Osteoarthritis is a degenerative joint disease and occurs as the result of wear and tear. It mainly affects the weight-bearing joints e.g. the spine, hips, knees, ankles and joints in the hands. It can affect both men and women at any age, but is more common as we get older.  Osteoarthritis has many names, Arthritis, spondylitis, rheumatism or rheumatics are names given to the pain and stiffness resulting from it.

Degeneration of your joints begins without you knowing and it happens slowly to all of us.

The general wear and tear of a lifetime results in joints laying down extra areas of bone in an attempt to support damaged areas. Generally our bodies compensate for this and we feel no pain up to point.

However, loss of movement in a joint wear of the joint cartilage will eventually cause you pain. It might come and go and then becomes more constant.

Chiropractic cannot stop you getting old, but it might stop you feeling it!

The symptoms of arthritis are commonly treated with non-steroidal anti-inflammatory drugs (NSAIDs), which don’t stop the progression of the disease and have risks associated, but sometimes help to relieve the pain.

However, chiropractic treatment is considered by some people to be more effective in the long run.

It has been suggested that chiropractic can prevent further arthritic development and regular treatment can even prevent osteoarthritic changes occurring in the first place. All we know for sure is that many of our patients say that it helps them feel better and are able to stay more active and take care of themselves better.

There is no real strong evidence that degeneration of your joints cannot be reversed but your chiropractor can help improve muscle and joint function and therefore reduce the symptoms of arthritis.

Along with chiropractic treatment, greater emphasis is now being placed on a controlled and regulated diet to reduce joint inflammation and arthritic pain.

Many elderly patients participate in spinal rehabilitation with specially modified exercise programmes.

Ageing of the Spine

During our lifetime, our spines are required to withstand considerable weight-bearing stresses resulting from activities of daily living.

As a result of these stresses ‘wear and tear’ or degeneration, occurs in all parts of the vertebral column. Degeneration which occurs in the spine as a consequence of daily living is considered part of the normal ageing process.

The intervertebral discs (IVDs) are the first to undergo changes, usually around the age of 40, followed later by the spinal joints and bony vertebra, form the ages of 50-60 onwards. Normal degeneration is usually well-established by the age of 70.

Characteristically, the IVD will lose its ability to absorb fluid as the chemical makeup and internal architecture of the disc changes in response to repetitive stresses.

As a result, the normally resilient disc will become tougher, more fibrous and less able to respond to weight-bearing load. The ageing of the discs puts greater stress on the spinal joints as well as the vertebrae itself.

The overall effect of degenerative changes in the disc, joints and bony vertebrae leads to the characteristic feeling of stiffness and reduced movement of the spine.

Degeneration of your joints cannot be reversed but your chiropractor can help improve how you feel and allow you to live life to the full.

What is Rheumatoid arthritis?

Rheumatoid arthritis (RA) is a specific type of arthritis that is chronic, progressive and often debilitating, characterised by the symmetrical joint involvement and the age at which it begins.

It differs from the more common osteoarthritis (OA) often known as wear and tear, spondylosis, degenerative joint disease (DJD) or rheumatism. It can also affect other parts of the body such as the heart, lungs, small blood vessels, the nervous system and eyes. When this occurs, it is referred to as rheumatic disease. Any type of arthritis involves inflammation which can cause redness, swelling, stiffness, pain, loss of joint function and eventually joint deformity.

With RA, an auto-immune response – (the body’s immune system starts to attack itself) causes damage to certain joints. The body’s white blood cells (immune defence system) cannot differentiate from bad cells and its own body cells. Nobody knows what causes or triggers RA, but it has long been believed that infectious agents such as bacteria, viruses and fungi are involved in starting the inflammatory chain of events, although none have been proven as yet.

Some scientists believe that certain environmental factors can trigger the inflammation to start, and that there is a hereditary link to RA with genetic make-up influencing who is susceptible to it.

Who is affected by Rheumatoid arthritis?

RA affects two to three times more women than men and typically occurs between the ages of 25 and 50 years of age, although the onset can vary to affect children as young as six months old as with juvenile rheumatoid arthritis (Still’s disease)? also known as juvenile idiopathic arthritis (JIA).

The joints affected by rheumatoid arthritis differ to those affected by osteoarthritis due to the nature of the disease. OA affects the weight bearing joints, which become more prone to erosion through wear and tear. The affected joint distribution is usually non-symmetrical and can affect the whole spine.

