Inspire Spring 2024

GET THE BEST NIGHT’S SLEEP Wave goodbye to night wake-ups EASE INTO EXERCISE Is yoga an answer for sore joints?

STEP OUTSIDE

Here’s how to have the best days out, whatever the weather

Have you recently…

Retired? Welcomed a new addition to the family?

If so, you may need to update your will. And we can support you to take the next steps.

Moved house?

Married or remarried?

Entered a civil partnership?

to the service that works best for you. And don’t worry, we understand it’s not always easy to get out and about – there are options to write your will online or at home with a solicitor.

Planning for the future is important for everyone. An up-todate will helps us to look after our loved ones when we die, and makes sure that our wishes are carried out, so the right people receive what we want them to. This can give those closest to us peace of mind at the most important time.

Despite this, most of us don’t have a recent will in place. This is often because we don’t know where to start, or there might be other challenges, like cost, to consider. We understand this and can help you to write your will, for free, through our will writing services.

Whether you’re starting the process from scratch – or perhaps a recent life event like marriage or grandchildren means you wish to update your will – the process is simple. Get in touch on the details below and we can connect you

“I didn’t hesitate to add Versus Arthritis to my will – and their free will service made it so easy. A gift in your will is a belief in more amazing, life-changing moments, for more people in the future.”

Ian, who lives with psoriatic arthritis

Once you’ve taken care of your loved ones, we’d be so grateful if you could consider a gift in your will to Versus Arthritis. These special donations fund a third of the work we do and are essential to the future plans we’re making. With your support, we can fund new advances in world class arthritis research, could help more people access treatments that ease their pain, and the tools they need to manage their condition – or perhaps the cures they need to stop their arthritis all together. All gifts, no matter what size, make a real difference.

Welcome...

… to the spring edition of Inspire! We’re here to share ideas, stories and tips for living with arthritis.

Are you coming out of your cosy winter cocoon? There is a lot to consider with arthritis and how it impacts your body, so days out may be a worry. Read about how to make them less stressful by being more prepared and finding the best outings for you (page 41).

We are very excited that our special guest, the Arthritis Foodie Emily Johnson, is here to share her journey with arthritis, from first symptoms, diagnosis and treatment, to self-management through diet (page 20). Then turn to page 37 for some of Emily’s most recommended recipes, which she wrote with arthritis in mind.

Pain and inflammation are very common in arthritis, and some people manage them with medication and exercise. But what about fatigue? We’re looking at what can cause fatigue, exciting

Our contributors this issue

Julian Worricker is a BBC presenter with psoriatic arthritis. He lives in west London, loves playing piano and hopes Tottenham Hotspur starts winning trophies again.

new research, and ideas on how to manage this difficult symptom (page16).

Exercise is one of the best things you can do to reduce some of your arthritis symptoms and we hope each edition of Inspire gives you ideas on how to move more. This time, we’re looking at yoga (page 31) and running (page 28), to see what the benefits are and how you can do these safely.

We really hope you enjoy this edition –we’ve loved putting it together for you! And remember, we’re a community, here to support you. If you need advice about navigating your life with arthritis, visit versusarthritis.org or call our helpline on 0800 5200 520.

Rachel Curtiss

Individual Giving Manager Versus Arthritis

Georgina Wintersgill is a health and parenting journalist who lives with her two children and three cats.

Victoria Goldman is a journalist and author who specialises in health and medicine, and is married with two boys.

3 versusarthritis.org

Editor: Tracey Lattimore inspire@versusarthritis.org 01223 378000

Design and production: CPL One

1 Cambridge Technopark, Newmarket Road Cambridge CB5 8PB 01223 378000, cplone.co.uk

For Versus Arthritis: enquiries@versusarthritis.org

0300 790 0400

Arthritis helpline: 0800 5200 520

Registered charity nos: 207711, SC041156

Registered office: Copeman House, St Mary’s Court, St Mary’s Gate, Chesterfield S41 7TD

©Versus Arthritis 2024

Views expressed in Inspire are not necessarily those of Versus Arthritis or Inspire (the Editor, the Editorial Advisory Board or the Executive Board). No responsibility or liability will be accepted, either for their contents or accuracy, or for any action taken as a result of anything contained in Inspire. Products, treatments and services in Inspire are not necessarily recommended by Versus Arthritis. Versus Arthritis is not equipped to test and approve products, treatments and services available to the general public. Please exercise your own judgement about whether or not the item or service advertised is likely to help you personally and, where appropriate, take professional advice from your doctor, nurse, physiotherapist or occupational therapist before buying or trying something.

Photography and illustration: iStock, Nassima Rothacker (page 20), yogaandphoto.com/sarah (page 33)

Walking on sunshine

Spring is the perfect season to start a new habit of regular walks to help you get moving this year. Walking is great for helping with symptoms of arthritis, while being outside with a group of people can give you a sense of community and motivation, and build meaningful friendships. It’s great for your mental health, too.

Get into the habit now, while the weather is enticing, and it’ll be much easier to continue come the end of the year.

Join a new Versus Arthritis Health Walk if you are in Scotland: pathsforall.org.uk/health-walks or The Ramblers’ Wellbeing Walks: ramblers.org.uk, which take place across the country – and are all free!

Good to know

Anyone with experience of arthritis can become a Research Partner and have a say on the research we fund – scan the QR code to find out more.

Success in rheumatoid arthritis trial

Researchers have found that the rheumatoid arthritis (RA) drug, abatacept, could be used to target the cause of inflammation in patients at high risk of RA. The trial showed the drug helped to delay the onset of RA for people with early symptoms. This is really positive news, especially because this therapy is already licensed for the treatment of the condition. Professor Andrew Cope, leading the project at King’s College London, said, ‘Our next steps are to understand people at risk in more detail, so we can be sure that those at higher risk of developing RA receive the drug.‘ Professor Lucy Donaldson, Head of Research at Versus Arthritis, said: ‘A prompt diagnosis followed by personalised treatment can make all the difference. This research highlights how important it is to spot the early signs of arthritis, to give us a chance at stopping it in its tracks.‘

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A step forward for stem cells

Grow your own

University of York-based company Mesenbio is working with engineered human stem cells to develop a treatment that reduces inflammation and kick-starts the process of regenerating damaged tissue. The treatment will initially target rheumatoid arthritis, and £1.4m in new funding has been raised. One of the founders, Professor Paul Genever said: ‘We have been developing this treatment for a decade, with support from Versus Arthritis. The funding will allow us to move towards human clinical trials.’

On trial

At the end of last year, ASCOT, our longest clinical trial, celebrated its final surgery of the study. Beginning in 2010, the trial investigated whether we can use stem cells as an effective alternative to other cells, to repair damaged

Maintaining a healthy diet is really important, and a mix of colourful vegetables can provide a range of vitamins and minerals. Why not try growing your own this year? You don’t need an allotment or a large garden – pots on a windowsill or balcony are perfect. What’s more, growing plants can really help improve your mental health. Kale, watercress and tomatoes will all thrive in pots, while salad, cress and herbs can be easily grown on a windowsill. Give it a go!

the ASCOT trial and how working with stem cells could improve patient recovery.

SAY goodnight TO UNWANTED wake-ups

We ask the experts for their advice on how to sleep better when dealing with pain

BY CLAIRE MUNNINGS

There’s nothing more frustrating than waking in the middle of the night in pain, unable to get back to sleep. Unfortunately, this is something people with arthritis know too well. Sleep –while a release for many – can lead to more pain for others.

‘Joints with arthritis love to be moved so, when we sleep, our joints can become stiff,’ explains Tim Allardyce, a physiotherapist, osteopath and health and lifestyle coach (surreyphysio.co.uk).

