experienced long-term symptoms severe enough for them to have visited their doctor.

It is, suspected that many more people are suffering, and that the problem is under reported.

A MORI study commissioned by the Arthritis Research Campaign found that 13 million people in the UK suffered from arthritis and joint pain.

As many people age, they are resigned to accept that pain, restriction and limitations are an unwelcome consequence.

As a result, many never consult their doctor and therefore never become a national statistic.

The case discussed this week is a good example of this.

Rheumatoid arthritis (RA) is a generalised connective tissue disease that selectively targets synovial tissue the body's natural lubricant particularly the joints of the wrist, hands, feet as well as larger joints, and also the cervical spine.

Between one and three per cent of the world's population are affected by RA. The disease is affects the same joints on each side of the body.

Other body systems may be involved including the heart, lungs, nervous system and the eyes.

The onset is usually between the age of 20-60 with a peak between 40 and 50 years. There is predominance in women of 3:1 in the 20-40 age group. If the disease develops below the age of 16 it is called juvenile rheumatoid arthritis.

Laboratory findings can support the clinical findings. An elevated ESR and anemia are typical.

The presence of rheumatoid factor in 70 per cent of patients is a useful determinant but it is not specific for rheumatoid arthritis. The features seen on X-ray are usually symmetrical in nature with an even loss of joint space, soft tissue swelling, erosions of the bone adjacent to the joint, and joint deformity.

The treatment of rheumatoid arthritis requires medication. Most rheumatologists control the symptoms of RA with a combination of drugs.

The pain can be controlled with analgesics, the inflammation is targeted by NSAIDS and/or steroids and the progression of the disease process is hopefully slowed down by drugs such as methotrexate and hydroxychloroquine.

I am surprised by the lack of a physical, hands on approach, however I am sure this is due to lack of funding.

Patients suffering with joint pain especially in a weight bearing joint, such as the knee or hip immediately adopt a different style of walking or gait.

This offers natural protection for the affected joint. The result is an uneven weight distribution through the pelvis and low back.

The imbalance at the base of the spine can exert effects throughout the spine causing upper back and neck problems.

The initial painful symptoms might well be due to rheumatoid arthritis which can only be controlled with drugs, however most often, as a consequence of the RA, additional painful biomechanical symptoms result that add to the patient's discomfort.

The good news is these can most definitely be treated by manual care as used by chiropractors and osteopaths.

The following case highlights that just because someone has been diagnosed with a particular condition, they are still at liberty to suffer from common biomechanical problems too!

In fact, many painful symptoms are put down to the existing condition and are therefore said to be part of that problem and go untreated.

Patients regularly believe all their symptoms are due to the diagnosed condition and often suffer pain and limitations needlessly.

Case History Mrs E is 39-years-old who had been diagnosed with RA when she was 27. Her current medication included methotrexate and hydroxychloroquine with analgesics when required.

Her presenting complaint was that of progressive low back pain which was mainly right sided but could also affect the left side.

It had been worsening over the previous two years. It was a constant ache and was never better than 4/10 for pain. On further questioning she had experienced this pain to some degree for 12 years, on and off, and had assumed that it was caused by the rheumatoid arthritis. The joints affected by RA included her hands, knees and pelvis.

Mrs E had finally sought treatment as it was beginning to be a real struggle to walk her dog twice a day and found that the only way to ease the symptoms was to sit, or lie down. This was understandably a depressing prospect for a 39-year-old who felt she could only get worse.

At the original consultation she was definitely resigned to a life of limitation, and pain. She had no expectations at all. As a chiropractor this is terribly sad.

Examination revealed findings including, a severely restricted right sacroiliac joint a major joint at the back of the pelvis and very tender, tight muscles around the hip and pelvis.

The pelvis itself exhibited a torque whilst the patient was lying on her front, despite having good balance when standing. This was caused by adaptations made to avoid the pain whilst walking. The human body is amazing at making compensations.

Treatment was aimed at restoring the pelvic balance with a technique known as blocking. Soft tissue work reduced the spasm within the muscles and manipulation restored the sacroiliac movement. Following two treatments Mrs E reported being able to walk much further before the pain increased.

After continued treatment she was delighted that even the constant pain she experienced had gone completely. Mrs. E is now on a maintenance programme so the symptoms caused by the restrictions which are likely to recur due to the underlying condition are kept under control. Just as she needs regular reviews by her Rheumatologist to ensure her drug regime is efficient, she has a regular assessment by me to keep her joints in check.

lIf you would like to contact me regarding any subject please call Ilkley Chiropractic Clinic on 605060 or email ilkleychiro@ tiscali.co.uk.