With RA, it is the synovial joints (specific type of joint) that are affected. The distribution tends to be symmetrical – with the most common joints affected being the smaller joints of the hands and feet, although it can affect any synovial joint. RA for example will tend to affect the smaller joints of the hands and wrists away from the fingernails, where as OA will favour the joints closest to the fingernails.

To date, no-one really knows why some joints are affected over others with RA. In the past, some theories have included an increased blood supply being responsible for targeting the specific joints, although to date, these have not been proven.

How a normal joint works

In a normal joint, the bone surfaces are lined with cartilage, which acts to reduce friction and helps absorb the stresses that are placed on the joint in everyday situations.

Surrounding the joint is a very thin membrane (called the synovial membrane or synovium) that produces synovial fluid, and acts like a sac. This fluid is important in providing the nutrients needed to feed the cartilage to make sure it is healthy and provides as much lubrication as possible within the joint. Encapsulating the joint and synovium is the joint capsule – a tough coating which keeps everything together – to which ligaments and tendons surround, providing stability and movement to the joint. Damage to any of these structures can result in pain and swelling around the joint with a potential loss of function depending on the structure that has been injured.

In Osteoarthritis, as a result of repeated stresses and shock absorbing, the joint space starts to narrow and the cartilage within the joint starts to wear away, becoming damaged. It becomes thinner and no longer provides as much lubrication as before. The joint surfaces therefore start to rub, causing irritation and pain which in turn causes inflammation and swelling. The bone surfaces react to this change by laying down more bone often in the form of spurs at the end of the bones themselves. The joint becomes deformed as a result causing further pain and stiffness, and loss of normal movement. These changes can be seen on X-Ray as a narrowing of the normal joint space, changes in the bone density (areas of increases whiteness) directly at the joint and bony spurs (osteophytes) present on the outer margins of the affected joints.

In Rheumatoid Arthritis, usually an infection or incident will trigger the body’s immune system to attack its own tissues and start the inflammatory process. The white blood cells infiltrate the synovium surrounding the joints causing them to become inflamed. This causes an excess production of fluid within the joint itself and thickening of the synovial membrane (pannus formation). Pannus progresses to spread throughout the whole joint and starts to erode away the cartilage covering the ends of bone, and eventually the bone surfaces which ultimately results in the deformation of the joint. The changes can be seen on X-ray as the bone surfaces and margins are eaten away.

The symptoms of RA can vary from person to person. When the disease is active, the tissues are inflamed. When the disease is in remission, the inflammation has eased and the symptoms disappear with patients generally feeling well. Remissions can occur spontaneously or with treatment and can vary in length between weeks and years in duration. When the disease becomes active again the symptoms return. The first symptoms of RA can start as pain, swelling and stiffness in one or more of the same joints in both sides of your body (symmetrical distribution). They can start suddenly (acute onset) or more commonly, over a longer period of time (insidious onset). The morning joint stiffness lasts considerably longer than 30 minutes and is often accompanied with poor sleep due to waking up in the middle of the night from the joint pain and stiffness. Patients will often experience fatigue, weight loss and generally feel unwell or have flu-like symptoms.

Other parts of the body can also be affected, although this doesn’t happen with everyone. The inflammation of RA can cause swelling under the skin in the form of rheumatic nodules – firm, non-tender nodules under the skin present in approximately 25% of patients with RA. These typically occur at bony areas where there is frequent pressure such as the elbows, but can also occur elsewhere in the body including the internal organs. Even though these do not cause any symptoms, they can occasionally become infected. RA patients can also develop inflammation of the membranes surrounding the internal organs such as the heart causing pericarditis, nodules and ischaemic heart disease. In some cases, the lung tissue becomes inflamed (pleuritis), causing again nodules and fibrosis. Inflammation of the tear glands in the eyes and salivary glands in the mouth is often referred to as Sjögren’s syndrome and will result in dry eyes and mouth. Rarely, inflammation can affect the blood vessels (vasculitis) causing problems with the skin in the form of ulcers and the nerves. It is usually visible as tiny black areas around the nail beds or as leg ulcers.

Diagnosis of Rheumatoid arthritis

Your GP and usually a consultant rheumatologist (joint specialist) are required to confirm the diagnosis and will base it on whether a certain number of criteria have been filled. These may be less obvious during the early stages of the disease, but can be confirmed with blood test results.

