Fatigue is a really common symptom experienced by most people at some time in their lives. It’s that feeling of persistent tiredness, exhaustion or low energy levels. Fatigue if often described as having many dimensions by patients:

• physical fatigue – not having enough energy to do physical activities,
• cognitive fatigue – less ability to concentrate and focus,
• emotional fatigue – feeling upset, distressed and
• living fatigue – inability to carry out daily tasks and social activities people need to.

Some patients may describe fatigue as overwhelming, not being helped by sleep and that it tops the list as their most disabling symptom.

What causes fatigue?

There are several medical causes for fatigue, some serious – so it’s important to see your GP to screen for these. It is also true that patients with many rheumatic conditions, including Fibromyalgia, Polymyalgia Rheumatica, Ankylosing Spondylitis, Lupus, Rheumatoid Arthritis, Sjogren’s Syndrome and even Osteoarthritis, commonly complain of fatigue. For example, fatigue affects up to 4 in 5 of patients with Rheumatoid Arthritis, and is felt to be severe by half of these. Fatigue associated with arthritis may be related to underlying inflammation, anaemia or medications, but for a large component of arthritis-related fatigue, the cause is unknown. The fact that some disease modifying anti-rheumatic medications seem to have a beneficial effect on arthritis-related fatigue suggests that inflammation has a pathological role, but it is also likely that fatigue occurs (and persists) due to a combination of medical (e.g. the level of inflammation), psychosocial and person-specific factors (such as mood and social support). Some studies have shown that fatigue is associated with mood and pain levels.

The effects of fatigue.

Studies have shown that inflammation can have effects on neural chemical pathways and the brain, which in turn can lead to fatigue, pain and depression. Patients often report negative effects on their well-being, mood, relationships and work. In Rheumatoid Arthritis patients, fatigue has been found to contribute to more than half of the problems these patients experience with physical and social functioning. Unsurprisingly, fatigue is associated with time off work and lack of productivity when at work.

How can we measure fatigue?

Healthcare professionals can use certain scoring systems to calculate the impact and severity of fatigue and also the response to interventions. The best ones capture the multiple areas that fatigue affects and are reliable, valid, sensitive and acceptable e.g. the Bristol Rheumatoid Arthritis Fatigue Scale, in Rheumatoid arthritis patients, the widely used SF36, measuring fatigue in many conditions, and the Chalder Fatigue Scale, used in chronic fatigue syndrome.

What can I do?

• Seeking medical advice from your GP (and, as needed, your Rheumatologist) is essential, to see if there is an underlying medical cause that may need specific investigation and treatment, for example with disease-modifying anti-rheumatic medications to reduce inflammation. Whereas there are many medical treatments to stem inflammation in patients with arthritis-related fatigue, fatigue often persists, but there are other evidence-based treatments that may help.
• Increasingly, healthcare professionals are encouraging self-management of fatigue through talking therapies such as Cognitive Behavioural Therapy (CBT), which can have lasting effects on reducing fatigue in some conditions. Initially, CBT usually involves a series of sessions with a CBT Therapist, which are designed to explore and challenge health beliefs and ideas about fatigue, followed by resetting  or reframing these beliefs and developing achievable goals.
• Trying to conserve energy is often advised, and a useful mnemonic is the Four Ps:
  • Problem solving – how to use less energy when my fatigue levels are high.
  • Planning – how to spread out energy-draining tasks over time, to lessen their impact.
  • Prioritising – how to try and do the tasks that are important first.
  • Pacing – how to break tasks down into achievable chunks and allow for rest periods in-between.

An occupational therapist may be able to help you with these.

• Some medications that are used in depression treatments can, interestingly, also help with managing fatigue. These need to be prescribed and medically supervised. If persistent pain accompanies your fatigue, your Rheumatologist may suggest you see a Consultant Pain Specialist, such as Dr Jon Valentine.
• Try exercise – Finding a good physiotherapist, osteopath or chiropractor is essential to help develop a manageable exercise programme. Although doing too much can increase fatigue levels, a lack of exercise reduces fitness levels and contributes to muscle weakness (de-conditioning). Exercise therapy may be useful in some patients with persistent fatigue. It’s usual to start slowly and to build up gradually under the supervision of a therapist.

For more information – please look at the Versus Arthritis website information. which can be found at:

The post Fatigue appeared first on London Sports Orthopaedics.

