P R E S I D E N T S N O T E We ceaselessly strive to disseminate information and spread awareness on arthritis and to this end, the latest edition of

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1 F R O M T H E E D I T O R S D E S K PP16636/11/2012 (031169) AUGUST 2014 THE OFFICIAL NEWSLETTER OF ARTHRITIS FOUNDATION MALAYSIA I www. afm. org. my Welcome to the August edition of our newsletter, Joint Efforts. With each issue, we strive to bring the latest as well the most relevant information on arthritis that will help you identify and cope with the condition better. Our news section contains the latest development in the research and treatment of arthritis which includes the benefits of taking 6000 steps a day, so take out your walking shoes and get started. There is also a note of caution as patients with RA may be a greater risk of developing kidney disease so close monitoring is called for! And those of you suffering from osteoarthritis, the next time you are hungry, pop a grape! Why? Refer to our news section for all this and more. But the main message for me and applicable to all readers is that while we can t avoid getting older, we can make an effort to maintain a healthy body weight, and to strengthen leg muscles with exercise. Both will help put less strain on the knee joints, and keep us mobile longer said Professor Tuan Nguyen in a universal message in a news article from Vietnam. In our center stage article, we have for you all the information that you would need to understand and manage Rheumatoid Arthritis (RA) better including symptoms to watch out for, your treatment options as well as things that you could do to help yourself like making that long overdue visit to a podiatrist! And do take our quiz prepared by one of our doctors at AFM who has generously shared varied information on the different forms of arthritis, its treatment options etc. I can assure you that you will come away with a lot more information on arthritis than you did before. I know I did! Enjoy reading! From The Editor s desk In This Issue 02 President s Note 03 News 06 Myth of The Month 08 Centre Stage: Rheumatoid Arthritis (RA) 16 Wellbeing 18 Be Patient 20 JIA: AFM Junior Club 22 Q & A 24 Moving Experience: Focus on the Neck 26 Events 28 Beneficiary 29 AFM Membership Form 30 Doc Talk: Recognition of Early Stages of Arthritis APRIL 2014 / JOINT EFFORTS _JE Final FA.indd 1

2 P R E S I D E N T S N O T E We ceaselessly strive to disseminate information and spread awareness on arthritis and to this end, the latest edition of our newsletter Joint Efforts brings you a wealth of information. Like most conditions, the key to effectively managing arthritis is early detection and treatment. So it is vital that both healthcare professional and laymen alike are aware and able to identify the early signs and symptoms and the various ways that it manifests. Our Doc Talk section is devoted to just that. So the next time you wake up with pain in your joints, it may not be because you walked the malls the previous day! Our Myth of the Month section deals with diet as there are several beliefs; false or otherwise, that are closely intertwined into our psyche with regard to what we should eat or shouldn t! Not to mention the many well-wishers who are more than anxious to share their opinions and cultural beliefs on what foods are beneficial or otherwise to the body. So we hope that after you read our section, you will be more empowered to sift through all the information that you continually receive and eat right for your condition! To inspire you to live your best life, we bring you the personal account of one woman, Nagula Thambidurai, who has weathered rheumatoid arthritis from a relatively young age and the manner in which she continues to cope optimistically. Also do read the personal account of Madam Cheong Seow Yoong, a beneficiary of our Arthritis Fund. For further details about the fund, please enquire with AFM and do spread awareness about it to people who will benefit from it. We urge you to continue to be in touch with us through reading our newsletters and participating in the various activities that we organize on a regular basis. Stay pro-active, informed and spread the awareness. Dr. Amir Azlan Zain PRESIDENT AFM Kita berusaha tanpa jemu untuk menyebarluaskan maklumat dan meningkatkan kesedaran tentang artritis, dan sehingga sekarang, edisi terkini surat berita Joint Efforts kami membawakan banyak maklumat. Seperti penyakit lain, cara terbaik untuk mengurus artritis secara berkesan adalah pengesanan dan rawatan awal. Oleh itu penting sekali bagi profesional penjagaan kesihatan dan orang biasa seperti kita sedar dan mampu mengenal pasti tanda-tanda dan simptom-simptom awal serta pelbagai cara ia berkembang perlahan-lahan. Bahagian Doc Talk kami hanya memfokuskan kepada topik ini supaya apabila anda terasa sakit sendi apabila bangun tidur, ia mungkin bukan kerana anda banyak berjalan ketika pergi membeli belah pada hari sebelumnya! Bahagian Myth of the Month kami pula adalah mengenai diet kerana terdapat kepercayaan; yang mungkin tidak betul atau sebaliknya, yang berkait rapat dengan jiwa kita mengenai apa yang kita patut atau tidak patut makan! Selain itu ramai yang teruja untuk berkongsi pendapat mereka serta kepercayaan mengikut budaya masing-masing tentang makanan yang bermanfaat ataupun sebaliknya kepada tubuh kita. Oleh itu, kami berharap selepas membaca surat berita ini, anda mampu mempertimbangkan semua maklumat yang anda terima terus menerus dan makan makanan yang betul untuk kesihatan anda! Untuk memberi inspirasi dalam menikmati kehidupan, kami membawakan kisah Nagula Thambidurai, yang telah melalui rheumatoid artritis sejak usia muda dan cara dia menangani penyakitnya secara optimistik. Jangan ketinggalan membaca kisah Madam Cheong Seow Yoong, seorang benefisiari Dana Artritis kami. Untuk maklumat lanjut tentang dana ini, sila hubungi AFM dan sebarkan kesedaran tentangnya kepada mereka yang akan menerima manfaat daripadanya. Kami menggesa anda untuk terus berhubung dengan kami melalui pembacaan surat berita dan menyertai dalam pelbagai aktiviti yang kami sering anjurkan. Kekal proaktif, bermaklumat dan sebarkan kesedaran tentangnya. Dr. Amir Azlan Zain PRESIDEN AFM 我 们 一 直 以 来 都 不 断 的 在 传 播 关 节 炎 方 面 的 讯 息 和 知 识 为 此, 这 最 新 一 期 的 会 讯 依 然 是 载 满 了 这 方 面 的 讯 息, 丰 富 你 的 知 识 跟 许 多 其 他 疾 病 一 样, 要 做 到 有 效 管 理 关 节 炎, 其 关 键 同 样 是 在 于 及 早 发 现 及 早 治 疗 有 鉴 于 此, 不 管 是 不 是 医 疗 专 业 人 士, 我 们 都 要 认 识 且 能 够 确 认, 关 节 炎 的 早 期 讯 号 和 症 状 以 及 它 们 的 各 种 呈 现 方 式, 这 点 是 很 重 要 的 ; 本 期 会 讯 内 的 Doc Talk 一 栏 讲 的 就 是 这 些 所 以, 如 果 有 一 天 早 上 你 起 床 时 感 到 关 节 疼 痛, 那 有 可 能 不 是 因 为 昨 天 逛 了 一 天 商 场 那 么 简 单! 在 Myth of the Month 专 栏 里, 本 期 讨 论 的 是 饮 食 方 面 的 几 项 迷 思 ; 对 的 或 错 的, 它 们 在 饮 食 禁 忌 上, 竟 与 我 们 的 想 法 那 么 紧 紧 的 纠 结 一 起 我 们 身 边 通 常 都 不 缺 许 多 乐 意 跟 你 分 享 的 善 心 人, 他 们 会 提 出 饮 食 影 响 健 康 的 个 人 看 法, 以 及 一 些 受 文 化 影 响 的 看 法 因 此, 我 们 希 望 你 阅 读 了 这 个 专 栏 之 后, 得 以 将 日 常 听 到 的 资 讯 好 好 过 滤 一 下, 选 择 有 益 改 善 病 情 的 饮 食 为 了 激 励 你 活 得 更 美 好, 我 们 介 绍 你 认 识 患 类 风 湿 性 关 节 炎 很 多 年 的 Nagula Thambidurai 女 士 她 很 年 轻 就 患 上 类 风 湿 性 关 节 炎, 请 听 听 她 这 一 路 是 怎 样 走 过 来, 以 及 会 怎 样 继 续 乐 观 面 对 这 个 疾 病 另 外, 也 看 看 关 节 炎 基 金 受 惠 者 之 一 的 张 秀 蓉 女 士 的 个 人 感 想 如 果 你 想 要 了 解 更 多 关 节 炎 基 金 的 详 情, 请 联 络 大 马 关 节 炎 基 金 会 (AFM) 查 询, 也 请 将 关 于 此 基 金 的 讯 息 散 播 开 去, 让 更 多 有 需 要 的 人 可 以 受 惠 我 们 借 此 呼 吁 各 位, 请 经 常 阅 读 我 们 的 会 讯, 同 时 也 请 踊 跃 参 加 本 会 举 办 的 各 项 活 动, 与 我 们 保 持 联 系 请 保 持 互 动, 吸 收 新 知 识, 也 请 散 播 这 方 面 的 知 识 Dr. Amir Azlan Zain 大 马 关 节 炎 基 金 会 主 席 2 JOINT EFFORTS / APRIL AUGUST _JE Final FA.indd 2