A specific marker within the blood (rheumatoid factor or RF) is often present in RA and a selection of other inflammatory conditions such as Sjorgen’s syndrome, dermatomyositis, scleroderma, systemic lupus erythematosus (SLE). However, if RF is not present it does not necessarily mean that you do not have RA, and likewise, if you do have RF it does not necessarily mean that you have RA. There are two different types of RA – sero-positive RA when RF is present in the blood, and sero-negative RA when RF is not present in the blood. However, the type of RA does not influence the treatment in any way – it is used as a diagnostic aid for the diagnosing physician.

Below are the criteria that must be present for at least six weeks for a diagnosis of RA to be made:

• Stiffness in and around the joints lasting for at least 1 hour in the morning
• Swelling in the area surrounding the joints in three or more joint areas at any one time
• Swelling of the first finger (proximal interphalangeal), hand or wrist joints
• Symmetrical swelling.

Once diagnosed with RA, the physician needs to determine at what stage of the disease you are in to come up with the most effective treatment plan and rehabilitation program. This is usually defined through the presence of rheumatic nodules, rheumatoid factor and x-ray changes.

Treatment and management of Rheumatoid arthritis

Due to the nature of the condition, the focus of the treatment is to suppress the joint damaging process. This is usually achieved through medication to control the inflammation and disease progression and is usually administered in the form of DMARDs, steroids and biologic agents. In advanced cases where medication is not sufficiently controlling the joint damage, surgery might be required to deal with structural changes.

An early diagnosis is important to minimise the amount of joint damage and complications that can occur with RA and improve the quality of life.

Once under control, there are several ways to ease the symptoms. These include:

• education about the condition and support to patients with RA and their families,
• non-drug treatments including topical treatments and pain relieving strategies (rest and relaxation),
• physical therapy such as chiropractic and occupational therapy,
• pain-killers and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen,
• immuno-supressants
• joint injections and
• pain management clinics.

Can chiropractic help?

Chiropractic treatment is concerned with the diagnosis, treatment and prevention of disorders of the neuro-musculoskeletal system. This means we focus mainly on the nervous system, the muscles and joints of the body and aim to make them work as well as they possibly can do.

Having taken a full and thorough history and completed a full examination, your chiropractor will discuss the treatment options with you and how best to optimise the care given in between treatments.

This may be in the form of mobility, strengthening and supporting exercises, icing and heat advice, and advice in a choice of supporting aids as part of the multi-professional care team needed for patients with RA.

The Chiropractic management itself will focus on easing the stiffness in joints built up from immobility and lack of use from pain, and relaxing tight muscles aimed at maximising joint function and mobility.

The techniques used will vary depending on your individual circumstances and presentation as not all types of treatment are appropriate for everyone. The use of a Low Level Laser Therapy or cold laser has been shown to be effective in controlling inflammation and improve healing.

Psoriatic (Sor-ee-at-tic) Arthritis is an autoimmune inflammatory arthritis, similar to Rheumatoid Arthritis, but with a negative RA factor.  When we talk about ARTHRITIS, most people think of the good old fashioned wear and tear arthritis where the joint has lost it’s cartilage or lubricating factor, so that it’s bone on bone grinding.  This kind of arthritis is known as OSTEO Arthritis.

There is another kind of arthritis, at the other end of the spectrum, called INFLAMMATORY ARTHRITIS.  These are the AUTO-IMMUNE types of arthritis where your body attacks it’s own tissue, thinking your own tissue is a foreign invader.  The immune system goes in to over-drive as it attempts to fight what it thinks is a bacteria or virus.  White blood cells flood the area, in this case the joint, and this creates inflammation, which causes swelling, redness, heat and pain.  In this realm of inflammatory arthritis, there is a further separation into two categories.  On the one side is the Rheumatoid Factor, RF or RA positive, which includes Rheumatoid Arthritis, Systemic Lupus, Scleroderma, etc.  On the other side is the “Negative RA Factor” side, meaning there is no RF antibodies present and is called SPONDYLO-ARTHRITIS (spon-de-low).  The blood test that indicates this side of inflammatory arthritis is called HLA-B27 (Human Leukocyte Antibody) and includes the inflammatory arthritis categories as Psoriatic Arthritis, Ankylosing Spondylitis, Enteropathic Arthritis, and Reactive Arthritis.

Managing Arthritis In Dublin, Ireland

Psoriatic Arthritis (PsA) is a long-term inflammatory joint disease that may cause swollen and painful joints, skin lesions, and fatigue. If you are one of the many people who suffer from PsA, you know how frustrating and debilitating it can be.

Thankfully, there are treatments available to help manage PsA and improve your quality of life.