‘We also know that movement helps reduce

inflammation, so being in one position for a few hours at night isn’t helpful. This is why some joints with arthritis are worse in the morning and ease up through the day.

‘Getting comfortable in bed can be a problem for those with arthritis, especially for arthritis in the neck, and many patients report difficulty finding the right pillows or getting comfortable at night,’ Allardyce adds.

Sleep experts, such as Dr Nerina Ramlakhan (drnerina.com), say that getting the basics right is

the first step towards a good night’s sleep. This means minimising caffeine and alcohol during the day and evening, making sure your bedroom is dark and a comfortable temperature, and not looking at screens too close to bedtime.

There are other things that you can try. Research funded by Versus Arthritis highlights the importance of the circadian clock in regulating our immune system – so our sleep can actually help to keep us healthy. Our experts share their top tips overleaf.

3

Try some gentle movements

If you find pain builds up while you sleep, try some gentle movements when you wake, says Allardyce. ‘For example, with osteoarthritis of the knee, lying on your back and gently bending and extending your leg can be useful,’ he says. ‘Simply bend your knee and straighten it, and repeat this 10-15 times.’ Sometimes, even just adjusting your sleeping position at  night when you wake can help you fall back to sleep, Allardyce adds.

Try our stretching exercises, which you can find by scanning this QR code:

GO TO BED

with a heat pack

Evidence suggests that heat can relieve arthritis pain, and using tools such as this can help delay pain that might usually start at night. ‘Lots of patients report that going to bed with a hot-water bottle helps and the heat may last

4

Focus on your breathing

What’s the first thing you do when you wake up in the night? For many of us, it’s look at the clock. Dr Ramlakhan advises against this, as it can fuel anxiety and increase wakefulness. Instead, she suggests bringing your attention to your breathing. ‘Place one hand over your heart and the other over your belly, and watch the rise and fall of your breathing,’ she says. ‘Encourage your breathing to drop into your belly by prolonging your out breaths.’

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Try to avoid

NAPPING

It’s a tricky cycle to fall into – if you’re up all night in pain, you may find you need to nap for long periods in the day, but this doesn’t always help you gain more rest in the long term. Ideally, naps should not be more than 30 minutes. ‘Rest breaks are important for pain management, but over-napping will stop you sleeping at night and enhance pain perception,’ explains Dr Ramlakhan.

6

Have a podcast ready

‘If pain and wakefulness persist, it might be helpful to have some relaxing podcasts on standby that you can listen to, to help soothe anxiety and restlessness,’ recommends Dr Ramlakhan. Apps such as Headspace and Calm can be useful, and free meditation can also be found on YouTube and Spotify.

Try this relaxing meditation

The below meditation exercise, taken from Dr Ramlakhan’s The Little Book of Sleep, uses a progressive muscle-relaxation technique and can help ease you back into the land of slumber

stress or anxiety

While joint pain may wake you up, other things may prevent you from getting back to sleep. That’s why looking at what else is going on in your life can help with any insomnia you may be experiencing. ‘We’ve all had periods where life is so stressful we wake in the early hours unable to get back to sleep,’ says Allardyce. ‘Seeking therapy, or addressing the underlying stressful issues in your life, should help here.’ Speak to your GP about accessing therapy and search online for “Every Mind Matters” for free self-help tools for managing stress and anxiety.

1

Focus your attention on your left foot, and repeat silently and softly to yourself: ‘I love my left foot. I love my left big toe. I love all the toes of my left foot. I love my left ankle. I love my left shin. I love my calf muscle.’

2

Continue going, working your way up to the top of your head and then back down, ending up on your right foot.

3

If you lose your train of thought, go back to your starting point and begin again.

‘Using the word love here is deliberate,’ Dr Ramlakhan says. ‘When we are in pain, it is easy to berate ourselves and our bodies. This simple meditation is a powerful way of sending subliminal messages of self-compassion and self-soothing to yourself and your body.’

It’s the stories that really hit home

Raising awareness about arthritis is the first step to helping people become better informed

Raising awareness. That was the focus of a Versus Arthritis World Arthritis Day event held at the end of last year, and I had the privilege of chairing it. The latest scientific and medical research was aired, which was important for everyone in the audience, but it was the stories that really hit home.

I was particularly pleased to share the platform with two people who drive a coach and horses through the myth that arthritis is merely ‘aches and pains for old people’. You and I know it’s not, but the more we disprove that nonsense the quicker we can bury it for good. Max and Parveen went a long way towards doing that.

Max was diagnosed with axial spondyloarthritis at the age of 17. This is from his website: ‘My whole sense of identity came crashing down around me. I wasn’t the “swimmer” any more. I was the guy sitting at home unable to walk because my sciatica was so bad.’ Now in his late twenties, Max can manage his condition with medication, and continue with most of his sporting activities. He’s a middle-distance triathlete and has run multiple ultra-marathon distances.

Parveen shared her experiences of being diagnosed

Julian Worricker is a BBC TV and radio presenter, and journalist. He has psoriatic arthritis

with rheumatoid arthritis, her everyday management of it, and some of the sideeffects she’s had to deal with. Alongside her musculoskeletal condition, she’s also diabetic. She was looking particularly well despite all of that, because she’d just returned from her honeymoon.

Keen for comments

I was keen to get some feedback from everyone involved, and here are some of the comments. Parveen said: ‘It was wonderful to be in a room with people of different ages, backgrounds, abilities and arthritis conditions, and to feel so connected, understood and supported.’ Then there

versusarthritis.org

was this: ‘I came away on a high and with a huge smile on my face.’ And this: ‘We all need to educate ourselves on invisible diseases and then support those around us.’ Plus this: ‘Talking to others who understand what it is like to have arthritis gives them the confidence to talk to people who don’t have the condition.’

For me, that last comment is really significant, because that’s where the “raising awareness” point is made – and I sense progress on that front. I was at a local drinks reception in January, and was collared by my MP. ‘I mentioned you in parliament a few days ago,’ she declared. ‘Oh Lord; what have I done?’ I replied.

It turned out she’d referred to the work I’ve done with Versus Arthritis, and she’s well and truly on board with it. When I read the Hansard account of the Westminster Hall debate –musculoskeletal conditions and employment – it was clear that MPs of all parties are taking a keen interest, too. Not just supportive, but better informed.

Don’t forget, this is an election year, so when prospective MPs come knocking on your door, I think you know what to do.

Making a JOINT DECISION

How do you know it’s time for a joint replacement?

BY VICTORIA GOLDMAN

ou may be offered a joint replacement if your pain is so severe that you’re finding it hard to do everyday tasks. In December 2023, actress Dawn French revealed on Instagram that she’d had a successful knee replacement after arthritis in her knee had affected her ability to walk.

Most people waiting for a joint replacement have osteoarthritis, although others

may have rheumatoid arthritis, other inflammatory joint problems, or joint pain because of an injury. The right time to have a joint replacement varies from person to person, and will be guided by your doctor.

‘Without joint replacement, people often continue to experience pain, reduced mobility and a diminished quality of life,’ says Luke Jones, orthopaedic surgeon at King Edward VII’s Hospital. ‘By restoring joint function,

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patients can perform daily activities more easily.’

Making a decision

Before considering a joint replacement, your doctor will encourage you to try other management options first, such as painkillers, steroid injections and physiotherapy. If these can’t manage your symptoms, they’ll discuss surgery.

There are no age restrictions, but the younger you are when you have surgery, the

‘The key is not to overdo it’

Ed Loftus, a 55-yearold restaurant manager in London, had a hip replacement in September 2023

‘I have inflammatory arthritis and was getting a lot of pain in my right hip,’ he says. ‘A scan showed the joint was worn out. I do a lot of cycling, I was taking various medications and was still in a lot of pain on longer rides.’