3 F R O M T H E E D I T O R S D E S K N E W S Walk 6000 steps a day June 2014 A new study shows that walking reduces risk of functional limitation associated with knee osteoarthritis (OA). The study funded in part by grants from the National Institutes of Health (NIH) and published in the American College of Rheumatology (ACR) journal, Arthritis Care & Research, suggests that walking 6,000 or more steps per day may protect those with or at risk of knee OA from developing mobility issues, such as difficulty getting up from a chair and climbing stairs. Data from the National Health and Nutrition Examination Survey (NHANES III) state that 80% of OA patients have some limitation in movement, with 11% of adults with knee OA needing assistance including personal care assistance. While walking is a common daily physical activity for older adults, medical evidence reports that two-thirds of U.S. adults with arthritis walk less than 90 minutes each week. Walking an additional 1,000 steps each was associated with a 16% to 18% reduction in incident functional limitation two years later. Walking less than 6,000 steps daily was the best threshold for identifying those who developed functional limitation. Dr. White concludes, Walking is an inexpensive activity and despite the common popular goal of walking 10,000 steps per day, our study finds only 6,000 steps are necessary to realize benefits. We encourage those with or at risk of knee OA to walk at least 3,000 or more steps each day, and ultimately progress to 6,000 steps daily to minimize the risk of developing difficulty with mobility. RA may lead to increased risk of kidney disease April 2014 A study published recently in the American Journal of Kidney Diseases reveals that people with rheumatoid arthritis may be at increased risk for kidney disease and require close monitoring. Researchers looked at 813 people with rheumatoid arthritis and an equal number of people without the condition. Over 20 years, the rheumatoid arthritis patients had a 25 per cent risk of developing chronic kidney disease, compared with a 20 per cent risk for those in the general population. That might not seem like a lot, but in fact that s quite a big difference, and it has important implications for the course of rheumatoid arthritis and for the management of the disease, study senior author Dr. Eric Matteson, chair of rheumatology at the Mayo Clinic in Rochester, Minn., said in a Mayo news release. Factors that contribute to a higher risk of kidney disease in rheumatoid arthritis patients include more severe inflammation in the first year of rheumatoid arthritis, use of corticosteroids, high blood pressure, obesity and high cholesterol levels. While the study found an association between rheumatoid arthritis and a raised risk of kidney disease, it did not establish a causeand-effect link. The researchers said that doctors should check rheumatoid arthritis patients periodically for signs of kidney problems. Patients need to keep their blood pressure under control, eat a low-salt diet and reduce or stop their use of medications that can harm their kidneys, including nonsteroidal antiinflammatory drugs (NSAIDS). AUGUST APRIL 2014 / JOINT EFFORTS _JE Final FA.indd 3

4 N E W S High incidence of Knee Osteoarthritis in Vietnam April 2014 The results of a study, undertaken in Vietnam for the first time reveals the high prevalence of knee osteoarthritis, showing that roughly a third of Vietnamese men and women over the age of 40 are affected. Professor Tuan Nguyen from Sydney s Garvan Institute of Medical Research, in collaboration with Dr Lan Ho-Pham, Head of Rheumatology at People s Hospital 115 in Ho Chi Minh City, randomly recruited 170 men and 488 women, aged between 40 and 98, from Ho Chi Minh City and measured the prevalence of knee osteoarthritis and self-reported pain. As with populations in other countries, the incidence of osteoarthritis in Vietnam increased with age and body mass index (BMI). Each 5-year increase in age was associated with a 56% increase in the risk of knee osteoarthritis, and each kg/cm2 increase in BMI was associated with a 14% increase. Roughly 8.5% of those between age 40 and 49 had knee osteoarthritis, compared with 30% between age 50 and 59, and 61% over the age of 60. The study is important because it reminds us that ageing, fatter, populations around the world will impose escalating skeletal healthcare costs in the future. The proportion of people aged 65 years and older in Asia alone is estimated to rise from roughly 7% in 2008 to16% in Apart from age and BMI, this study found three other predictors of knee osteoarthritis: pain when squatting; a bony enlargement of the knee; and crepitus grating or popping sounds in the joint. The main message is that while we can t avoid getting older, we can make an effort to maintain a healthy body weight, and to strengthen leg muscles with exercise. Both will help put less strain on the knee joints, and keep us mobile longer said Professor Tuan Nguyen. EAT GRAPES TO LESSEN PAIN May 2014 New research presented at the Experimental Biology conference in San Diego, California, suggests that regular grape consumption may help alleviate pain associated with symptomatic osteoarthritis of the knee, and improve joint flexibility and overall mobility. Researchers attribute these potential benefits to the polyphenols found in grapes. The sixteen week clinical study, undertaken by Texas Woman s University, was designed to investigate the benefits of grape consumption on inflammation and osteoarthritis outcomes. 72 men and women with knee osteoarthritis (OA) were assigned to either consume grapes in the form of a whole grape freeze-dried powder, or a placebo powder. The study results, presented by lead investigator Shanil Juma, Ph.D., showed that both men and women consuming a grape-enriched diet had a significant decrease in self-reported pain related to activity and an overall decrease in total knee symptoms. This beneficial effect was more pronounced in females. Evidence of increased cartilage metabolism was observed in men consuming the grape-enriched diet; they had higher levels of an important cartilage growth factor (IGF-1) than those on placebo. This protective effect was not observed in the females. The researchers noted that no difference in range of motion was observed for either the grape group or the placebo group. The serum marker for inflammation (IL1-β) measured was increased in both placebo and grape groups, although much less of an increase was observed in the grape group. These findings provide promising data that links grape consumption to two very important outcomes for those living with knee osteoarthritis: reduced pain and improvements in joint flexibility, said Dr. Juma. More research is needed to better understand the results of the serum biomarkers, as well as the age and gender differences observed. C M Y CM MY CY CMY K 4 JOINT EFFORTS / APRIL AUGUST _JE Final FA.indd 4