Dublin Physical & Chiropractic offers a variety of treatments specifically designed to help those with Psoriatic Arthritis. We have years of experience in helping people just like you get relief from their symptoms.

Contact us today to learn more about our services.

What Causes This Form Of Arthritis?

Psoriatic arthritis is an immune-related illness. PsA is believed to be a genetic disease that triggers the body’s immune system to attack healthy tissue, causing inflammation and damage in multiple areas of the body, including joints and skin.

Psoriatic arthritis affects about 30 percent of people with psoriasis (a common skin condition).

Psoriasis And Psoriatic 

Psoriasis causes patches of red, scaly skin. Psoriatic arthritis is more common in people who have a family history of the disease.

What Are The Risk Factors? Psoriatic Arthritis Diet 

There are two main risk factors, along with having psoriasis:

• Age: Psoriatic arthritis typically occurs between the ages of 30 to 35.
• A family history of psoriatic arthritis.
• Diet: Increased weight is associated with psoriasis.

Psoriatic Arthritis Symptoms 

The symptoms of psoriatic arthritis can vary from person to person and change over time. Some people may experience only mild symptoms while others may have severe PsA.

Symptoms may include joint pain, swelling, stiffness, and tenderness of the joints. Psoriatic Arthritis can affect any part of your body including:

• Fingers
• Toes
• Wrists
• Elbows
• Ankles
• Knees

PsA may also cause fatigue, a low-grade fever, and changes in mood.

How Is Psoriatic Arthritis (PsA) Diagnosed?

There is no definitive test for diagnosing psoriatic arthritis. A doctor will likely ask about your medical history and do a physical examination. He or she may also order tests such as:

• Blood tests (to check for inflammation)
• X-rays, MRIs, or CT scans to look at the affected joints and tendons.

Psoriatic arthritis is often misdiagnosed as rheumatoid arthritis, osteoarthritis, or gout because they share many of the same symptoms.

It is important to see a doctor who is familiar with PsA and can make an accurate diagnosis.

Treatment Of Psoriatic Arthritis In Dublin, Ireland

Suffering from psoriatic arthritis? You’re not alone.

Millions of people around the world suffer from psoriatic arthritis, and our team of experts specializes in providing an optimal treatment plan for this condition. We offer a range of evidence-based innovative treatment options that have helped many people achieve relief from their symptoms.

Our treatment options are drug-free, non-surgical interventions, and are tailored to you. You can be confident that we will work with you to develop a treatment plan that meets your specific needs and goals.

Contact us today to schedule a consultation and learn more about how we can help you manage your psoriatic arthritis.

How Do We Help People With This Form Of Arthritis

We use a combination of chiropractic, physical therapy, and other treatment modalities that are highly effective in Psoriatic Arthritis.

Chiropractic Care For Arthritis

A chiropractor will evaluate your spine, joints, tendons, and ligaments to determine if there is a misalignment of the vertebrae or injury to any of the components that make up the spine. Psa often affects areas such as the lower back, shoulder, and neck.

If there is misalignment or injury to these structures, a chiropractor will use a series of manual adjustments in an effort to restore alignment and improve mobility. Chiropractic treatment can help reduce pain and inflammation associated with PsA and improve mobility.

Physical Therapy Care

A physical therapist uses a variety of techniques to help reduce pain and inflammation associated with PsA, as well as improve strength and flexibility in joints that have been affected by PsA.

Physical therapy can include stretching, exercise therapy, massage therapy, and laser therapy.

Laser Therapy For Psoriatic Arthritis

We use a Class IV laser at Dublin Physical & Chiropractic. It is highly effective for reducing pain, swelling, and inflammation of arthritic joints, to allow freedom of movement and improved range of motion.

Laser therapy is also effective for skin conditions.

Laser therapy uses light therapy to increase cellular activity, speed up the recovery process, and promote cellular regeneration.

Ankylosing Spondylitis (AS) and Chiropractic Treatment

Ankylosing Spondylosis is an inflammatory disease affecting mainly the pelvic (sacroiliac) joints, spine and rib joint, causing pain and progressive stiffness.

It affects young male about four times as often as female.  Onset typically occurs between the ages of 15 to 45

Symptoms Of Ankylosing Spondylitis

The main presenting complaints in the early stages are lower back pain with morning stiffness that often wares off during the day with activity. In some cases the inflammation can be so severe that the pain is constant and severely disabling, but this is rare.

The pain and stiffness can progress to affect the mid back and neck, and in about a quarter of people with AS it affects the joints in the limbs, with the hips being the most common, affecting half the people with AS.