Ed’s initial recovery period after the surgery was tough. ‘I was on a lot of painkillers,’ he says. ‘I had to sleep on my back for around six weeks as I couldn’t turn over.

Health

I realised the key was not to overdo it. It’s about taking time to build up the hip muscles again.’

He says being pain-free has been a huge benefit. ‘Until surgery, I couldn’t put my right sock on. Now, I can also do my shoes up with ease, and kneel down. I do daily stretching and weight-bearing exercises with ankle weights. I’m back to cycling, and I’m slowly getting back to full fitness.’

more likely it is that you’ll need another replacement joint in the future, as they wear out eventually. So you may be encouraged to try other options first.

Jones says that most patients recover from the surgery with no problems.

‘Full recovery can take up to one year, but patients can expect to be 90 per cent recovered by 12 weeks,’ he says. ‘Rehabilitation with a physiotherapist is always required to get the best possible result. Studies show 80 per cent of joint replacements are in place and functioning well at 20 years.’

Managing the wait

According to a survey by Versus Arthritis in 2020, many people find that their joint pain and mobility get worse while they are waiting for surgery. Your consultant should give you a self-management programme

to ease any pain. Preparing for surgery in advance will make your recovery easier.

‘Going into an operation with stronger muscles is preferable,’ says physiotherapist Tim Allardyce. ‘Physiotherapy prior to a joint replacement can help by improving flexibility, reducing pain, preparing the patient mentally, to help reduce anxiety, and providing realistic expectations.’

Living with chronic pain can also affect your mood. In a survey by Versus Arthritis in 2020, 72 per cent of people with arthritis reported their mental health had declined while waiting for joint-replacement surgery.

‘You may find some mental and emotional preparation helps,’ says Jones. ‘Educate yourself on what to expect, ask family and friends for help, and speak with your clinicians if you have any concerns.’

NHS or private?

Once you’ve decided to have a joint replacement, your name will be added to a waiting list. NHS waiting times have increased over the past few years, so some people pay for private treatment.

‘Private healthcare provides shorter wait times compared with the NHS,’ says Jones. ‘NHS waiting times often vary based on factors including the urgency of surgery, as well as location and available resources.’

Going private may not be possible for a lot of people, but if you can afford it or have health insurance, it may be an option you would like to explore – but you’ll need to do some research. Some private healthcare schemes will pay for the surgery, otherwise you’ll need to self-fund. Many hospitals offer a fixed-price, self-pay package. ‘Private joint replacement surgery costs can vary widely based on factors such as the type of procedure, the specific joint involved, and the hospital or clinic chosen,’ says Jones. ‘We advise patients to book a consultation with the clinic.’

Versus Arthritis is here to support you every step of the way. If you are waiting for surgery, you may find our Let’s Move For Surgery programme helpful. See versusarthritis.org/surgery-toolkit

versusarthritis.org

OVER TO YOU

Here's your chance to have your say

Taking steps for joint pain

I thought your readers may want to know about a free programme for people with mobility and pain. I have recently taken part in a 12-week joint pain programme run by Nuffield Health (nuffieldhealth.com). It helps by talking about exercises, diet, pain control, sleep problems, emotional wellbeing, and more. You can self-refer or get a doctor to refer you.

I have had arthritis for 30 years and the course has been very beneficial. It’s not just for arthritis, but other conditions where mobility and pain are a problem. It is a good way to socialise and get to know how others deal with the pain. After attending the course, you can, if you want, join the gym at half the cost of normal membership. The classes in which I participate are aqua aerobics, Pilates and gentle stretching exercises. There are many more to which you are gently introduced during the 12 weeks, and you do as much as you can without being judged.

Jacqui, via email

Hard to handle

I purchased some mackerel from Waitrose. It came on a plastic tray with a thinner layer of plastic shrink-wrapped over it. I am 72 and have mildly arthritic hands. I find this type of packaging almost impossible to open. I have tried scissors, but the vacuum is so tight you often cannot lift the top layer. I emailed customer services, but they were no help. Have you noted difficulties with, this type of packaging?

Via email (name withheld)

Versus Arthritis says: We know food packaging can be extremely difficult to open for people with arthritis. Try running a sharp knife around the fish to release it from the clinging plastic. Hope this helps!

versusarthritis.org

Top tip

When going on a car journey, place a silky scarf on your seat before you sit down. This makes movement much easier when adjusting your position.

Gillian, via email

Handy gadgets

I thought I’d share three useful purchases that are helping to make life a little less painful:

1. CampTeck U7220 yoga knee-pad cushion, £8.99, amazon.co.uk

2. Homecraft freehand tray, £29, amazon.co.uk

3.Breville HotCup hot water dispenser, £60, amazon.co.uk

Gill, via email

Get in touch!

Send your tips and letters to Inspire magazine, 1 Cambridge Technopark, Newmarket Road, Cambridge CB5 8PB, or email inspire@ versusarthritis.org

Health

Crushing FATIGUE

Fatigue can be one of the most debilitating symptoms of arthritis, but new research could help us learn how it can be managed

HBY GEORGINA MARIC

ave you ever felt a tiredness that is overwhelming and uncontrollable: you are constantly exhausted, your concentration is shot, and all you want to do is sleep? Then it’s likely that you have fatigue, a symptom of arthritis and related conditions that affects many people with arthritis. In fact, studies show that more than 80 per cent of people with rheumatoid arthritis experience regular, severe fatigue.

It is so debilitating that one in seven people with musculo-skeletal conditions find that fatigue affects day-to-day activities, according to research by Versus Arthritis.

‘Fatigue is one of the worst parts of having a chronic inflammatory disease,’

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says Kelly Gavigan, manager of research and data science at the Global Healthy

Living Foundation. Symptoms vary widely, but include feeling that you have no control over the exhaustion, waking up with it, or experiencing sudden overwhelming changes in energy levels.

‘Research shows that poor sleep can make the symptoms of fatigue worse, increasing sensitivity to pain and irritability, and making it that much harder to concentrate,’ says Dr Aly Cohen, a rheumatologist at Integrative Rheumatology Associates. Brain fog – or cognitive dysfunction – is often a symptom of arthritis and can be a symptom of fatigue.

‘If you don’t have restful sleep, you can have brain fatigue, and it’s difficult to carry on cognitive functions,’ explains rheumatologist Vinicius Domingues. Brain fog makes you more forgetful, and you may have a shorter attention span

‘Feeling such extreme symptoms can have a massive impact on everyday life‘

Exciting research

Versus Arthritis funded research has shown that non-drug treatments, such as physical activity and talking therapies delivered by non-specialists, can improve fatigue across inflammatory rheumatic diseases. The researchers have identified the parts of the brain that may be important for this improvement in fatigue. It is hoped that by understanding these brain pathways, we may identify new treatment options.

How to help yourself

and less mental alertness than usual. Feeling such extreme symptoms can have a massive impact on your everyday life, affecting work, socialising and being able to just get on with living your life.

What is the cause?

We still don’t fully understand everything about fatigue. It is reported by people with all different types of arthritis, and even if you have your pain under control you can experience fatigue. It is usually a symptom of high disease activity and inflammation.

‘During a flare-up, the body is fighting itself and it gets tired,’ says Dr Cohen. ‘If your overactive immune system doesn’t quieten down, it zaps your energy.’

Dealing with pain for months at a time over many years can affect your sleep habits, too, which adds to your exhaustion. Being fatigued, in turn, can worsen pain and make it more difficult to manage.

According to a 2017 study published in Current Rheumatology Reports, your fatigue level is influenced by other factors, including obesity, physical inactivity, sleep disturbance, and depression.