5 F R O M T H E E D I T O R S D E S K C M Y M Y Y MY K AUGUST APRIL 2014 / JOINT EFFORTS _JE Final FA.indd 5

6 M Y T H O F T H E M O N T H helpful in the long term for some people with rheumatoid arthritis. A vegan diet, which doesn t include any meat, fish or other animal products, may also be helpful possibly because of the types of polyunsaturated fatty acids included in the diet. If you eat a vegan diet though, make sure you get all the nutrients you need, particularly calcium, vitamin B12, vitamin D and selenium. Diet And Its Effects On People Living With Rheumatoid Arthritis It is inevitable that you must have come across many opinions on what you should and shouldn t eat when you have arthritis. While no diets or dietary supplements will cure your arthritis, there could be an improvement in your symptoms as a result of incorporating some changes in your diet. THE TWO MOST IMPORTANT FACTORS TO CONSIDER ARE Your weight if you re overweight, losing some weight will reduce the strain on your joints, so you may find you don t need to take painkillers quite so often. Whether your diet gives you the vitamins and minerals you need a good diet can help to protect you against some possible side-effects of drugs and heart disease (which can sometimes be a complication of certain types of arthritis). In rheumatoid arthritis, some drugs used to treat are linked with an increased risk of heart and circulatory problems. Several of the diet and lifestyle changes which are useful for arthritis are also useful for heart and circulation health, including exercise and omega-3 fatty acids. So the guidelines to diet are: A balanced and varied diet to get all the vitamins, minerals, antioxidants and other nutrients you need A more Mediterranean-style diet which include fish, pulses, nuts, olive oil and plenty of fruit and vegetables More omega-3 fatty acids, for example from oily fish. ON VEGETARIANISM AND GOING VEGAN Some studies have shown that people who eat a lot of red meat have a higher risk of developing inflammatory types of arthritis. Vegetarian diets have been shown to be SHOULD I AVOID CERTAIN FOODS? There are always foods that people will recommend you exclude as they are bad for arthritis. These foods include: Citrus fruits, such as oranges, lemons and grapefruit Vegetables from the nightshade family (solanaceous plants) including potatoes, tomatoes, peppers, chillies and aubergines. We don t recommend leaving these fruits and vegetables out of your diet because of the important nutrients they contain. There s no scientific evidence that cutting out these foods can help with arthritis. In fact, they re rich in antioxidants oranges and red peppers contain an antioxidant cryptoxanthin which studies have shown may slow down the progression of arthritis. WHAT ABOUT FOOD ALLERGIES, INTOLERANCE? Some people are allergic to certain foods such as peanuts or shellfish. Allergic reactions occur quickly after the food is eaten and there s no real evidence that food allergies are relevant to the development of arthritis or its treatment. Some people are also intolerant of certain foods. Symptoms of food intolerance develop fairly slowly after eating a food after hours or even days. So food intolerances can be difficult to identify without the help of an expert. Research has shown that some people have an improvement in their symptoms if they cut out particular foods. The reasons for this aren t yet clear and the foods involved vary from person to person. We recommend that you speak to a registered dietitian who can check that you re not excluding important nutrients. And do make mealtimes an enjoyable affair. 6 JOINT EFFORTS / APRIL AUGUST _JE Final FA.indd 6

