Health Living with multiple conditions Dealing with arthritis is one thing, but what if you have another health issue at the same time? words: PeteR stannett W hen someone has one or more conditions or disabilities, its known a cLoser Look as co-morbidity. The Kings Fund, the charity that shapes health and social care policy and practice, says Close monitoringthere are around 15 milliongroups. One waswho have of rheumatoid two people in England a nursearthritis and other conditions, long-term conditions,led programme, and becomes more such as arthritis, and it the other a common ashealth professionals both by you get older. self-assessment of the disease and patients, has been shown activity group. Heart problems to lead to better outcomes. The It showed that more coTwo of the most commonly co-occurring conditions in older people are research, conducted in Paris morbidities were identified in osteoarthritis and cardiovascular diseases, such nurse-led or heart attack. A with 970 patients, looked at the as a stroke group, but that study in Canada has suggested that total joint replacements may reduce the risk of heart conditions and strokes, reduce pain and increase both mobility and survival rates in people with osteoarthritis. The fact that people who have had joint replacements are more mobile and capable of taking exercise may go some way to explaining this. a cLoser Look the self-assessment group identified more changes in RA, drugs and drug dosages. This find out more study suggests that both closer monitoring by professionals and the person with arthritis is likely to be beneficial. Obesity The association between osteoarthritis and obesity is a well-known risk factor in the onset and progression of osteoarthritis. Obesity can also have an adverse effect on surgery. Weight-loss can reduce the symptoms, and it has been found that decreasing the amount of body fat and increasing physical activity results in the relief of symptoms of osteoarthritis of the knee. Rheumatoid arthritis Cigarette smoking has been shown by numerous studies to be associated with the risk of developing rheumatoid arthritis (RA), and the risk increases with how many cigarettes you smoke and for how long. However, the risk does decrease 10 to 20 years after youve stopped smoking. Depression It has been suggested that the incidence of depression in RA is 13-20 per cent, which is nearly three times the rate found in the general population. Poor sleep and fatigue are often assumed to be symptoms of RA, when in fact they are indicators of depression or anxiety. There are a number of reasons why depression may go undiagnosed in people with arthritis. The graph below shows that, of the people with arthritis who called the Arthritis Care Helpline in 2015, people with different types of arthritis experienced different co-morbidities. Overall, 10 per cent of callers with arthritis said that they were living with another condition, the most common being depression and mental health issues, followed by osteoporosis and cardiovascular disease. Our sample shows that, of those with RA, 26 per cent had depression and other mental health problems. Of those with gout, 27 per cent also reported cardiovascular problems. The drug allopurinol is used to treat and prevent gout, which occurs when too much urate naturally produced in the body is generated and forms crystals around the joints. Allopurinol blocks an enzyme that is involved in the production of urate. Keeping the amount of urate low means that the crystals are able to dissolve, which prevents further attacks of gout. However, allopurinol may increase the blood-thinning effect of the drug warfarin. This is prescribed when people have a condition caused by a blood clot such as a stroke, heart attack or deep vein thrombosis. Around 40 per cent of people with gout also have high blood pressure, with many not realising that gout is a form of arthritis. In some cases, it is a challenge for doctors to treat co-existing conditions because some drugs used for one may interact with drugs to treat others. Having your treatment reviewed regularly ensures that you receive the best treatment available. If you are taking more than one prescription medicine, or you are taking medicinesfor a long-term condition, you can visit your local pharmacy for a free Medicines Use Review. It is an opportunity for you to discuss your medication with a pharmacist, to understand how your medicines should be used and why they have been prescribed, as well as solving any problems you may have with them. there are a number of things you can do to manage living with arthritis and one or more co-morbidities: n Manage your weight n Review your medicines annually n Be aware of how your medicines affect each other n Ask your GP if other treatments may help n Seek emotional support Peter Stannett is information find out more officer at Arthritis Care. For more about a Medicines Use Review from your local pharmacist, visit here