Several of them may work together to cause your extreme tiredness, but identifying and treating even one of these factors can provide relief.

You can order our free fatigue information booklet at shop.versusarthritis.org or simply scan the QR code to the right.

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•Plan your day carefully to avoid overdoing it, but try to include some gentle exercise as this can increase the amount of energy you have.

•Try to get a good night's sleep, as poor sleep patterns can make fatigue worse.

•Make a list of how much energy you have at certain times throughout the day, such as on wake up, after activities and at bedtime, to help spot trends or habits.

•Stress and worry can make you feel worse, so try to identify anything that's on your mind.

The Four Ps

Think of the four Ps at the start of each day or week to help manage your energy levels:

Problem solving: Work out the problems that might be adding to your fatigue, and think of ways around them.

Planning: Try to plan the things you want to achieve in the week, and break down big tasks into manageable chunks. Plan rest breaks around them.

Prioritising: Work out the order of importance of your jobs. Can something be left for another day?

Pacing: Don't use all your energy up in one go. Spread activities out over days or a week – or longer.

Angie Jefferson is a registered dietician who specialises in translating complex science into simple practical messages for everyday great nutrition

Q I’ve been considering stopping eating meat as I’m concerned about its impact on the planet. Will a meat-free diet be good for me?

A There are three great reasons why eating less meat may be good for you.

First, switching from meat to fish or a plant protein – such as beans, chickpeas or nuts – fits the Mediterranean style of eating recommended for arthritis.

Plant proteins are also often cheaper, saving you money – and, if we all cut our meat intake by one-third, it could help to reduce global warming.

But you don’t have to give up meat completely – unless you want to, of course. Think about your week and plan one or two meat-free days. Why not experiment with a few new meat-free recipes, such as a bean chilli, a savoury nut crumble, or veggie shepherds’ pie?

Dr Sarah Jarvis is a medical writer and broadcaster. She has been the BBC Radio 2 doctor for many years, and is doctor to the BBC’s The One Show

Q Why did it take so long to confirm my diagnosis of axial spondyloarthritis?

A Axial spondyloarthritis, also called axSpA, is a form of chronic arthritis that mostly affects the spine, although it can also cause issues with other joints, tendons and ligaments. One type – ankylosing spondylitis –shows up on X-ray. However, other forms don’t always show on X-rays or MRI scans, so it’s not uncommon for diagnosis to be delayed.

Unlike ankylosing spondylitis, axSpA is just as common in women as men. AxSpA runs in families, and symptoms often start in your 20s or 30s. Symptoms include low back/ buttock/hip pain (especially at night or early morning), stiffness on waking, and extreme tiredness.

Newer treatments, such as JAK inhibitors and biologics, are revolutionising the outlook for axSpA. Two new drugs – tofacitinib and bimekizumab – were approved for some in October last year.

Claire has been working on the Versus Arthritis Helpline for seven years. She enjoys time with family and friends, and exploring the countryside

Q I have been prescribed steroids for polymyalgia rheumatica (PMR). Will I be on them all my life?

A Steroids work by reducing inflammation. They can’t cure PMR, but the symptoms should improve significantly within two weeks.

The duration of treatment depends on how your condition affects you and how well you respond to it. Typically, treatment of 12 to 24 months is needed for most people to prevent symptoms from recurring.

After a few weeks, your GP will gradually cut the dose of steroids and monitor your symptoms and inflammation levels. If your symptoms return, your doctor may have to increase the dose for a short time and then try to reduce it again.

Steroid treatment reduces the amount of calcium in the body. It’s recommended you aim for a daily intake of 700-1,200 mg of calcium and vitamin D to help reduce the risk of getting osteoporosis.

The Versus Arthritis community is here for you. Our website is full of useful advice and stories about how to manage your arthritis, and you can order free information booklets at shop.versusarthritis.org. Meet people in person at our local support groups, or chat to us online at community.versusarthritis.org or on the phone on 0800 5200 520.

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Emily Johnson says she is now ‘living with arthritis’

BY KATY SUNNASSEE

'I COULD SLOWLY SEE THE DIFFERENCE'

Emily Johnson, aka Arthritis Foodie, tells us how arthritis affected her at a young age – and how she now manages her symptoms through a combination of diet and medication, and helps others to do the same

Igot diagnosed with arthritis when I was 20, but the first symptoms began when I was four. I was hospitalised with swollen knees for a week and checked for juvenile idiopathic arthritis in the three months afterwards. Nothing came of it, but that kind of susceptibility to having arthritis was always there. Then, in 2013, when I was a 20-year-old student, I was juggling all kinds of things: working hard in a hotel while doing an internship in PR, and I went to Italy to teach. I wasn't looking after myself; I wasn't sleeping well, and my immune system probably wasn’t at its finest.

The first symptom was swelling on my finger – I couldn't bend it. It was stiff in the mornings, too. I was also overwhelmingly unwell. I was sleeping up to 16 hours a day. I was full of cold – and that was the start of my body attacking itself, and of having autoimmune disease-based arthritis. This went on for about six weeks, so I ended up going home. The symptoms seemed to settle, but then they started to spread into my thumbs and other fingers. I ended up in A&E at

one point because I couldn't bend my thumbs. I was just so scared. But they couldn't tell me anything. They said I had to see the GP.

It took 18 months to two years to get a diagnosis. Only when I got an ultrasound on my fingers and thumbs could they see the fluid inside my joints, which I was told was “severe”. That’s what got me the diagnosis of seronegative arthritis.

I was put on various medications and some of them just didn't work. It took a while to find ones that worked for me and get myself back on track. That’s when I moved to London. I was thriving, but again, wasn't really taking care of myself.

Things came to a head in 2018 when my symptoms were at their worst. I had swelling in my ankles, elbows, hands and left knee – I was miserable and in so much pain. The medications weren't doing the job that they once had. Before, I would go to the GP and get a steroid injection to keep pain at bay, but now they weren’t working.

My colleagues, who were all super healthy, asked me if I had looked into my diet. I was feeling so rubbish, I thought ‘why not?’. I couldn’t find much online about diet and arthritis, so I thought, ‘I’m going to do this myself’ and set up @arthritisfoodie on Instagram, which was initially anonymous. I posted food things, research, books I was reading. I got inspiration from Deliciously Ella, Dr Rupy from The Doctor’s Kitchen, and Dr Jenna Macciochi, who specialises in immunity.

I completely overhauled my diet and cooked everything from scratch. I was experimenting in the kitchen, starting with things that I used to eat and making them healthier.

That’s how I developed my recipes. There’s a Chinese takeaway-style recipe in my book, and it’s packed full of polyphenols [beneficial plant compounds with antioxidant properties], spices and loads of vegetables. After three months, alongside my medication, I started to feel a difference in my swelling and overall symptoms. I spent a year healing my gut and getting things back on track. When  I was feeling better, I would reintroduce something I wasn’t eating to see what might happen. Deep-fried foods made my finger swell up. I kept a diary of absolutely everything: sleep, diet, toilet habits, pain levels, and symptoms. I was obsessed with it, because I wanted to change.

I cut out processed foods and anything

that was in a packet or pre-prepared. Before, an easy dinner would have been oven chips, chicken Kiev, and frozen peas. Those are fine in moderation, but I had been having them all the time. Pasta for me would be in tomato sauce with lettuce and cucumbers. So basic! Now, I make the sauce from scratch and pack in loads of different veg, spices and herbs.

Previously, my breakfast was Weetabix sprinkled with sugar lactose-freeandmilk.