7 F R O M T H E E D I T O R S D E S K Diet dan kesannya terhadap orang yang menghidapi Reumatoid Artritis Memang tidak dapat dielakkan anda pasti pernah mendengar pelbagai pendapat tentang apa yang boleh atau tidak boleh dimakan jika anda menghidapi artritis. Walaupun tiada diet atau pemakanan tambahan yang dapat menyembuhkan artritis anda, namun simptom anda boleh dikurangkan jika anda mengubah sedikit diet anda. DUA FAKTOR PALING PENTING UNTUK DIPERTIMBANGKAN ADALAH: Berat badan anda sekiranya anda mempunyai berat badan berlebihan, anda boleh mengurangkan tekanan pada sendi anda jika anda mengurangkan berat badan anda dan supaya anda tidak perlu mengambil ubat penahan sakit dengan lebih kerap. Sama ada diet anda membekalkan anda dengan vitamin dan zat galian yang anda perlukan sebenarnya, diet yang baik boleh membantu melindungi anda daripada kemungkinan kesan sampingan daripada ubat-ubatan dan daripada penyakit jantung (yang kadang kala merupakan komplikasi daripada sesetengah jenis artritis). Sesetengah ubat yang digunakan dalam merawat reumatoid artritis dikaitkan dengan peningkatan risiko masalah jantung dan pengaliran darah. Beberapa perubahan pada diet dan gaya hidup yang berguna terhadap artritis juga mempunyai manfaat untuk kesihatan jantung dan pengaliran darah, termasuk senaman dan asid lemak omega-3. Oleh itu garis panduan diet adalah: Diet yang seimbang dan pelbagai untuk memperoleh semua vitamin, zat galian, antioksidan dan khasiat-khasiat lain yang anda perlukan Diet ala-mediterranean yang merangkumi ikan, kekacang, minyak zaitun dan banyak buah-buahan dan sayur-sayuran Lebih banyak asid lemak omega-3 seperti ikan yang berminyak. BERUBAH MENJADI VEGETARIAN DAN VEGAN Sesetengah kajian menunjukkan bahawa orang yang makan banyak daging mempunyai risiko yang lebih tinggi mendapat artritis jenis keradangan. Diet vegetarian secara jangka panjang banyak manfaatnya bagi mereka yang menghidapi reumatiod artritis. Diet vegan, yang tidak makan sebarang daging, ikan atau hasil haiwan, juga mungkin ada manfaatnya kerana jenis asid lemak politaktepu yang ada di dalam diet. Sekiranya anda makan diet vegan, pastikan anda mendapat semua khasiat yang diperlukan, terutamanya kalsium, vitamin B12, vitamin D dan selenium. PERLUKAH SAYA MENGELAK SESETENGAH MAKANAN? Pastinya ada makanan yang orang cadangkan untuk dielakkan kerana ia tidak baik untuk artritis. Makanan ini termasuklah: Buah-buahan sitrus seperti oren, lemon dan limau gadang Sayur-sayuran daripada famili nightshade (tumbuhan solanum) termasuk kentang, tomato, lada Benggala, cili dan terung. Kami tidak menggalakkan anda menyingkirkan buah-buahan dan saur-sayuran sama sekali kerana makanan tersebut mengandungi khasiat yang penting, Tiada bukti saintifik yang menunjukkan bahawa mengelakkan makanan tersebut dapat membantu keadaan artritis anda. Malah, makanan tersebut kaya dengan antioksidan - di mana oren dan lada Benggala merah mengandungi antioksidan yang digelar β cryptoxanthin, dan kajian menunjukkan bahawa khasiat ini mungkin memperlahankan kemajuan artritis. ALAHAN MAKANAN Sesetengah orang mempunyai alahan terhadap sesetengah makanan seperti kacang atau kerang-kerangan. Reaksi alahan berlaku dengan cepat selepas makanan itu dimakan dan tiada bukti sebenar yang menunjukkan bahawa alahan makanan itu relevan dengan kemajuan artritis atau rawatannya. Sesetengah orang juga tidak tahan dengan sesetengah makanan. Simptomsimptom tidak tahan makanan terjadi secara perlahan-lahan selepas makanan tersebut dimakan iaitu, selepas beberapa jam atau hari. Oleh itu ketidaktahanan dengan makanan mungkin susah untuk dikenal pasti tanpa bantuan pakar. Kajian menunjukkan bahawa sesetengah orang mempunyai peningkatan dalam simptom-simptom mereka sekiranya mereka tidak mengambil makanan yang tertentu. Sebabnya adalah kurang jelas dan makanan yang terlibat juga berbeza-beza antara satu orang dengan orang yang lain. Kami mencadangkan agar anda berbincang dengan pakar diet yang berdaftar, yang dapat memeriksa agar anda tidak mengecualikan khasiat penting. Pastikan waktu makan itu adalah waktu untuk dinikmati. 饮 食 对 类 风 湿 性 关 节 炎 患 者 的 影 响 患 上 关 节 炎 之 后, 经 常 难 免 有 人 会 告 诉 你 什 么 食 物 是 该 吃 或 不 该 吃 的, 而 且 意 见 还 因 人 而 异 在 目 前 尚 没 有 任 何 饮 食 或 饮 食 补 给 品 可 以 根 治 关 节 炎 的 当 儿, 若 能 够 在 饮 食 上 作 某 些 调 整 的 话, 结 果 或 许 能 减 轻 关 节 炎 的 症 状 應 該 考 慮 的 兩 大 重 要 因 素 是 体 重 如 果 身 体 超 重, 减 轻 体 重 可 以 减 少 关 节 的 劳 损 这 样 一 来, 你 或 许 就 不 再 经 常 需 要 止 痛 药 了 日 常 饮 食 是 否 提 供 各 种 人 体 需 要 的 维 他 命 和 矿 物 质 良 好 的 饮 食 可 以 帮 助 人 体 抵 御 药 物 可 能 引 起 的 一 些 副 作 用, 也 可 以 避 免 心 脏 疾 病 ( 某 些 关 节 炎 有 时 会 引 起 这 方 面 的 并 发 症 ) 在 类 风 湿 性 关 节 炎 的 药 疗 上, 一 些 用 来 治 疗 这 种 关 节 炎 的 药 物 会 提 高 患 上 心 脏 疾 病 和 循 环 系 统 疾 病 的 风 险 在 那 些 能 够 改 善 关 节 炎 病 情 的 饮 食 及 生 活 习 惯 当 中, 有 些 是 同 时 对 增 进 心 脏 健 康 和 循 环 系 统 健 康 有 助 益 者, 它 们 包 括 运 动 及 omega-3 脂 肪 酸 關 於 這 方 面 的 飲 食 准 則 如 下 : 均 衡 且 多 样 化 的 饮 食 可 以 让 人 体 吸 取 到 各 种 维 他 命 矿 物 质 抗 氧 化 物 以 及 其 他 所 需 的 营 养 素 将 饮 食 习 惯 改 为 稍 偏 向 地 中 海 式 饮 食, 饮 食 中 有 鱼 类 豆 类 坚 果 橄 榄 油, 再 加 上 大 量 的 蔬 菜 和 水 果 多 多 摄 取 omega-3 脂 肪 酸, 例 如 多 吃 富 含 脂 肪 的 鱼 类 素 食 和 純 素 食 根 据 一 些 研 究 显 示, 吃 大 量 的 红 肉 会 增 加 患 上 炎 性 关 节 炎 的 风 险 研 究 也 显 示, 长 远 而 言, 素 食 对 某 些 人 在 纾 缓 类 风 湿 性 关 节 炎 方 面 有 一 定 的 正 面 影 响 至 于 完 全 不 含 肉 类 鱼 类 或 其 他 动 物 类 产 品 的 纯 素 食, 在 这 方 面 也 有 助 益 原 因 可 能 是 因 为 纯 素 食 饮 食 内 含 有 许 多 种 的 多 不 饱 和 脂 肪 酸 如 果 你 奉 行 纯 素 食, 请 确 定 有 从 日 常 饮 食 中 摄 取 到 各 种 人 体 需 要 的 营 养, 尤 其 是 钙 质 维 他 命 B12 维 他 命 D 以 及 硒 我 應 該 不 吃 某 些 食 物 嗎? 经 常 会 有 人 提 醒 你 不 要 吃 某 些 食 物, 因 为 它 们 对 关 节 炎 有 坏 影 响 这 些 食 物 包 括 : 橘 类 水 果, 例 如 鲜 橙 柠 檬 和 葡 萄 柚 茄 科 蔬 菜 包 括 马 铃 薯 番 茄 灯 笼 椒 辣 椒 及 茄 子 以 上 这 些 水 果 和 蔬 菜 都 含 有 重 要 营 养 素, 我 们 因 此 不 建 议 你 避 开 它 们 目 前 没 有 科 学 研 究 可 以 证 明 避 而 不 吃 这 些 食 物 对 纾 缓 关 节 炎 会 有 帮 助 它 们 其 实 富 含 大 量 抗 氧 化 物, 当 中 的 鲜 橙 和 红 色 灯 笼 椒 均 含 有 一 种 叫 做 β 隐 黄 素 的 抗 氧 化 物, 研 究 显 示 此 抗 氧 化 物 能 够 令 关 节 炎 的 进 程 放 缓 食 物 過 敏 及 食 物 不 耐 跟 關 節 炎 有 關 係 嗎? 有 些 人 对 某 些 食 物 会 有 过 敏 反 应, 例 如 花 生 和 贝 壳 类 海 鲜 过 敏 反 应 在 吃 下 相 关 食 物 后 很 快 就 出 现, 没 有 确 实 证 据 可 以 证 明 食 物 过 敏 是 跟 关 节 炎 的 形 成 有 关, 或 者 与 它 的 治 疗 有 关 有 些 人 则 会 出 现 食 物 不 耐 的 反 应 吃 下 相 关 食 物 之 后, 食 物 不 耐 的 症 状 发 生 得 比 较 慢, 通 常 是 数 小 时 或 数 天 以 后 才 出 现 因 此, 若 没 有 专 家 的 协 助, 食 物 不 耐 是 不 容 易 鉴 定 出 来 的 研 究 显 示, 有 些 人 身 上 的 关 节 炎 症 状 确 实 在 少 吃 某 些 食 物 之 后 有 所 改 善 箇 中 原 因 尚 未 知 晓, 而 所 谓 的 有 益 食 物 也 因 人 而 异 我 们 建 议 你 找 一 位 合 格 的 注 册 营 养 师 谈 谈, 他 会 帮 你 看 看 你 的 饮 食 中 到 底 是 不 是 已 经 包 含 了 各 种 重 要 的 营 养 成 分 还 有, 进 餐 时 心 情 要 好, 欢 喜 享 受 用 餐 时 光 AUGUST APRIL 2014 / JOINT EFFORTS _JE Final FA.indd 7

