Health Whether it’s a health niggle, emotional problem or you’re just looking for guidance, Inspire magazine’s Dr Sarah Jarvis gets straight to the point QI have osteoarthritis in my hip and hands. My hip is now so bad that I use a crutch if I’m walking outside, but even that’s difficult because of my hands. I’m 53 and I’d heard it’s not advisable to have a hip replacement at my age because I’m likely to run into trouble in the future. Do I really have to suffer like this for another 10 years? Ann Waterson, St Ives the doctor Dr Sarah Jarvis answers: While 53 years old would be relatively young to have a hip replacement, it can still be done. In fact, in the last decade, the number of hip replacements carried out in England on those under 60 has increased by 76 per cent – from just over 10,000 in 2004-5 to almost 18,000 l ast year. There are several reasons for this. The first is that the surgical techniques have improved, and so have the prosthetics used to replace the worn joint. When I became a GP, patients were routinely advised that they could expect their ‘new’ hip to last a decade – now it could be two. The second is that with improvements in technique has come faster recovery time, so the surgery is not seen as quite as arduous as it was. Progress has also been made on reducing the risk of complications. Deep vein thrombosis (DVT) is a clot that usually forms in the deep veins of your calf. This can cause symptoms on its own, but part of the clot can also break off and travel to your lungs, causing a potentially life-threatening pulmonary embolus (PE). Every patient is now assessed for the risk of DVT when they go into hospital. Depending on your risk, you may be given blood-thinning tablets. It’s important to remember that you’ll need to take care of your new hip if you want it to last. A physiotherapist will give you exercises to do and it’s very important that you perform these regularly. The less strain you put your hip under, the longer it will last. It is possible to have a replacement of the replacement – a so-called revision hip replacement. However, revisions are more challenging than the first procedure, which is why having prosthetics that last 15-20 years has been such a game changer. Dr Sarah Jarvis answers: Raynaud’s disease is common – it’s thought that up to 10 million Britons are affected. In primary Raynaud’s, there is no obvious reason for it to occur, while in ‘secondary’ Raynaud’s there is an underlying disease – often an autoimmune disease in which your body’s immune system turns on part of your body and attacks it. This can include rheumatoid arthritis. The symptoms of Raynaud’s are caused by the small blood vessels – usually in the hands but sometimes also in the toes, earlobes nose or nipples – going into spasm and shutting off circulation. This is usually in response to the cold but can sometimes be triggered by emotional upset. As well as autoimmune conditions, some medicines could be to blame, as can other causes of damage to the blood vessels, such as frostbite. Avoiding getting cold is the mainstay of treatment for Raynaud’s. Smoking damages the blood vessels, and quitting can reduce attacks or prevent them from getting worse. Regular exercise may help improve your circulation, and could reduce stress levels if this is a trigger. Some medicines more commonly used to treat other things can be used if your symptoms are troublesome, such as heart treatment nifedipine, the anti- depressant fluoxetine and sildenafil (Viagra). Complications from Raynaud’s are rare, but occasionally the blood vessel spasm doesn’t resolve on its own and blood supply to the affected area can be seriously compromised. You should always seek medical help if there is any evidence of a skin ulcer in the affected area. You may find the Raynaud’s & Scleradoma website helpful. The helpline is free, confidential and open to anyone with arthritis and their families. Call 0808 800 4050 – the line is open Monday to Friday, 10am to 4pm. For a copy of our booklet, Surgery and Arthritis, call the helpline, write to Publications Orders, Arthritis Care, Floor 4 Linen Court, 10 East Road, London, N1 6AD or click here to email. QI’ve had rheumatoid arthritis for a decade, and in cold weather my hands get freezing cold and the skin colour changes. This has been happening for a few years, but it’s getting more and more painful. My doctor says it’s called Raynaud’s disease, but doesn’t seem to have any solutions. Could it do serious damage to my hands? Jo Chambers, Exeter Do you have a problem you’d like answered? If so, write to us at: Inspire magazine, 1 Cambridge Technopark, Newmarket Road, Cambridge CB5 8PB or email inspire@ arthritiscare.org.uk