Now, I have overnight oats with chia seeds topped with raspberries, blueberries, banana and peanut butter. For extra nutrition, I add a sprinkle of cinnamon or ground ginger. It comes much more naturally to me now to make a breakfast from scratch.

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Three top tips

1

Be patient

When thinking about something as big as changing your diet, give it time. Around 12 weeks is a good barometer.

2

Build up your kitchen

When I started Arthritis Foodie, I would buy ingredients for one recipe at a time, rather than having to overhaul everything at once. So, build up your spice cupboard gradually, and get bits as and when you need them.

3 Keep staple items in your fridge, freezer and store cupboard –something can usually be rustled up with them. When you’re in pain, having these items at the ready will help. Freezing food in batches is also a good idea.

Follow Emily on Instagram @arthritisfoodie and at arthritisfoodie.com. Her books, Beat arthritis naturally and Eat well with arthritis are available from Amazon and all independent book shops.

Turn to page 37 to try some of Emily’s delicious recipes.

When I cook, I don’t use highly processed oils; I stick to extra virgin olive oil. Occasionally I use coconut, sesame and avocado oil, but not for cooking. The more phytonutrients [natural compounds found in plants] you can get into your diet, the better, and extra virgin olive oil has the most.

My diet transformation and reducing my symptoms was a gradual thing. Not all my symptoms got better in three months, but I could slowly see the difference in the movement and the swelling. My friends were also saying that my skin was glowing. So, when I talk about changing your diet and overhauling something as big as this, you have to give it time. That’s why I think 12 weeks is a good barometer.

Spices and herbs are fantastic for limiting my symptoms. I love rosemary, basil, oregano and thyme, which are anti-inflammatory. You can add them to salad dressings or roast vegetables. Turmeric is amazing for joints, too. Nuts and seeds are good. I love chia seeds – I add them to smoothies or sprinkle them on porridge. Walnuts make a good base for pesto, or on salads.

I was shocked when I had a flare-up in my elbow at Christmas, and knew it was down to diet. I woke up the day after Boxing Day and couldn’t stretch my arm. But I’d relaxed more than usual and had some wine and a couple of gins across the holiday period. I’d also eaten more processed foods and sugary treats than usual, hadn’t slept as much, and was stressed because of an exam. From that point on, I decided to avoid all treats and alcohol and, after five days, the swelling had gone down and is now completely gone.

I now say I'm ‘living with arthritis’, as it’s not going to go away – it’s something I have to manage. But I’m in a much better place than I was in 2018, and I’ve been able to reduce my medication, as I’m doing so well. This means I get fewer drug-related side effects.

When I got my diagnosis, I didn’t want to tell anyone, as I was embarrassed, but I’m not now. And I’m so fascinated with nutrition – hence why I’m studying at the Institute of Optimum Nutrition. A lot of the research is new, but it’s so exciting to be a part of it. When I was 17, my dream was to become a published author. I never envisaged I’d be writing about arthritis one day!

It is essential to listen to your own body, as we all experience arthritis differently. What works for one person, may not work for somebody else. Keep this in mind as you navigate living with arthritis.

Emily spent a year healing her gut and getting things back on track

Get involved

Versus Arthritis works with and for people who have any type of arthritis, and we’re here to help you stay active, independent and connected

Hearing your voice

Last year, hundreds of people across our community shared their stories, shining a light on what it’s like to live with arthritis – day in, day out. We took these stories to party conferences and shared them with politicians up and down the country. It’s time they heard about the devastating impact arthritis can have on so many, and to take our community seriously. We’re a powerful community when we come together. With a general election on the horizon, it’s more important than ever to share these stories far and wide, and to speak up for people with arthritis. Throughout 2024, we will demand that those in power make real change happen, from tackling waiting lists to funding breakthrough research. Together, our community won’t stop until everyone with arthritis can live the lives they choose.

There will be lots of ways for you to take action with us in the run-up to the general election. Find out more at versusarthritis.org/campaign-with-us

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Make a strong start

We’ve developed three new resistance-band workout videos to help strengthen your bones and muscles, and improve your posture. The exercises have been designed by fitness professional Leon Wormley, joined in the videos by his mum, Janet, who lives with arthritis. They will help strengthen your legs, arms, shoulders and back. Doing them regularly will make activities such as carrying shopping, going up and down stairs, opening doors, and getting up out of a chair easier. A resistance band puts less stress on your joints than weight training. The videos are already popular with our Let’s Move community. One Versus Arthritis Facebook member said: ‘Leon makes these classes so good, and they definitely hit the spot!’

Watch the videos at youtube.com/VersusArthritis. Remember, listen to your body and consult your doctor if you are unsure if resistance training is appropriate for your condition.

Workshops to help yourself

We know how much strength it takes to live with arthritis. Our range of self-management programmes are designed to support you to manage your condition better and improve your confidence. They are

delivered by our Accredited Peer Trainers who live with a long-term health condition, and know from personal experience the challenges people face. You’ll learn about selfmanagement, how to communicate

Join our group

The Involvement Network is a group of people with arthritis or who care for someone with arthritis, and we’re looking for new members. Our group uses its experience to contribute to a future free from arthritis. As a member of Versus Arthritis’ Involvement Network, you will be invited to take part in a range of activities – and the great thing is you choose how much or how little you want to be involved. There is no minimum time commitment. We will share opportunities to join focus groups, take part in surveys, get involved in ongoing projects, and much more. You don’t need previous experience of involvement and we welcome all to join to increase diversity of thought and knowledge.

For more information and details of how to join, scan this QR code.

your symptoms, understanding pain, goal setting, how to improve your lifestyle to benefit your condition, and more – all in a small, supportive group. Search at versusarthritis.org/ in-your-area for upcoming courses.

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THE SHOPPING EDIT

Things to make you feel better and brighter, and live easier

These comfy trousers are easy to get on, with no cuff and stretchy fabric. Perfect for exercise and relaxation inside and out.

2. John Lewis yoga mat, £15 johnlewis.com

Ease into your exercise routine with this soft yoga mat, perfect for long stretches and gentle moves.

3. The Puzzle of Happiness, £9.99 laurenceking.com

Tap into the mindful appeal of jigsaws. The mesmerising artwork of this little puzzle focuses on happiness, with accompanying words to maximise these feelings.

4. St Eval bergamot & nettle candle, £14.65 st-eval.com

This unique herbal fusion will leave you feeling refreshed and inspired – perfect to help you unwind after a busy day.

5. Bayliss & Harding sport shower gel, £3.30 boots.com

This invigorating citrus, lime and mint shower gel prepares you for the day ahead, with added vitamins to help rejuvenate your skin.

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6. Klean Kanteen water bottle, £39.95 berryuseful.co.uk

Keep yourself hydrated with this stylish, leakproof water bottle. It helps keep drinks hot or cold and has a built-in reusable straw.

1. Cream side-stripe trousers, £20 tuclothing.sainsburys. co.uk

RUNNING MYTHS, BUSTED! 5

Ahead of the TCS London Marathon, Kirsteen Innes, from Nuffield Health, reveals how to adapt your running style to not only safeguard your joints, but also to embrace the joy of movement

BY HOLLY TREACY

The prospect of high-impact exercise, such as running, might seem counterintuitive to those with arthritis, which has led to misconceptions about its potential to exacerbate the condition. Here, we dispel common myths and even discover that running can be a powerful ally in managing arthritis.

1 Is running with arthritis safe?

As with all exercise, it’s best to start slow, then gradually increase the intensity. If you are new to running, take it easy and alternate between walking and running, and build up your distance, time and speed gradually, over

time. A dynamic warm-up (rhythmic movement) is important to prepare you for your run, and a cool down with stretches will reduce the risk of injury. The NHS website has useful warm-up and cool-down exercises.’