8 C E N T R E S TA G E What is Rheumatoid Arthritis (RA)? RA, is a form of inflammatory arthritis and an autoimmune disease. For reasons yet unknown, in rheumatoid arthritis, the immune system which is designed to protect our health by attacking foreign cells such as viruses and bacteria instead attacks the body s own tissues, specifically the synovium, a thin membrane that lines the joints. Fluid builds up in the joints, causing pain in the joints and inflammation which can eventually result in bone erosion and joint deformity. RA may also affect other organs of the body such as the skin, eyes, lungs and blood vessels. 8 JOINT EFFORTS / APRIL _JE Final FA.indd 8

9 F R O M T H E E D I T O R S D E S K WHAT CAUSES IT? Most scientists agree that a combination of genetic and environmental factors are responsible. Researchers have identified genetic markers that cause a tenfold greater probability of developing rheumatoid arthritis. These genes, associated with the immune system, could cause chronic inflammation or the development and progression of RA. Still, not all people with these genes develop rheumatoid arthritis and not all people with the disease have these genes. Female hormones are also a probable suspect as approximately 70 per cent of people with RA are women. The body s response to stressful events such as physical or emotional trauma is another factor. Smoking may also play a role as it not only boosts the risk of developing RA among people with a specific gene, it can also increase the disease s severity and reduce the effectiveness of treatment. Research is ongoing. DID YOU KNOW? Although rheumatoid arthritis can occur at any age, it usually begins after age 40. Children too can develop RA. The disorder is much more common in women than in men. Nearly three times as many women as men are prone to contracting the disease. The disease is chronic; which means it cannot be cured. SYMPTOMS Symptoms of rheumatoid arthritis tend to come and go. You may have flare-ups when your symptoms become worse than normal. Common symptoms are: Joint pain and swelling Stiffness Tiredness (fatigue), depression, irritability Anaemia Flu-like symptoms, such as feeling generally ill, feeling hot and sweating. Less common symptoms include: Weight loss Inflammation in the eyes Rheumatoid nodules Inflammation of other body parts, for example lungs and blood vessels and the membrane around your heart, but this is rare. Rheumatoid arthritis varies from one person to another but it usually starts quite slowly. A few joints often your fingers, wrists or the balls of your feet become uncomfortable and may swell, often intermittently. You may also feel stiff when you wake up in the morning. For about 1 in 5 of those with rheumatoid arthritis, the condition develops very rapidly, with AUGUST APRIL 2014 / JOINT EFFORTS _JE Final FA.indd 9

10 C E N T R E S TA G E FOUR MAIN GROUPS OF DRUGS USED TO TREAT RHEUMATOID ARTHRITIS: Painkillers Non-steroidal antiinflammatory drugs (NSAIDs) Disease-modifying anti-rheumatic drugs (DMARDs) Steroids. HOW IS RA DIAGNOSED? No single test can give a definite diagnosis of rheumatoid arthritis in the early stages of the condition. Doctors have to arrive at a diagnosis based on your symptoms, a physical examination and the results of x-rays, scans and blood tests. Because rheumatoid arthritis can affect other parts of your body besides your joints it s important to tell your doctor about all the symptoms you ve had even if they don t seem to be related. Blood tests can measure inflammation. X-rays will show any damage caused to your joints by the inflammation in rheumatoid arthritis. The changes often show up in x-rays of your feet before they appear in other joints, so your doctor may want to x-ray your feet even if they re not causing you any problems. You may need repeat blood tests and x-rays from time to time to help your doctor assess how quickly your arthritis is developing and whether you need any changes to your medication. pain and swelling in a lot of joints, severe morning stiffness and great difficulty doing everyday tasks. If you have painful, swollen joints and stiffness in the morning that lasts for longer than half an hour, you should see your doctor. Research shows that the sooner you start treatment for rheumatoid arthritis, the more effective it s likely to be, so early diagnosis is important. Evidence shows that early diagnosis and aggressive treatment to put the disease into remission is the best means of avoiding joint destruction, organ damage and disability. TREATMENT Treatment focuses on controlling symptoms and preventing joint damage through a combination of drugs, physical therapy and surgery. Drugs. Most people with rheumatoid arthritis may need to take more than one drug. This is because different drugs work in different ways. If you take two or more anti-rheumatic drugs they can be more effective than just taking one and there are no extra side-effects. Your drug treatment may be altered from time to time depending on how active your arthritis is or in response to changes in your circumstances. For example, you may be advised to stop taking a particular drug if you need surgery. Physical therapies are vital to look after your joints in the treatment of rheumatoid arthritis. Exercise is key and a physiotherapist can suggest different exercises that may help ease your symptoms. A podiatrist can help with problems with your feet and ankles. They can suggest appropriate footwear for both daily life and sport. If you re having difficulty with day-to-day activities an occupational therapist can suggest ways that you could do them without putting too much strain on your joints. They can also give you information on splints if you need supports for your hands and wrists. Surgery is occasionally needed for rheumatoid arthritis. Operations vary from quite minor ones such as the release of a nerve or a tendon to major surgery such as joint replacement. 10 JOINT EFFORTS / APRIL _JE Final FA.indd 10