If the chest and ribs are affected, it can make it difficult to take a deep breath. The legs can become weak and numb if certain nerves are pinched or trapped but this is very rare.

What Is Ankylosing Spondylitis?

The exact cause is not fully understood but it is classified as an autoimmune disorder, which means that the body’s immune system is attacking some of its own cells causing ongoing inflammation. It is classified as one of the so-called sero-negative arthropathies (the rheumatoid factor is not present).

As it progresses, ossification is triggered by the body’s defense mechanism. Ossification causes new bone to grow along the ligaments between vertebrae gradually limiting movement and eventually fusing them together. Further, ossification may affect spinal ligaments causing narrowing of the spinal canal (central stenosis), which can result in compression of nerves but this is very rare.

What Tests Will The Chiropractor Do To Confirm AS?

Case history and Examination

The chiropractor will first of all review your general health and family medical history. It is important for the chiropractor to know if any family member has had the problem.

A family history of Ankylosing Spondylitis may be indicative in diagnosing this condition, but it is not necessary.

During the physical examination, you will be asked to move and bend in different ways so the chiropractor can see how flexible your spine is.

In the early stages subtle changes can be significant. In a later stage the mobility can be significantly reduced.

The chiropractor will also check your chest expansion which can be reduced in AS.

The chiropractor will also do a neurological examination.

X-ray Examination

If the findings in the history taking and examination suggest that you may have AS, the chiropractor will take X-rays.

The signs on X-rays are usually quite characteristic and if the findings correlate with the history and examination, a diagnosis can often be made with good accuracy.

There are very characteristic signs on x-rays that the chiropractor can look for.

In the early stages there is a widening of the pelvic (sacroiliac) joints (SI) with irregularity of the joint surface and sclerosis (whitening of the bone). There may be squaring of the vertebrae and mild calcification of the outer part of the discs (causing what is called ‘shiny corner signs’ and syndesmophytes).

In the later stages when the condition has been present, usually for many years, fusion may occur causing a so called ‘bamboo spine’.

A CT- or MRI-scan may be ordered to see the spine in greater detail, especially if the x-rays do not correlate with the findings in the history and examination.

However, we would inform your GP and normally suggest that you have blood tests taken to support the diagnosis.

Blood Tests

A blood sample is taken to look for an antigen called HLA-BA27, which is positive 96% of the time. But the presence of HLA-BA27 does not mean that you have AS for sure. It is just an indicator that you may have it. (An antigen is a protein that helps the body to make antibodies to fight infection.)

Blood tests are usually negative for rheumatoid factor, which will rule out Rheumatoid arthritis.

ESR is usually raised. This is an indication that your body is fighting an inflammation.

Why Do I Need These Tests?

When it comes to diagnosing a medical condition, one or a collection of symptoms can have many causes.

For example in AS, the most common presentation is pelvic (sacroiliac) joint pain from inflammation of the sacroiliac joint. Sacroiliitis (inflammation of the sacroiliac joint) can have many causes.

It can be caused by Psoriatic arthritis, Reiter’s syndrome, Ulcerative colitis or infection, to mention a few.

But by doing various tests one or the other condition can be ruled out. This is of course important so the most appropriate treatment can be given.

Chiropractic Treatment Of Ankylosing Spondylitis (AS)

The treatment includes nonsteroidal anti-inflammatory medication and physical therapy.

The chiropractor will show you exercises designed to strengthen your back, improve posture, increase flexibility, range of motion, and techniques to improve your breathing. We normally also use spinal manipulation of a kind that is safe and comfortable for you.

Because chiropractors specialize in treatment of lower back pain and usually have X-ray facilities on-site we often pick up when patients have AS early on.

Unfortunately, in some cases patients in past have been told by their medical practitioner that chiropractic treatment is not appropriate for them. But it is important to know that chiropractic treatment is a very helpful, safe and effective way of managing your AS.

We have had several patients over the years that have found that chiropractic treatment has maintained their mobility, improved their function and therefore helped to control their pain.

There is no doubt that anti-inflammatory medication will help if the inflammation is particularly bad. So, ideally you should be co-managed. Which means that your GP and/or rheumatologist and chiropractor should both be involved.

At the Isis Chiropractic Clinics we encourage co-operation between medical and complementary practitioners to give you the best possible care.

Here is some research for you if you want to read further.

Links to research

Research Link 1: Ankylosing Spondylitis and Chiropractic Care.

Research Link 2: Ankylosing Spondylitis and Chiropractic Care.