2 Is exercise with arthritis recommended?

Yes absolutely. Some people worry that exercise will make their condition worse, but, generally, the opposite is true if the level and type of exercise is appropriate for you. It’s important to do a mixture of exercises, including stretching, strengthening, fitness, and balance exercises.

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3

How much running is too much for someone with arthritis?

Everyone is different – so go at your own pace and don’t overdo it. It’s important to listen to your body and pain levels, noting how you feel during and after your runs, and don’t ignore any new pain or injuries. Allowing rest time between runs will give your body time to recover and lower the risk of injury. If you are new to running, the Couch to 5k app, which is recommended by the NHS, is a great starting point. Parkrun also provides an opportunity for a regular outdoor run every Saturday at 9am – search on its website for one near you.

4 Can running cause arthritis?

Research suggests that running is unlikely to cause arthritis and may, in fact, be good for you. Running stimulates the production of synovial fluid, which nourishes and protects the joints. A large study looking at the risk of knee and hip arthritis in runners taking part in the Chicago marathon showed no association with an increase in running and arthritis. However, starting too quickly can place strain on your joints, so it’s best to start gradually.

5 How can you adapt your running style to protect your joints?

Appropriate footwear is important. Try not to overstride – keep your pace nice and controlled and your shoulders relaxed. Running on softer surfaces – such as grass, smooth trails and paths – can reduce the impact on joints. Be careful with uneven surfaces – and you may find flat terrain easier to begin with. Most importantly, take your time. If you enjoy it and look forward to getting out there, you’re much more likely to keep it up and experience all the benefits running has to offer.

If running isn't for you, there are many other ways to add movement to your life. Check out our yoga article on page 31 and the Versus Arthritis website for more information.

‘It’s a privilege to be able to run’

Heather, age 58, from Middlesex, is running the TCS London Marathon in April

I was diagnosed with rheumatoid arthritis (RA) five years ago, having experienced joint pain in my elbow and hands. After trying various medications, I've now been on a drug for three years that keeps my flare-ups to a minimum. While I find that keeping moving keeps it under control, I am well aware that RA is a disease for life.

I'm equal parts super-excited and petrified to be part of Team Versus Arthritis, but I’m confident that, with sensible training, I will at least be able to fast-walk the marathon – and, in the process, raise a substantial amount for this wonderful charity. I was inspired by my sister, who completed last year’s London Marathon after going through treatment for breast cancer.

As a “non-runner”, I’ve adopted the mindset that it’s a privilege to at least be able to try to run. I’m well aware that not everyone can run and there may well be a day when I’m unable to. Often, I ache while running and my feet hurt. But I feel a sense of achievement. I always try to think about how far I’ve come, not how far I’ve got to go.

Fundraising for Versus Arthritis has made me feel very proud of myself for raising so much. The fundraising also really motivates me with my training. I recently had a donation from someone whose little girl has JIA. Her story really touched me, and I’ll be thinking of her as I do the marathon.

THE FAST TRACK

With Ramadan approaching, we look at the impact of fasting on arthritis – and how Syeda has adapted her approach to remain involved

BY LOUISE PARFITT

Fasting is a practice that dates back centuries. It is done for religious and spiritual reasons, such as during the month of Ramadan, and more recently has become popular for its health benefits.

‘Fasting can help in resetting your metabolism, improving insulin sensitivity, and aiding in weight management,’ says nutritionist and life coach Yasmeen Alsumait.

Fasting during Ramadan

Syeda Hana (pictured above) was diagnosed with rheumatoid arthritis 10 years ago, when she was in her late teens. She has found ways of managing her symptoms, such as through exercise – she is now a personal fitness trainer – but she has to make adaptations to her lifestyle, including during Ramadan, which begins on 10 March this year. This is the time when Muslims abstain from food and drink during daylight hours.

Hana receives a monthly intravenous infusion of tocilizumab. It makes her feel nauseous and faint, so she does not fast during Ramadan on these days. She is also very mindful of listening to her body when she is fasting. ‘I fast for about half the month. That works for me –but it might not work for someone

else,’ she says. People with health conditions are exempt from fasting in Ramadan, but Hana says this can make you feel isolated and disconnected.

Hana says that preparing food for others for when the daily fast is broken – called iftar –and taking part in community events helps her to feel involved. ‘It means you still feel part of the community,’ she adds.

How can you fast healthily?

Fasting may have a positive impact on your health when done safely. However, research is still evolving, specifically its impact on arthritis, so Alsumait urges caution. ‘The impact of fasting can vary depending on the type of arthritis and individual health conditions,’ she says.

You may need to modify your fasting regime depending on your medication, Alsumait adds. ‘Some medications need to be taken with food to be effective or to reduce side effects, so it’s vital to understand how fasting might affect your medication’s efficacy and your body’s response to it,’ she says. ‘Remember, fasting is not suitable

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for everyone. Shorter fasting periods or intermittent fasting might be more appropriate... it’s about finding what works best for your body.’

•Begin with shorter fasting periods and gradually increase as your body adjusts.

•Adapt the fast according to your medical needs – such as reducing what you eat or type of food, rather than not eating completely.

•Drink plenty of water. Herbal teas and nutritious broths can also be good options.

•When not fasting, make sure you eat a nutrient-rich diet.

•Speak to your doctor.

BY CLAIRE MUNNINGS

EASY DOES IT

Looking for a gentle exercise to help ease sore joints? Yoga could be the answer

e’ve all heard the advice that keeping fit and active can help with achy joints and other arthritis symptoms – but what if the idea of jogging feels impossible, and swimming just isn’t your thing? Enter yoga. This gentle, holistic form of exercise can build strength and flexibility, and support emotional wellbeing, and it’s a practice that has soared in popularity in recent years.

Research supports the idea that it can have a specific impact on arthritis. For example, one study published in Restorative Neurology and Neuroscience found that eight weeks of yoga improved the physical and mental health of participants with rheumatoid arthritis. Other research has also demonstrated the benefits for those with knee and hand osteoarthritis.

The benefits

So, what makes it so good?

‘Yoga is a great form of exercise for arthritis as it promotes a range of movement and can help reduce stiffness with stretching,’ explains Victoria Anderson, clinical exercise physiologist and founder of Longevity Health & Fitness.

Exercise

‘The balance aspect of yoga is hugely advantageous, too, as it requires not only strength, but also control and joint stability.’ As a result, practising certain holds can be useful in reducing the risk of falls, she adds.

That’s not all. For Anderson, one of the biggest benefits of yoga is the way it has been proven to help reduce anxiety and stress, which is often heightened for those with arthritis.

Jessica Symondson, a yoga teacher in Oxfordshire (rogueyoga.co.uk), has seen these benefits first hand. She

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teaches a range of classes and has several students with arthritis.

‘As my osteopath says, “motion is lotion”, and this couldn’t be truer when it comes to arthritis,’ she says. ‘With regular yoga practice, we can reduce inflammation throughout the body and encourage increased blood flow, which has a range of benefits.’

How to get started Keen to try it yourself? First of all, it’s key to find the right class for you. There are a

range of different yoga styles out there, including: vinyasa yoga, where you flow through poses in a smooth motion; lyengar yoga, where poses are often held for longer periods of time, sometimes with the use of props; restorative yoga, which tends to be very gentle and relaxed; and kundalini yoga, which often has a strong spiritual focus.

Finding the best one for you may involve trying a few different classes or listening to recommendations from friends and relatives. While you can practise at home using online videos or books as a guide, Symondson says there’s nothing like practising in a group.

‘In my opinion, finding a local group class can increase the benefits,’ she says. ‘The sense of community you get from sharing your yoga practice with others is what we as a society are yearning for.’