11 F R O M T H E E D I T O R S D E S K APRIL 2014 / JOINT EFFORTS _JE Final FA.indd 11

12 C E N T R E S TA G E Apakah Reumatoid Arthritis (RA)? RA adalah sejenis radang artritis dan merupakan penyakit auto imun. Atas sebab yang masih belum diketahui, dalam kes reumatoid artritis, sistem imun yang sepatutnya melindungi kesihatan kita daripada serangan sel-sel asing seperti virus dan bakteria menyerang tisu badan sendiri, khususnya synovium, iaitu membran nipis yang melapisi sendi. Cecair yang berkumpul di dalam sendi menyebabkan kesakitan pada sendi dan keradangan, lama kelamaan akan menyebabkan hakisan tulang dan kecacatan sendi. RA juga mungkin menjejaskan organ-organ pada badan lain seperti kulit, mata, paru-paru dan saluran darah. APAKAH YANG MENYEBABKAN RA? Kebanyakan ahli sains bersetuju bahawa RA disebabkan oleh kombinasi faktor genetik dan persekitaran. Para penyelidik telah mengenal pasti penanda genetik yang menyebabkan sepuluh kali kemungkinan untuk mendapat reumatoid artritis. Gen ini dikaitkan dengan sistem imuniti yang boleh menyebabkan keradangan kronik atau membangunkan RA. Walau pun begitu, bukan semua orang dengan gen ini mempunyai reumatoid artritis dan bukan semua orang yang mempunyai penyakit ini mempunyai gen tersebut. Hormon wanita juga berkemungkinan menjadi penyebab kerana anggaran 70 peratus orang yang menghidapi RA adalah wanita. Respons tubuh kepada keadaan sukar seperti trauma fizikal atau emosi juga menjadi faktor. Merokok juga memainkan peranan kerana ia bukan sahaja meningkatkan risiko pembentukan RA di kalangan mereka yang mempunyai gen yang tertentu tetapi tabiat tersebut juga meningkatkan keamatan penyakit dan mengurangkan keberkesanan rawatan. Kajian masih lagi dijalankan. TAHUKAH ANDA? Walaupun reumatoid artritis boleh berlaku pada pelbagai peringkat usia, RA selalunya bermula selepas usia 40 tahun. Kanak-kanak juga boleh mendapat RA. Penyakit ini lebih kerap dihidapi oleh wanita berbanding lelaki. Wanita berisiko hampir tiga kali ganda untuk mendapat penyakit ini. RA adalah penyakit kronik. Ini bermakna penyakit ini tidak boleh disembuhkan. SIMPTOM Simptom reumatoid artritis datang dan pergi. Keadaan 12 JOINT EFFORTS / APRIL AUGUST _JE Final FA.indd 12

13 F R O M T H E E D I T O R S D E S K mungkin marak apabila simptomnya lebih teruk dari biasa. Simptom-simptom biasa adalah: Sakit sendi dan bengkak Kekakuan Keletihan (lesu), depresi, cepat marah Anemia Simptom seperti selesema seperti rasa kurang sihat, rasa panas dan berpeluh. Simptom kurang biasa termasuklah: Hilang berat badan Keradangan di dalam mata Nodul reumatoid Keradangan di bahagian lain badan, seperti paru-paru dan saluran darah dan membran di sekeliling jantung, tetapi ini jarang sekali berlaku. Reumatoid artritis berbeza-beza dari seorang dengan orang lain tetapi selalunya ia bermula dengan perlahanlahan. Beberapa sendi - selalunya jari, pergelangan tangan atau tumit kaki merasa tidak selesa dan mungkin bengkak, selalunya sekejap-sekejap. Anda mungkin juga rasa kaku apabila bangun tidur pada waktu pagi. Lebih kurang 1 dalam 5 daripada mereka yang menghidapi reumatoid artritis mempunyai keadaan yang merebak dengan cepat, dengan kesakitan dan bengkak pada banyak sendi, kekakuan yang teruk pada waktu pagi dan sukar melakukan tugas harian. Sekiranya sendi anda sakit dan bengkak, serta rasa kaku pada waktu pagi selama lebih daripada setengah jam, anda hendaklah berjumpa doktor anda. Kajian menunjukkan bahawa lebih awal rawatan dimulakan untuk reumatoid artritis, ia lebih berkesan, oleh itu rawatan awal itu amat penting. BAGAIMANA RA DIDIAGNOSIS? Tiada ujian tunggal yang dapat memberi diagnosis yang tepat untuk reumatoid artritis pada peringkat awal penyakit ini. Doktor perlu mendiagnosis berdasarkan simptom anda, pemeriksaan fizikal dan keputusan sinar-x, imbasan dan ujian darah. Memandang reumatoid artritis boleh memberi kesan kepada bahagian-bahagian lain badan, selain daripada sendi anda, ia penting bagi anda untuk memaklumkan kepada doktor tentang semua simptom yang anda alami walau pun ia mungkin tidak berkaitan. Ujian darah mengukur keradangan. Sinaran-x akan menunjukkan sebarang kerosakan pada sendi akibat keradangan dalam reumatoid artritis. Perubahan selalunya timbul dalam sinaran-x pada kaki anda sebelum ia nampak pada sendi-sendi lain, oleh itu doktor mungkin mahu membuat sinaran-x pada kaki walau pun anda tidak mempunyai masalah dengan kaki anda. Anda mungkin perlu mengulangi ujian darah dan sinaran-x dari semasa ke semasa untuk membantu doktor anda menilai berapa cepatnya artritis anda berkembang dan sama ada anda perlu memerlukan perubahan pada ubat-ubatan anda. RAWATAN Rawatan memfokuskan pada pengawalan simptom dan mencegah kerosakan sendi melalui kombinasi ubat-ubatan, terapi fizikal dan pembedahan. Bukti menunjukkan bahawa diagnosis awal dan rawatan agresif supaya penyakit berada di dalam keadaan remisi adalah cara terbaik untuk mengelakkan kerosakan sendi, kerosakan organ dan kecacatan. Kebanyakan orang yang menghidap reumatoid artritis mungkin perlu mengambil lebih daripada satu jenis ubat. Ini adalah kerana ubat yang berlainan bertindak dengan cara yang berbeza. Sekiranya anda mengambil dua atau lebih ubat anti- reumatik, ia adalah lebih berkesan daripada mengambil satu jenis ubat sahaja dan tiada sebarang kesan sampingan tambahan. Rawatan ubat-ubatan anda mungkin ditukar dari semasa ke semasa bergantung kepada bagaimana aktifnya artritis anda atau perubahan dalam keadaan anda. Sebagai contohnya, anda mungkin dinasihatkan untuk berhenti mengambil ubat yang tertentu sekiranya anda perlu menjalani pembedahan. Penting bagi ahli terapi fizikal menjaga sendi anda dalam merawat reumatoid artritis. Senaman itu penting dan ahli fisioterapi boleh mencadangkan senaman yang mungkin membantu melegakan simptom-simptom anda. Seorang ahli penyakit kaki juga boleh membantu dengan masalah kaki dan buku lali anda. Mereka boleh mengesyorkan kasut yang sesuai untuk kehidupan harian dan sukan. Sekiranya anda mempunyai masalah dengan aktiviti harian, ahli terapi pekerjaan boleh mencadangkan cara yang anda boleh lakukan tanpa memberi banyak tekanan pada sendi anda. Mereka juga akan memberi maklumat tentang splin sekiranya anda memerlukan sokongan untuk tangan dan pergelangan tangan anda. Pembedahan kadang-kala perlu bagi reumatoid artritis. Pembedahan yang diperlukan itu berbeza-beza daripada pembedahan kecil seperti melepaskan saraf atau tendon hinggalah kepada pembedahan besar seperti penggantian sendi. Empat kumpulan utama ubat-ubatan yang digunakan untuk merawat reumatoid artritis adalah: Ubat penahan kesakitan Ubat anti-radang bukan steroid (NSAID) Ubat anti-reumatik pengubah penyakit (DMARD) Steroid. AUGUST APRIL 2014 / JOINT EFFORTS _JE Final FA.indd 13