For further information on Ankylosing Spondylitis please visit the Versus Arthritis website:  CLICK HERE

The post Ankylosing Spondylitis appeared first on London Sports Orthopaedics.

For further information on Fibromyalgia please visit the Versus Arthritis website: CLICK HERE

The post Fibromyalgia appeared first on London Sports Orthopaedics.

What is gout?

Goutis a type of arthritis  that  was noted by the Ancient Egyptians more than 2000 years BC. It causes pain and swelling in the joints. It can develop in some people who have an elevated level of a substance called uric acid or urate in their blood  – this is called hyper- (elevated) uricaemia (urate level in the blood). Urate can build up and form crystals that can inflame joints, but not everyone with hyperuricemia gets gout. The inflammation of gout happens when your own cells try to engulf and digest the urate crystals found in synovial joint fluid, the fluid that bathes and lubricates joint surfaces. This causes a cascade of chemical reactions in and around the joint, which cause the pain, redness, and swelling people feel. Urate crystals can also cause kidney stones, which can damage the renal system.

Gout tends to affect men between the ages of 30 and 45, and women usually after their menopause, but other ages can be affected, especially if there is a family history of gout in a close blood relative.

Risk factors

Risk factors that increase your chances of developing Gout include:

• being obese
• having skin conditions like psoriasis
• being dehydration
• having high blood pressure
• having chronic kidney disease
• heavy drinking of alcohol on a regular basis (particularly beer)
• eating large amounts of meat or seafood
• drinking drinks containing high fructose (such as some fizzy drinks)
• taking  certain medications that  increase blood levels of urate.

What are the symtoms of gout?

Gout attacks or flares give sudden episodes of severe pain accompanied by redness and swelling of and around (usually one) joint, such as a big toe or knee, or in a joint affected by other types of arthritis. However, some people with gout have several acutely inflamed joints at a time. The attacks of pain can wake people up at night, but they can occur at any time. These acute symptoms usually peak within a day and generally completely disappear within 7 days, even if the person does not have any treatment.

Further acute gout attacks can occur within the next couple of years, and if gout is left untreated, the interval between gout attacks / flares may get shorter and the flares may become more severe.

Some people who have repeated gout flares for many years can develop gouty “tophi” –  deposits containing large numbers of urate crystals. Tophi can occur in a number of places, including the ear and around joints and tendons, and may ‘eat into’ (or ‘erode’) bone, leading to joint damage and deformity – this is called ‘erosive chronic tophaceous gout’.

Tophi can cause pressure on the parts of the body they build up on, and when they become inflamed, they can cause a Gout flare.

Urate crystal renal (kidney) stones occur in about 3 in every 20 people with gout. A common symptom of kidney stones is pain on the sides of the back and abdomen.

Kidney stones can also cause blockages and damage to the renal system.

Diagnosing gout

Many illnesses can cause joint pain and inflammation, sometimes making gout hard to diagnose, as symptoms are similar to other conditions; however, usually the history gives your Rheumatologist the clues to making the correct diagnosis. To help, you may be asked to have some blood tests, urine tests, an ultrasound scan or X-rays, and sometimes a needle is used to take a sample of fluid from the inflamed joint, and this fluid is then analysed in the laboratory.

Consider calling call NHS 111 or going to your nearest A&E Department if the pain is getting much worse, and particularly if you have a very high temperature or you feel hot and shivery, as this could mean that you actually have an infection inside the joint, and this might need urgent treatment.

Treating gout attacks

The aim of treatment is to reduce symptoms as quickly and safely as possible. You may be advised to

• Take medicine (e.g. a non-steroidal anti-inflammatory drug (NSAID) such as Ibuprofen, or a different medication called Colchicine, if you are allowed to have these (always check with your GP or a Pharmacist), and you should notice a response within 3 days.
• Rest and raise the inflamed joint.
• Apply an ice pack or a bag of frozen peas wrapped in a towel (to avoid skin burns) for up to 20 minutes at a time.
• Drink lots of water (unless you have been told not to by your doctor)
• try to avoid putting pressure on the affected area

NSAID medications: these include Ibuprofen, and they are for short-term use. Further information on NSAID medications can be found at:

Colchicine, which was originally derived from the Autumn Crocus plant, may be prescribed for a gout flare instead of a non-steroidal anti-inflammatory like Ibuprofen. It is a prescription-only medication and can be very effective for stopping flares, but it can cause gastrointestinal side effects in higher doses.

