Healthy Blog

Arthritis and the Immune System

Thursday, August 6, 2020

Many of you will have heard of the term ‘Autoimmune' regarding health conditions and may even have first-hand experience.

The Immune System is the body's way of defending itself against foreign bodies such as viruses and bacterial infections. Foreign cells replicate in the body and build up numbers to the point you begin to experience symptoms such as fever. Sometimes you might successfully fight off a virus or bacterial infection with minimal to no symptoms. This is because as soon as your body detects a foreign cell it produces defence cells that target specific cells (i.e. virus or bacteria).

An autoimmune condition occurs when the immune system starts attacking normal, healthy cells. The type of cells damaged will determine the type of autoimmune condition a person develops. There is a genetic link to many autoimmune conditions, and it is not unusual for someone to develop more than one autoimmune condition. Autoimmune conditions can affect the thyroid, gut, skin, spine, and peripheral joints to name a few.

In Physiotherapy Clinics we commonly see clients with autoimmune conditions that affect the musculoskeletal system. The most common conditions we treat include: Rheumatoid Arthritis, Psoriatic Arthritis and Ankylosing Spondylitis. Many of our patients have other autoimmune conditions that whilst they don't directly affect the musculoskeletal system, they may have indirect effects such as slower healing timeframes, medication side effects or the co-existence of fatigue. Arthritic autoimmune conditions can affect the joints of the spine and pelvis, or the peripheral joints such as knees, ankles, wrists, toes and fingers. Tendon's and fascia (connective tissue) can also be affected, causing multiple painful and/or swollen areas in the body. Medical management of autoimmune conditions is a team effort comprising of a Rheumatologist, GP and allied health (such as Physio or Occupation Therapy). Prescription of medication such as anti-inflammatory medication, pain medication and immune suppressant medication can help to control both pain and joint degenerative changes caused by chronic inflammation.

As Physiotherapists our role often includes education, pain management and exercise prescription. Some patients will benefit from hands-on therapies such as massage, electrotherapy, and acupuncture. Symptom management is an important part of the Physiotherapists role in patient care, as although we cannot ‘cure' these conditions, they do tend to be episodic and have periods of flares and remission. Most arthritic autoimmune conditions will cause some degree of pain, stiffness, and fatigue which can be different day to day.

Rheumatoid Arthritis

In Rheumatoid arthritis, the immune system attacks the lining of the smaller joints (typically hands and feet), causing inflammation and damage to the joint surfaces. Symptoms typically include joint pain, stiffness (especially in the morning) and swelling around the joints. Usually both sides of the body are affected. Diagnosis is made by a Rheumatologist based on results from blood tests, radiological investigations (xray, CT, MRI), family history and symptoms. Medical treatment involves medication; however, lifestyle plays an important part in managing your symptoms.

Psoriatic Arthritis

Psoriatic Arthritis is another common autoimmune condition causing joint pain anywhere in the body and is often accompanied by a skin rash called psoriasis (however, having Psoriasis does not necessarily mean you have or will get Psoriatic Arthritis). This type of arthritis can also affect your tendons such as at your heel or under the foot. This is diagnosed by a Rheumatologist based on symptoms, blood tests and radiological examination. Medication often plays an important role in managing symptoms and preventing damage to the joints by chronic inflammation.

Ankylosing Spondylitis

This condition causes inflammation of the joints of the pelvis and spine, causing pain and stiffness especially after rest. Inflammation can also occur elsewhere in the body including the ribcage, tendons, and eyes. Diagnosis is made by a Rheumatologist based on symptoms, blood tests and radiological examination. Medication is important to reduce inflammation and manage symptoms and can range from anti-inflammatory medication to immune suppressant medication.

Similarities of these conditions

• All of these are diagnosed by a Rheumatologist based on symptoms, blood tests and radiological findings
• There is a genetic link – the HLA-B27 gene has been linked to both Psoriatic Arthritis and Ankylosing Spondylitis. People with Rheumatoid Arthritis often test positive to Rheumatoid Factor in their blood tests.
• A multi-disciplinary approach often gives the best outcomes as both medication and lifestyle factors play an important role.

Tips for living with an autoimmune condition

I was diagnosed with Ankylosing Spondylitis over 10 years ago. Here are a few things I think are important to do, regardless of your specific diagnosis or medication.

1. Educate yourself about the condition – preferably from recognised medical sources such as Arthritis Australia. There are many Facebook groups and forums for different conditions which can be useful to learn how other people manage their condition.
   1. Education on your specific condition as well as understanding chronic pain can help you know what is expected and develop strategies for dealing with good and bad days.
   2. Take the reins and be proactive in managing your condition. Waiting around for ‘someone' to ‘fix you' is not going to happen. There are many aspects of your health that only you can change – such as lifestyle factors and your attitude.
2. Don't Catastrophise!! The way the brain processes various inputs is pretty impressive and pain is a very complex phenomenon. Constantly thinking about how bad your symptoms are or expecting the worst can affect the way your brain processes pain and may increase the pain you experience.
   1. The converse of this is true – by understanding your condition and having a positive view on your prognosis you can ensure that your brain processes signals normally and whilst you will still feel pain – this is because of the physical condition you have and can help you manage your symptoms more effectively.
   2. I recommend either doing a pain management course or reading up on pain such as ‘Explain Pain' which is a book by David Butler and Lorimer Mosely (Aussies involved in pain research).
3. Healthy Lifestyle – Try to eat good nutritious food, exercise regularly and make sure you get enough sleep.
   1. Some people find that certain diets work for them – but this varies between individuals – if you would like more information on diets look up ‘auto-immune diet'. Other common diets include gluten-free, low-starch or the Mediterranean Diet. Personally, I try to avoid processed foods as much as I can, but basically eat all types of food. I try to limit ‘junk-food' as much as possible – but if I'm going to indulge, I make sure I enjoy it (if it doesn't taste great I won't finish it).
   2. Exercise – regardless of your condition, the world health organisation recommends we all try for 30min moderate intensity exercise most days of the week. It can be difficult to exercise when you are in pain, however, maintaining a healthy weight is a vital part of reducing load on your joints and therefore managing joint pain. Try for low impact exercise and variety. Walking, swimming and cycling are great low-impact cardiovascular exercise options. You also need some form of strength exercises to help maintain healthy muscles and bones, and finally, don't skimp on your stretching to maintain mobility. Don't be afraid to move when you are in pain! You are not damaging your joints when you exercise sensibly – often you will find that exercise helps reduce pain and stiffness – getting started is the hardest part.
   3. Sleep – fatigue is a common complaint in people with autoimmune conditions and unfortunately one that can be hard to get enough of. Whether you are an early-bird or a night-owl being consistent with the time you go to bed and get up in the morning helps. Make sure your pillow and mattress are as good and comfy as you can get. Try to avoid doing or thinking about stressful situations just before bedtime – this can activate your sympathetic nervous systems ‘flight or fright' response and make it harder for you to switch your brain off.
4. Stress – this can be a big factor in triggering flares, make sure you give yourself time to rest and recover, especially when you have an unavoidable stressful situation. Don't beat yourself up if you can't do everything you want to do, but at the same time – don't admit defeat too easily. It's vital for you to maintain both your physical and mental health.

Hopefully, this summary will be helpful to those with an autoimmune condition or their partners/family members. If you would like further information on any of these conditions, I recommend the Arthritis Australia page to start your journey of education.