Yoga teacher Sarah Highfield, founder of Yogagise Yoga (yogagise.com), agrees that an in-person class is best when you’re just starting out.

‘If you are new to yoga, look for a beginner’s class to attend, or even one that is seated, or specially for people with arthritis. This is ideal because your yoga teacher will be able to see you clearly and answer any questions you have. Don’t forget to let your teacher know at the start of the class if you are experiencing joint pain, or have areas that are particularly sensitive.’

Consider where the classes are based, too. Highfield recommends finding

somewhere that offers a warm space to practise – not a chilly village hall.

‘A warm room will help to loosen your joints and muscles, making them more open to deep stretches,’ she says.

In terms of equipment, all you need is comfortable clothes to stretch in, and a yoga mat of your own if the class doesn’t provide one. Extra props, such as straps and blocks, can be useful, but aren’t necessary.

Stretch and release

There are also some things to bear in mind when practising. Remember that stretching or moving in yoga should never cause or increase pain in your joints, so don’t push yourself too hard – and stop if it becomes too painful. Some poses may be best avoided and others can be easily adapted, depending on your type of arthritis. This is why having an expert teacher on hand can be handy.

‘I would encourage you to take it easy,’ says Symondson. ‘Yoga can exacerbate any inflammation in the body if you move through poses quickly and try to push your body to the absolute limit. Build up to the bigger twists.

‘If you have arthritis in the knee, try not to bend it more than 90 degrees – and be careful when it comes to balancing on one leg. If you can, support yourself with a wall or chair, or take the modified version of the pose.’

Part of what makes yoga so appealing is that the practice and poses you do can be tailored exactly to your needs. And, once you’ve found your flow, the chances are you might never turn back.

Namaste to that.

3 poses to try at home

Highfield shares her top three arthritis-friendly poses

1

Hamstring and chest stretch: This simple seated stretch can help reduce pain and stiffness in your body by gently increasing flexibility in your joints and muscles.

2

Seated side stretch: This soothing stretch will relieve tension in the side of your torso, and get your blood flowing. It promotes good mobility, too.

3

Twist on back: This restorative pose will gently stretch your spine and help lower stress levels and tension.

FEET FIRST

With brighter days on the horizon – and more time to walk outside – we look at how to ease foot and toe pain

BY RUBY DEEVOY

When foot and toe pain strikes, it can be debilitating. But there are things you can do to ease the discomfort and prevent your days from being hindered by hobbling.

Gentle stretching

Increasing your foot flexibility can help prevent foot and toe pain from occurring so often. The right kind of gentle stretch can also work wonders for relieving discomfort when it arises. The key here is to move slowly and gently, listen to your body, and of course stop if it becomes painful.

For an easy foot-muscle stretch, try sitting down with your feet resting on the floor, lifting just your big toe and holding for a few seconds before setting back down. Then lift the four toes while keeping the big toe down. A gentle toe extension (holding your toes and carefully pulling them towards you) will target the toes, forefoot and bottom of the foot.

Three to try...

M&S flatform sandals, £45 marksandspencer.com

Enertor insoles, £39.99 www.enertor.com

CeraVe foot cream, £9.50 boots.com

Check out the Versus Arthritis website for more suggestions.

structural foot problems, and provide support for your feet and ankles. Used correctly, they can make a big difference to foot pain. Orthotics need to be custom-designed for you after you have seen a specialist, such as a physiotherapist, so the first point of call is an appointment with your GP.

It’s easy to slip on your favourite shoes without thinking too much about whether or not they are good for your feet. As we approach the warmer seasons, try to make sure that your footwear is suitable. Flat sandals with thin soles will offer little support to the arches of your feet. Instead, opt for shoes that offer a wider fit, sandals with straps that can be adjusted (especially around the back of the ankle), and those with added support. High heels are a no-no – try wide, rubbersoled platforms if you need

Looking after your feet can help prevent additional health issues, such as bunions, corns and ingrown toenails. It doesn’t need to take long. Simply keep your feet clean and dry, especially between your toes. Check them weekly (or ask someone to help) for swelling, cuts and sores, and keep them soft and prevent cracks by using moisturiser.

BY ANGIE JEFFERSON, REGISTERED DIETICIAN

BOOSTING GUT BACTERIA –helpful or just hype?

We look at whether prebiotics and probiotics can help your arthritis

Products to boost gut bacteria are booming, with a rapidly increasing range of shots, pots, cereals and bars on the market. With claims that they help ailments ranging from diarrhoea to depression, should science-minded consumers believe the hype – and how relevant are they for people living with arthritis?

Food products made using bacteria are not new – for example, humans have been consuming yoghurt (milk fermented by bacteria) for more than 7,000 years. We all have a gut teeming with bacteria, with the balance shifting constantly between bacteria that are ‘good’ (they have potential positive health effects) and those that are ‘bad’ (such as those causing food poisoning).

Gut bacteria helps with digestion by breaking down (fermenting) parts of food that we are unable to use (such as dietary fibre) and adding bulk to faeces. Bacterial fermentation in the gut also produces useful byproducts, including vitamins B2, B12, folate and vitamin K, and short-chain fatty acids, which can help reduce inflammation. It also produces some less useful by-products such as gas (harmless, but potentially embarrassing and uncomfortable).

Prebiotics and probiotics

More than 1,000 types of bacteria are known to live in the human gut, but, typically, we each have around 150 bacteria making up our gut

community, technically called the ‘gut microbiota’. Like fingerprints, no two individuals have the same gut microbiota, which makes this a difficult area to study. We don’t know what the make-up of the perfect gut microbiota is, or how this might vary across different ages, stages, or health conditions. What we do know is that many factors affect gut bacteria.

There are two types of supplements that may help to support the gut microbiota. Prebiotics are a food source for gut bacteria, and provide an overall health benefit for the gut. Some foods are naturally prebiotic, including onion, artichoke, garlic or banana, while some foods may have prebiotic substances added (typically a complex carbohydrate or

Are some foods better than others?

Fibre in plant foods varies from soluble fibre – such as in fruit and oats – to the more resistant fibres found in cereal brans. There are bacteria able to use all types of fibre, however, so all are good. Fruit and vegetables also contain prebiotic antioxidants and polyphenols – colour is often a guide – hence the advice to eat a rainbow of fruit and vegetables.

The more types of prebiotics you consume regularly, the more diverse and stable your gut bacteria will be.

fibre) to help support gut wellbeing. Probiotics, on the other hand, are living bacteria that, if consumed in sufficient amounts, can give you an overall health benefit. Once inside

numbers. Again, probiotics could be in foods that we eat, such as yoghurts, kefir or sauerkraut, or they may be taken as a supplement. If a prebiotic and a probiotic are combined, they are called synbiotic, containing both the bacteria and a food source for them to live on.

The effect on arthritis

Those living with rheumatoid arthritis appear to have an altered gut microbiota – called dysbiosis – compared with those without rheumatoid arthritis. This results in increased gut permeability, allowing bacteria to interact more easily with the body’s immune system. This increases inflammation and might exacerbate symptoms. Research is still exploring if this is the case for other types of arthritis.

Is dysbiosis caused by the disease, medications, or diet? It’s the proverbial chicken and egg question that we are unlikely to answer soon. Can

taking probiotics help bring the gut bacteria back to normal? Maybe –but research is quite limited, although ongoing. Analysis of studies that have been carried out suggest taking probiotics may reduce blood markers of inflammation, but whether this helps reduce symptoms remains unclear.

Pre and probiotic supplements come at a cost, so the wellestablished route to supporting gut bacteria is to eat a wide variety of plant foods that are rich in prebiotic substances every day – ideally topping up the food supply to your bacteria several times a day. The healthy Mediterranean-style diet recommended for arthritis is perfect.