14 C E N T R E S TA G E 什 么 是 类 风 湿 性 关 节 炎? 类 风 湿 性 关 节 炎 是 一 种 炎 性 关 节 炎, 同 时 也 是 一 种 自 身 免 疫 疾 病 由 于 一 些 至 今 还 未 明 的 原 因, 类 风 湿 性 关 节 炎 的 发 生, 是 因 为 那 原 本 应 该 去 攻 击 病 毒 和 细 菌 之 类 外 来 物, 以 便 保 护 人 体 健 康 的 免 疫 系 统, 竟 然 倒 过 来 侵 犯 自 身 的 组 织, 尤 其 是 侵 犯 关 节 里 一 层 叫 做 滑 膜 的 薄 衬 滑 膜 发 炎 时 关 节 里 会 积 满 液 体, 令 关 节 疼 痛 和 发 炎, 日 子 久 了 就 会 耗 蝕 骨 头, 使 关 节 变 形 类 风 湿 性 关 节 炎 也 会 侵 犯 身 体 其 他 器 官, 例 如 皮 肤 眼 睛 肺 部 和 血 管 它 是 什 么 原 因 造 成 的? 大 多 数 科 学 家 都 同 意 它 是 由 遗 传 加 上 环 境 因 素 所 造 成 的 研 究 人 员 已 经 确 认 出 能 够 令 人 有 更 大 几 率 患 上 类 风 湿 性 关 节 炎 的 遗 传 标 记 只 要 这 些 基 因 与 免 疫 系 统 联 合 起 来, 是 会 引 起 慢 性 发 炎, 或 导 致 类 风 湿 性 关 节 炎 的, 它 们 也 会 使 这 疾 病 渐 渐 演 进 话 虽 如 此, 但 并 非 每 个 有 这 些 遗 传 基 因 的 人 都 会 患 上 类 风 湿 性 关 节 炎, 也 不 是 每 个 患 上 此 疾 病 的 人 都 有 这 些 基 因 研 究 也 怀 疑 女 性 荷 尔 蒙 亦 是 原 因 之 一, 因 为 类 风 湿 性 关 节 炎 患 者 人 口 当 中 有 大 约 百 分 之 七 十 是 女 性 身 体 承 受 了 巨 大 压 力 例 如 身 体 或 精 神 上 的 创 伤, 也 是 致 病 因 素 之 一 抽 烟 也 是 致 病 原 因 之 一, 因 为 抽 烟 不 但 提 高 身 上 有 该 特 定 基 因 的 人 得 此 病 的 风 险, 它 也 会 使 这 疾 病 变 得 更 严 重, 同 时 还 会 降 低 治 疗 的 效 果 有 关 这 方 面 的 研 究 仍 在 不 断 进 行 中 14 JOINT EFFORTS / APRIL AUGUST _JE Final FA.indd 14

15 F R O M T H E E D I T O R S D E S K 你 知 道 吗? 虽 然 类 风 湿 性 关 节 炎 会 在 任 何 年 龄 发 病, 但 是 它 通 常 是 在 40 岁 以 后 才 出 现 儿 童 也 会 患 上 类 风 湿 性 关 节 炎 女 性 比 男 性 容 易 患 上 此 疾 病 在 那 些 较 容 易 患 上 这 个 疾 病 的 人 口 当 中, 女 性 是 男 性 的 三 倍 这 是 一 种 慢 性 疾 病 ; 这 意 味 着 它 是 无 法 根 治 的 症 状 类 风 湿 性 关 节 炎 的 症 状 时 好 时 坏 当 疾 病 发 飙 时, 它 的 症 状 会 比 平 时 严 重 许 多 常 见 的 症 状 有 : 关 节 疼 痛 和 发 肿 僵 硬 感 疲 累 ( 疲 乏 ) 忧 郁 容 易 发 怒 贫 血 像 似 感 冒 般 的 症 状, 例 如 浑 身 有 如 生 病 般 的 不 舒 服 觉 得 热 而 且 冒 汗 比 较 少 见 的 症 状 包 括 : 消 瘦 眼 部 发 炎 类 风 湿 结 身 体 其 他 部 位 发 炎, 例 如 肺 部 和 血 管 ; 心 脏 周 围 的 薄 膜 也 会 发 炎, 不 过 却 甚 为 少 见 类 风 湿 性 关 节 炎 的 情 形 因 人 而 异, 但 是 疾 病 刚 开 始 时 的 演 进 都 很 缓 慢 开 始 时, 会 有 几 个 关 节 通 常 是 手 指 手 腕 或 跖 球 ( 脚 掌 处 接 近 大 脚 趾 根 部 的 圆 形 部 位 ) 显 得 不 舒 服 且 肿 胀, 而 且 是 间 歇 性 发 生 早 上 起 床 关 节 会 有 僵 硬 感 每 五 位 患 者 之 中, 会 有 一 人 的 病 情 是 迅 速 演 进 的, 他 会 有 多 处 关 节 发 痛 和 发 肿, 早 上 起 床 时 关 节 严 重 僵 硬, 就 连 处 理 生 活 事 物 也 感 觉 非 常 困 难 如 果 你 早 上 起 床 时 有 多 个 关 节 感 到 僵 硬, 而 僵 硬 感 又 持 续 半 个 小 时 以 上 才 消 退, 那 你 就 应 该 寻 医 了 研 究 显 示, 越 早 开 始 治 疗 类 风 湿 性 关 节 炎, 治 疗 效 果 越 好, 因 此 及 早 确 诊 很 重 要 治 疗 治 疗 方 案 专 注 于 通 过 药 物 物 理 和 手 术 治 疗, 来 进 行 疾 病 控 制 和 避 免 关 节 受 损 实 例 证 明, 及 早 诊 断 加 上 积 极 的 治 疗, 将 疾 病 处 理 到 进 入 缓 解 期, 是 避 免 关 节 损 坏 器 官 受 损 以 及 残 障 的 最 佳 方 法 多 数 患 上 类 风 湿 性 关 节 炎 的 人 都 需 要 服 用 一 种 以 上 的 药 物, 原 因 是 不 同 的 药 有 不 同 的 作 用 假 如 你 服 用 两 种 或 以 上 的 抗 风 湿 药, 效 果 会 比 只 服 用 一 种 来 得 好, 而 且 也 不 会 有 额 外 的 副 作 用 你 的 药 疗 会 时 而 改 变, 令 药 疗 改 变 的 原 因, 无 非 是 病 情 的 活 跃 程 度 或 病 况 的 改 变 例 如, 当 你 需 要 动 手 术 时, 医 生 会 吩 咐 你 先 停 止 服 用 某 一 种 药 物 物 理 治 疗 在 治 疗 类 风 湿 性 关 节 炎 方 面, 其 重 要 性 在 于 它 能 够 帮 你 把 关 节 照 顾 好 在 这 方 面, 锻 炼 就 是 主 要 方 案 物 理 治 疗 师 会 建 议 你 做 各 种 有 益 关 节 的 锻 炼, 帮 助 你 减 轻 不 适 足 部 医 生 可 以 帮 你 解 决 足 部 和 足 踝 的 问 题, 他 们 会 建 议 你 穿 上 适 当 的 日 常 鞋 或 运 动 鞋 如 果 你 在 处 理 日 常 生 活 事 项 时 面 对 困 难, 技 能 治 疗 师 会 教 你 一 套 方 法, 让 你 在 不 劳 损 关 节 的 情 况 下 做 这 些 日 常 事 要 是 你 需 要 用 上 夹 板 来 支 撑 手 部 或 腕 部, 他 们 也 会 为 你 提 供 适 当 的 讯 息 类 风 湿 性 关 节 炎 患 者 有 时 会 需 要 手 术 治 疗 需 动 的 手 术 大 小 不 一, 小 手 术 可 以 只 是 松 释 一 条 神 经 线 或 一 条 肌 腱 那 么 简 单, 而 大 手 术 的 例 子 则 是 关 节 置 换 手 术 治 疗 类 风 湿 性 关 节 炎 使 用 的 四 大 类 药 物 如 下 : 止 痛 药 非 类 固 醇 抗 炎 药 (NSAIDs) 改 变 病 程 抗 风 湿 药 物 (DMARDs) 类 固 醇 如 何 诊 断 类 风 湿 性 关 节 炎? 在 患 病 初 期, 我 们 是 无 法 只 通 过 一 种 检 验 就 可 以 将 类 风 湿 性 关 节 炎 诊 断 出 来 的 医 生 会 根 据 你 的 症 状 身 体 检 验 结 果 以 及 X 光 片 扫 描 和 验 血 报 告 来 诊 病 由 于 类 风 湿 性 关 节 炎 除 了 令 关 节 发 炎 以 外, 也 会 侵 犯 身 体 其 他 部 位, 所 以 求 医 时 一 定 要 将 所 有 的 症 状, 即 使 是 好 像 没 有 什 么 关 连 的 症 状, 都 一 一 告 诉 医 生, 这 点 很 重 要 我 们 可 以 从 血 液 检 验 报 告 中 看 出 发 炎 的 情 况 X 光 片 会 看 出 任 何 因 为 类 风 湿 性 关 节 炎 而 造 成 的 关 节 损 坏 关 节 上 的 变 化 通 常 最 先 出 现 在 脚 部 X 光 片 里, 所 以 即 使 你 的 脚 部 没 有 任 何 不 适, 医 生 也 可 能 会 给 你 的 脚 部 照 X 光 做 检 查 之 后, 你 经 常 需 要 重 复 进 行 血 液 检 验 和 照 X 光, 好 让 医 生 可 以 诊 视 疾 病 的 演 进 情 况, 以 及 决 定 药 物 的 加 减 AUGUST APRIL 2014 / JOINT EFFORTS _JE Final FA.indd 15