Glucocorticoids, otherwise known as steroid medications, are effective and frequently used for treating Gout flares. They are prescription-only and may be given orally or delivered straight into the joint by injection. Further information about joint injections can be found at:

Preventing gout

Rheumatologists suggest long-term prevention therapy to some people, to limit the chances of damaging joints and to reduce the risk of getting further acute tacks and complications such as tophi, kidney stones and kidney damage.

If you are having frequent, prolonged, painful or disabling Gout flares, or if you already have joint damage or tophi, your Rheumatologist may well  advise starting long-term urate-lowering therapy. Blood tests can show a reduction in serum urate with the correct treatment, and Rheumatologists try to set a target to lower blood urate closer to a concentration of 300 micromol/L. Often the medication is required indefinitely, as coming off medication can precipitate hyperuricemia and gout returning.

Prescribed medications lower urate by increasing your kidney excretion of urate, or by reducing the body’s production of urate, or by directly breaking down urate. Allopurinol and Febuxostat work by preventing urate forming, and  Allopurinol is the most  commonly used preventative medication. Both are effective, but they can cause side effects in some people.

Further information about Allopurinol and Febuxostat can be found at:

Colchicine is often prescribed alongside Allopurinol for the first 6 months of Allopurinol treatment, as some people notice more attacks when starting Allopurinol, Colchicine can help prevent these occurring.

Dietary modification

Changes in diet are often recommended, and may help lower your urate by up to 15%. Losing weight can also help in the management of gout, as obesity is a known risk factor. A healthy diet and weight loss can bring benefits to your health in general. However, extreme diets are not advised.

The UK Gout Society (http://www.ukgoutsociety.org) has more detailed advice on diets for people who have gout, which can be found at:

http://www.ukGoutsociety.org/PDFs/Goutsociety-allaboutgoutanddiet-0917.pdf

The NHS website on Gout (https://www.nhs.uk/conditions/gout/) advises:

• “get to a healthy weight, but avoid crash diets – you could try the NHS weight loss plan,
• aim for a healthy, balanced diet, with plenty of vegetables and some low-fat dairy foods,
• have at least 2 alcohol-free days a week,
• drink plenty of fluids to avoid getting dehydrated,
• exercise regularly – but avoid intense exercise or putting lots of pressure on joints,
• stop smoking and
• ask a GP about vitamin C supplements”

Treating associated conditions

Gout can be associated with being overweight, high levels of cholesterol, diabetes, high blood pressure and cardiovascular disease. It is important that people with gout are checked for all these associated problems and that these issues are treated in their own right as well as the gout being appropriately managed.

Further information on Gout  can also be found at:

About Dr Simon Paul

Dr Simon Paul specialises in looking after people with gout using an holistic approach, which may include medications, injections and various non-medicine-based therapies, all tailored to the person’s individual circumstances. Successful treatment allows the person to take control of the disease, reduces the frequency of gout attacks and helps reduce potential complications.

For further information about Dr Simon Paul CLICK HERE

The post Gout appeared first on London Sports Orthopaedics.

There are many factors which are associated with developing OA, and it most frequently affects the hands, knees, hips, and spine. It is the commonest type of arthritis worldwide and it also can occur along with other types of arthritis.

OA is considered a chronic condition that can gradually worsen; however, OA treatment can help improve symptoms and your ability to move and do the things you want to.

Dr Simon Paul specialises in looking after people with OA using an holistic approach, which may include medications, injections, various non-medicine-based therapies, and in some cases, surgery; all tailored to the person’s individual circumstances. Successful treatment allows the person to take control over the disease and mange their symptoms.

For further information on Osteoarthritis please visit the Versus Arthritis website:  CLICK HERE

The post Osteoarthritis appeared first on London Sports Orthopaedics.

Rheumatoid arthritis symptoms may develop gradually. Some people with this type of arthritis have continual symptoms whereas others may have flare-ups and then periods when the disease is well controlled, called ‘disease remission’. The pattern and severity can vary greatly from person to person.

Prompt treatment plays a vital role in combatting the inflammation and the possibility of permanent joint damage. Treatment is usually needed under the direction and supervision of a Consultant Rheumatologist, who specialises in looking after people with this disease using an holistic approach, which includes the use of medications and injections, various non-medicine-based therapies, and in some cases, surgery; all tailored to the person’s individual circumstances.

For further information on Rheumatoid Arthritis please visit the Versus Arthritis website: CLICK HERE

The post Rheumatoid Arthritis appeared first on London Sports Orthopaedics.