Gut bacteria are amazing, and eating a Mediterranean diet rich in plant foods of different colours will help feed our gut bacteria with every bite. The benefits of taking probiotics are unclear because of a lack of research, but they are usually well tolerated and unlikely to harm – so if you wish to try them go ahead, if you have had guidance from your doctor.

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HOW TO eat well

Did you know?

Sweet potatoes have been shown to help some people with inflammatory arthritis

Recipes

Sweet potato ‘hash brown’ patties and poached eggs

Serves 2-3

Ingredients

2 small eggs

2 large sweet potatoes (peeled weight 520–530g)

1 red onion

1 tsp garlic powder

½ tsp paprika

½ tsp sea salt

½ tsp black pepper

60g chickpea flour (or buckwheat or brown rice flour)

1-2 tbsp extra virgin olive oil

For the toppings

1 avocado 4 eggs

Method

1. Whisk the eggs in a small bowl and set aside. Peel then grate the sweet potatoes, then place in a sieve over a bowl. With a spoon, press down on the grated sweet potato to release the water.

2. Finely chop the onion into half moons and add to a separate large mixing bowl. Stir in the grated sweet potato.

3. Mix in all the seasonings, then the flour, then add the beaten eggs.

4. Add 1 tablespoon of oil to a large frying pan and, once hot, scoop in the sweet potato mix in 6-8 tight mounds. Flatten each one into a hash-brown patty shape with a spatula and cook for 3-5 minutes on each side until golden brown.

5. Halfway through cooking the patties, heat a pan of hot water until it bubbles. Turn down to a simmer and plop the eggs in using ramekins or mugs to prevent breaking. Time for exactly 3 minutes for perfect poached eggs.

6. Smash or slice the avocado flesh in a small bowl.

7. Top your sweet potato fritters with the avocado and poached eggs.

Butternut squash and leek risotto

Serves 4-6

Ingredients

1 butternut squash

Extra virgin olive oil

1 red onion, chopped

2 garlic cloves

250g leeks, sliced

300g brown rice

1 vegetable stock cube dissolved in 800ml hot water

200ml plant milk

1 tbsp tahini

1 tbsp nutritional yeast flakes

1 tsp white miso paste

¼ tsp ground nutmeg

¼ tsp paprika

1 tsp apple cider vinegar

200ml water

16–24 sage leaves (4 leaves per person)

Sea salt and black pepper

2 handfuls of spinach, to serve

Method

1. Preheat the oven to 200°C fan.

2. Cut the butternut squash down the middle from the top to the larger bottom end and scoop out the seeds. Lay each side flat down to peel off the skin – it is easier this way. (Or leave the skin on, if you prefer.) Then cut into chunks.

3. Transfer the squash to a roasting tray, sprinkle with sea salt and black pepper and roast for 30 minutes, turning halfway through.

4. Gently heat 1 tablespoon of extra virgin olive oil in a pan, add the onion and garlic and cook for 2 minutes, then add the leeks and soften for 1 minute.

5. Add the brown rice and coat with the oil and juices from the pan, and seasoning with a pinch of salt and pepper.

6. Pour in 800ml vegetable stock, then turn the heat to medium-low

and gently simmer for 20 minutes, with the lid on.

7. Meanwhile, in a blender, blend 250g of the roasted butternut squash (around a third) with the plant milk, tahini, nutritional yeast, white miso paste, nutmeg, paprika, apple cider vinegar and water.

8. After the risotto has simmered for 20 minutes, add the butternut squash sauce mixture, put the lid back on and cook for 15 minutes with 300ml water, stirring halfway through and 4 minutes before the end.

9. Heat some olive oil in a separate small pan and lightly fry the sage leaves until crispy.

10. Stir the rest of the roasted butternut squash into the risotto, or place it on top.

11. Serve topped with the sage leaves and fresh spinach, if liked.

Top tip

Eat well with arthritis by Emily Johnson (Yellow Kite, £25) is out now

Makes 4 Ingredients

1 mango

6 passion fruit

½ tsp vanilla extract

40g (3 tbsp) honey (or maple syrup, if vegan)

2 tsp coconut sugar

200g coconut yoghurt

½ tsp chia seeds

Squeeze of lime juice

4 tbsp desiccated coconut

Method

1. Peel the mango and cut into small chunks. Place in a bowl with the flesh of the passion fruit.

2. Stir in the vanilla extract, honey and coconut sugar. Spoon into 4 glass containers.

3. Chill in the fridge until you are ready to serve.

4. When ready to serve, top each serving with 3½ tbsp of coconut yoghurt. Sprinkle with chia seeds, lime juice and desiccated coconut.

BY GEORGINA WINTERSGILL

A GRAND day out

Spring has sprung, and getting out and about seems a lot more appealing. Help your outings go as smoothly as possible with these tips for stress-free trips

Sunshine, fresh air and a change of scene: a day out lifts your spirits and is good for your mental health, giving you something to look forward to when times are tough and memories to treasure when you’re feeling down.

We asked Angela Jacklin, a rheumatology occupational therapist at Manchester Royal Infirmary, for advice on planning a day to remember.

Do your homework

Visit your chosen venue’s website or call before you go. For inspiration, go to your local library or tourist information centre, or visit tourismforall.co.uk.

The National Trust’s Access Guide, on the National Trust website, details the terrain, toilets, and mobility aids for its properties.

Allow recovery time

Occupational therapist Angela Jacklin says: ‘You may be tired the next day, and possibly in a bit more pain, so assign time to rest. It’s a balancing act – recognising that there’ll be a pay-off, but getting out is good for mind and body.’

Enjoy yourself!

It's easy to get caught up with all the planning, but remember to have a fun day out! The fresh air and (hopefully) sunshine will boost your spirits, and being with others is great for mental health.

Use an aid

Even if you don’t normally use a stick, it can be helpful if you’re on your feet for long periods. ‘Some people take a folding walking stick,’ says Jacklin. ‘Others like hiking poles.’

Consider hiring a wheelchair or mobility scooter for the day, even if you don’t normally use one. Some venues and shopping centres hire them for free. See ShopMobility UK at shopmobilityuk.org

Find out where the toilets are

Many public places have locked loos that are accessible to disabled people using a Radar key. You can buy a Radar key from Disability Rights UK for just £5 – just search online.

Research

car parks

Is there plenty of parking close by? Some historic houses provide a minibus service between the car park and the property. Remember, some venues have several entrances. Use the one closest to where you want to go –and save yourself a walk.

Consider the terrain

Choose venues with smooth, flat paths rather than muddy fields, uneven surfaces or hills. Wheelchair-accessible paths are ideal, even if you don’t use a mobility aid. If you struggle with steps, look for venues with step-free access.

Carry pain medication and a bottle of water

Jacklin says: ‘Take your meds in advance; don’t wait until you’re in significant pain. When you stop for a break, see how you feel.’

Pace yourself

Find out where cafés and toilets are, and schedule plenty of stops to sit down. Can someone carry a portable chair for you?‘Have a break even if you don't think you need it,’ says Jacklin. ‘Remember, however far you walk, you have to walk back!’

Choose the right clothing

‘The weather can be unpredictable, so wear layers,’ says Jacklin. ‘That way you can remove a layer if you need to. Take gloves in your bag, particularly if you have a condition such as Raynaud’s, which causes really cold and sometimes numb hands.’ And don’t forget comfortable shoes!

Get in touch

Have you had any great experiences with accessible days out, or visited places that have been really good for mobility needs?

Let us know by emailing inspire@versusarthritis.org

versusarthritis.org

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Dreaming

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