Joint pain is widely considered to be a universal and inevitable sign of ageing. While it is true that aches and pains do tend to increase with age, there are many forms of arthritis, and not all are age-related. A growing number of young people are affected as well, and some types even affect children.
Arthritis is a condition causing painful inflammation of one or more joints. There are two major types of arthritis: osteoarthritis and rheumatoid arthritis. Both damage joints but in different ways. According to the Chinese University of Hong Kong, osteoarthritis is particularly common in Hong Kong and is one of the most frequent causes of disability in the elderly. On the other hand, despite a very low prevalence of rheumatoid arthritis (roughly 20,000 to 30,000 people), it is the most common type of autoimmune arthritis and has killed more than 30,000 people in Hong Kong.
What is Arthritis?
Arthritis develops when there is damage to the cartilage, bone or synovium (lining) of a joint. Cartilage is connective tissue in our joints that cushions them by absorbing the pressure and shock created by movement and applied stress. When cartilage is insufficient, the joints become more susceptible to friction and damage, which leads to pain and inflammation.
The two most common types of arthritis are:
- Osteoarthritis: Normal wear and tear causes this form of arthritis; however an infection or injury in a joint can speed it up, particularly in the neck, lower back, hips and knees.
- Rheumatoid Arthritis: Rheumatoid Arthritis is an autoimmune disorder where the body’s immune system attacks tissue in the body. One of the tissues affected is synovium, which provides nutrients for the cartilage and makes the joints smooth. The synovium becomes inflamed and swollen, and eventually, the joint cartilage and even the bones can be destroyed. It most often affects the finger joints initially but may affect many other joints in the body.
There are well over 100 forms of arthritis. Other common types of arthritis include psoriatic arthritis, gouty arthritis, ankylosing spondylitis and reactive arthritis.
Signs and Symptoms
Arthritis symptoms include some or all of:
- Restricted joint movement
- Joint pain
In the case of rheumatoid arthritis, you might also experience:
- Morning stiffness lasting anywhere from 30 minutes up to several hours
- Loss of appetite
- Anaemia (low red blood cell counts)
Risk Factors for Arthritis
The risk of developing arthritis may be affected by:
- Genetics: Some forms of arthritis run in the family. In these cases, your genes may make you more susceptible to environmental factors that trigger arthritis
- Age: The risk of arthritis including osteoarthritis increases with age
- Gender: Certain types of arthritis target one gender more than the other. For example, rheumatoid arthritis happens 2.5 times more frequently in women than in men.
- Previous Joint Injury: People who have suffered a joint injury are more likely to develop arthritis in that joint in the future
- Obesity: Carrying extra weight puts stress on the joints, especially the knees, hips and spine, resulting in a higher risk of arthritis.
How is it Diagnosed?
There are several ways to diagnose arthritis:
- Physical Exam: Your doctor will check the joints for swelling, redness, warmth and difficulty in movement.
- Laboratory Tests: Fluids might be taken from your body to determine the type of arthritis you have. The fluid sampled may be blood, urine or joint fluid. The joint fluid is typically taken by inserting a needle into the joint space.
- Imaging: Different types of imaging tests can be performed to detect problems in the joints, including X-rays, CT scans, MRI or ultrasound.
How is Arthritis Treated?
Arthritis treatment focuses on relieving pain and improving joint function. Treatment modalities may include:
- Medication: Medications can help relieve pain and inflammation, and some can even alter the course of the disease. Some commonly used ones are:
- Analgesics (reduce pain), e.g. Paracetamol, Tramadol
- Non-steroidal Anti-inflammatory Drugs, or NSAIDs, (reduce both pain and inflammation), e.g. Ibuprofen, Diclofenac, Celexicob
- Pain modulators (alter the body’s perception of pain), eg. Pregabalin, Amitriptyline
- Counterirritants (interfere with the transmission of pain signals from the joint), e.g. Capsaicin, Menthol, Methyl Salicylate
- DMARDs (slow or stop your immune system from attacking the joints in the case of rheumatoid arthritis and other autoimmune forms of arthritis), e.g. Methotrexate, Hydroxychloroquine, Sulfasalazine
- Biologic response modifiers (drugs that target various protein molecules that are involved in the immune system), e.g. Anakinra, Rituximab, Tocilizumab
- Corticosteroids (reduce inflammation and suppress the immune system), e.g. Betamethasone, Prednisolone, Hydrocortisone
- Physical therapy: Exercises that can improve range of motion and strengthen the muscles surrounding joints.
- Surgery: Joint repair, joint replacement and joint fusion are some of the procedures that doctors may recommend, depending on which joint is hurting and the degree of damage.
Should I Take Supplements Like Glucosamine and Chondroitin for Arthritis?
What are glucosamine and chondroitin? Glucosamine promotes growth and repair of cartilage, as it is a structural component, while chondroitin is one of the building blocks of connective tissue. Some people believe that taking these supplements provides more raw materials for cartilage formation and thus may alleviate symptoms of arthritis.
The use of such supplements for arthritis is, however, still a matter of debate, as research results are conflicting or show insignificant improvement. Despite this, a variety of products and commercials in the market praise their effectiveness. Consult your pharmacist or doctor if you would like to take them.
Do’s and Don’ts When Diagnosed with Arthritis
- Exercises that help build weight-bearing capacity and strengthen the muscles around the joints without damaging the joints themselves. An occupational therapist or a physiotherapist can help determine which exercises are best for you.
- Eat a diet with plenty of natural antioxidants such as those found in fruits, vegetables, fish, nuts and herbs. These foods may help reduce inflammation.
- Walking aids help reduce pressure on joints.
Avoid activities that involve high impact and repetitive motion, such as:
- High-impact aerobics
Prevention of Arthritis
- Minimise weight in the joints, especially the knees, by reducing body weight and avoiding carrying heavy weight
- Avoid prolonged standing or walking
- Avoid putting the joints in one position for long periods of time
- Find a balance between work and rest
- Joint exercises
What is the cost of Arthritis Treatment in Hong Kong?
Costs of arthritis treatment in Hong Kong’s Public Sector:
For eligible persons with a HKID card, the cost for a specialist outpatient consultation is $135 for the first attendance and $80 per next attendance, and $15 per drug item.
For non-eligible persons without a HKID card, the cost for a specialist outpatient is $1,190 per day.
Costs of arthritis treatment in Hong Kong’s Private Sector:
Cost will vary widely depending on what is needed. Surgery and certain newer medications can be expensive.. The price for a full physical check-up ranges from $1,000-$4,000 while surgery (depending if its for hip, knee, etc) ranges from $50,000-$190,000
* All amounts are in HKD and were last updated in July 2020. No responsibility is accepted for any inaccuracies, errors, or omissions. It is always best to call ahead to make sure the information is still up-to-date.
Useful Resources for Arthritis in Hong Kong
Dr. Sarah Borwein is a Canadian trained General Practitioner who co-founded the Central Health Group and has been practicing family medicine in Hong Kong for over 15 years. After obtaining Certification in Family Medicine from the College of Family Physicians of Canada, she completed a Masters degree in Infectious Diseases from the London School of Hygiene and Tropical Medicine. She worked as a staff physician at the Beijing United Family Hospital where she was Director of Infection control during the SARS outbreak in China. A French speaker, Sarah is the advising and referral doctor for the French Consulate in Hong Kong. She is the site director for GeoSentinel (an international disease surveillance network) in Hong Kong and is past President of the Asia Pacific Travel Health Society. In addition, she sits on the Centre for Health Protection's Scientific Committee on Vector-borne Diseases, which advises the Hong Kong Department of Health on this type of illness.