Health Dr Sarah Jarvis A s if living with arthritis wasnt enough, around four in five people with conditions such as rheumatoid arthritis have at least one other medical ailment. Sometimes, as with carpal tunnel syndrome, its directly thanks to inflammation of your soft tissues, while with other conditions it could be related to chronic inflammation. Whatever the reason, a healthy lifestyle and not hesitating to seek medical help if youre struggling are really important. Osteoporosis Osteoporosis, or thinning of the bones, leads to more than one in three women and one in five men breaking a bone at some point. As a woman, the risk increases after the menopause and is higher if you went through the menopause before the age of 45. For both sexes, you are at increased risk of osteoporosis if other people in your family have it or have broken a hip; if youre immobile; or if you have other conditions, including rheumatoid arthritis (RA). In fact, if you have RA, youre up to twice as likely to have osteoporosis and to break a bone than people of a similar age who dont have RA. Osteoporosis is more common if you have RA because youre more likely to be immobile and more likely to have taken high-dose steroids, which increase your risk. Its really important to speak to your doctor about osteoporosis if your condition makes it hard for you to get about or if youve taken steroid tablets. They may recommend a DEXA bone scan and, if this shows evidence of osteoporosis, prescribe bisphosphonate medication (usually taken weekly) or other treatments to improve bone density. While many medical conditions are made worse by being overweight, your risk of osteoporosis is increased by being very underweight. Keeping your alcohol intake low, avoiding smoking, getting enough calcium in your diet, taking a vitamin D supplement if you dont get out in the sunshine much, and trying to do regular weight-bearing exercise (pretty much anything except swimming or cycling) will all help cut your risk of osteoporosis. Fibromyalgia Many medical conditions are made worse by being overweight, but your risk of osteoporosis is increased by being very underweight Fibromyalgia is a long-term condition that causes pain and tenderness all over your body. It doesnt affect your joints, but causes widespread pain in the muscles, tendons and ligaments. As well as pain, it often leads to tiredness which can be severe in addition to headaches, pins and needles in fingers and toes, irritable bladder or bowel, and restless legs syndrome. While about one in 12 people develops fibromyalgia at some point, most often between their mid-20s and mid-50s, it affects up to one in five people with rheumatoid arthritis. The reason for this link isnt clear. While rheumatoid arthritis is an autoimmune disease (where the immune system attacks part of your body), fibromyalgia may be because of an imbalance in brain chemicals that affects the way pain signals are transmitted in the brain and central nervous system. Its possible that chronic pain in rheumatoid arthritis makes your nervous system even more sensitive to pain. Chronic inflammation may also play a part. Pain-relieving medication may ease the pain of both rheumatoid arthritis and fibromyalgia. Antidepressant and anti-epilepsy medications, which damp down signals in the nervous system, may help fibromyalgia pain. While exercise does not always help fibromyalgia, it does improve symptoms for many people, as long as you build up very gradually, ideally with help from a specialist physiotherapist. Heated-pool therapy may also help. Depression Both rheumatoid arthritis and fibromyalgia can increase your risk of depression hardly surprising if youre in chronic pain. There is also some research that suggests inflammation in rheumatoid arthritis may lead directly to depression in some people. Its important to speak to your doctor if your mood is affected by either or both conditions talking therapy is available on the NHS and can be really helpful. Anaemia Anaemia a shortage of red blood cells or haemoglobin is one of the commonest causes of tiredness. Its three times more common in people with rheumatoid arthritis. In about one in four cases, its down to iron deficiency. If youre feeling tired or breathless, its important to speak to your doctor. They can check for iron deficiency, which is usually easily treated. If your iron isnt low, you may still be anaemic because of the chronic inflammation associated with rheumatoid arthritis. Your doctor can advise on whether referral to a haematologist, who specialises in blood disorders, is needed. istock.com / michellegibson All about multiple conditions Many medical conditions are made worse by being overweight, but your risk of osteoporosis is increased by being very underweight