Rheumatoid arthritis can affect people from a very young age. Its exact cause is unknown but it is an autoimmune disease — there is a fault in the body’s natural self-defence system, making it attack its own tissues. The joint membranes become inflamed, and cartilage and bone degenerate.

Osteoarthritis is wear and tear of the joints and usually affects people over the age of 40. The smooth cartilage which takes the strain in a normal joint becomes rough and brittle, and the bone beneath thickens and spreads out to compensate. Eventually, bones start to rub against each other and ligaments become strained. As a result, the joint becomes deformed, inflamed and painful.

Diagnosis: A GP may begin to suspect arthritis if joint pain and stiffness do not settle after a couple of days and there is no other obvious cause for reduced mobility in the joint. Further tests will be necessary to produce a definite diagnosis.

The two most important tests are X-rays, which reveal bone damage in the joint; and blood tests, which can indicate the extent of inflammation in the body. These tests will normally be carried out at a hospital. At the same time, or shortly afterwards, the patient may be referred to an arthritis specialist (rheumatologist or orthopaedic surgeon), who may recommend further tests such as a magnetic resonance imaging (MRI) scan.

Treatment: Joint damage can occur soon after arthritis starts, so early treatment is very important. The two most important elements of treatment are drugs and exercise. The medicines prescribed may be to relieve pain (for example, analgesics such as paracetamol and coproxamol, and stronger prescription drugs). Other drugs will reduce inflammation in the joint (for example, non-steroidal anti-inflammatory drugs or, occasionally, steroids — the latter may produce side-effects so are prescribed only in severe cases). There is also medication to act on the immune system. “Disease-modifying” medicines may be used for autoimmune forms of arthritis; the drugs act on the immune system itself rather than the symptoms of the disease and are taken orally, or given by injection.

The right exercise can help to keep joints mobile and build up muscles around them, so that they take the strain. An arthritis specialist may provide advice on this or refer the patient to a physiotherapist, who can teach specially designed exercise programmes and provide strengthening and pain-relieving treatments such as hydrotherapy.

If damage to a joint is severe and other treatments are not making life easier, surgery may be the best option. Joint replacement — of the hip, knee, ankle, shoulder, elbow, wrist or finger joints — is the most common form of surgery for arthritis, but others include removal of an inflamed joint lining, repair of joint tendons, removal of bone “spurs” and release of trapped nerves.

Incidence: More than seven million people in the UK are affected — 15 per cent of the population. Rheumatoid arthritis affects one in 100 people and most commonly starts between the ages of 30 and 50. Three times as many women are affected as men. The risk of osteoarthritis increases with age. Women, and anyone who is overweight and already has a joint injury, are more likely to develop the condition.

“As the treatment of arthritis has become more and more successful, more people have come forward, particularly those with spondyl arthritis, of which ankylosing spondylitis is the most common,” says Paul Emery, professor of rheumatology at the University of Leeds. “These conditions involve inflammation of the vertebrae, but because they aren’t obviously arthritis, people have not realised treatments were available.”

It is thought that one per cent of the population is affected by these conditions.

New research/developments: Humira, a new drug for rheumatoid arthritis, was launched in September. It mimics the body’s natural antibodies and dampens down the inflammatory process by targeting one key protein, tumour necrosis factor. (Rituximab is another similar drug.) Patients inject themselves fortnightly with a pre-filled syringe — not only can they do this at home but, as the medication is ready mixed, it is easier for people whose hands are badly affected by the disease to administer.

It has been shown to be effective against rheumatoid arthritis: it works by stopping the production of auto-antibodies — the bad antibodies that lead to the inflammation — and has been found to be most powerful when given with other conventional arthritis drugs such as methotrexate (all of the newer drugs have been found to be more potent when combined with methotrexate).

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