16 W E L L B E I N G Emotional Challenges of Rheumatoid Arthritis Rheumatoid arthritis (RA) is primarily a disease of the joints, but people afflicted with rheumatoid arthritis face severe emotional challenges as well as physical ones. It can affect virtually every area of a person s life; from work life to family life. You have to deal with chronic pain and physical limitation; a whole new way of living and being. It can take you through a whole gamut of emotions ranging from fear, anger, depression and anxiety, frustration, feelings of being overwhelmed and low self-esteem. Life can be very stressful indeed and the bad part of stress is that it may affect the amount of pain you feel. Despite drug treatments for RA having improved markedly, it cannot be cured, and even the best medications and medical care can only help so much. Thus, there is a great need for additional activities patients can do to reduce pain, disability, and take control of the overall impact of arthritis on their lives. Learning to live with it is essential. Life does go on after being diagnosed with arthritis. COPING WITH STRESS There are a number of successful techniques for coping with stress. Regular rest periods can help, as can relaxation or visualization exercises. Exercise programs, participation in 16 JOINT EFFORTS / APRIL AUGUST _JE Final FA.indd 16

17 F R O M T H E E D I T O R S D E S K support groups, and good communication with the health care team are other ways. Meditation is another powerful technique to manage stress. Meditation allows you to achieve a state of profound calm commonly referred to as the relaxation response. Meditation has been shown to alter physical and emotional responses to stress and may reduce the psychological distress that often accompanies chronic illness. Results of various studies suggest that the regular practice of meditation can reduce arthritis pain as well as relieve anxiety, stress, and depression. In a study reported at an American College of Rheumatology meeting, rheumatoid arthritis patients were assigned to one of two groups. Half of the group took a class on Mindfulness-Based Stress Reduction (MBSR), a program that includes meditation, yoga, and other relaxation exercises. The rest of the group had no intervention. After six months, patients who practiced MBSR experienced a 33% reduction in psychological distress, an 11% decrease in standard measures of disease activity such as the number of painful or swollen joints, and a 46% decrease in erythrocyte sedimentation rate (indicating a reduction in inflammation). Deep Relaxation Technique This technique is very beneficial as it reduces your heart rate, respiration rate, and blood pressure thus bringing about a reduction in the damaging fight-or-flight response that can be triggered by physical or emotional stress. Lie on your back with the feet slightly apart and hands slightly away from the body. Let your awareness flow over your body from the tips of your toes to the top of your head. Tell yourself to relax your feet, your ankles, your calves, your knees, your thighs. Let your legs completely relax. As your awareness travels upwards; tell yourself to relax your abdomen, your chest, your back, your arms, your shoulders, your neck, your face. Feel your whole body completely relaxed. Feel your breath flowing in and out. With every exhalation feel your body release into deeper and deeper states of relaxation. Stay in this state for 10 minutes to start with and work up to minutes. A Meditation Technique to Manage Your Stress Sit in a comfortable position on the chair. Keep your eyes closed. Focus attention on an object, a word, or your own breathing, as a way of suspending the stream of thoughts that normally occupy your mind. If you choose to mentally repeat a word, make sure that it is positive, uplifting and something that resonates with you. If you choose your breath, then just be aware of your breath as you inhale and exhale. You will find yourself distracted from time to time, but each time draw your awareness back to your breath. By your consistent effort to focus on your breath, all other worries and distractions naturally fade into the background and the mind experiences a release from its stressful patterns of thinking. Begin with 5 minutes and then work up to minutes a day. AUGUST APRIL 2014 / JOINT EFFORTS _JE Final FA.indd 17

18 B E PAT I E N T A Full Life with RA N agula Thambidurai was in her mid-forties, relishing her varied roles; as a loving wife, mom to two adorable daughters, as a high-school teacher and as an individual with a huge zest for life; who loved wearing high heels and partying! But one day, she felt pain and discomfort in her ankles. Her right ankle seemed to have collapsed! To her credit, she didn t dismiss it and went without much delay to consult a rheumatologist at a private hospital in KL. After the consultation and blood test, the doctor confirmed her worst fears; that she had rheumatoid arthritis. The doctor also immediately started her on steroids and over the years her medication and dosages were regularly monitored and changed according to her experience of pain. Why her worst fear, I asked? Nagula answered, I grew up watching my mother struggle with rheumatoid arthritis. At that time, there wasn t much awareness and treatment options were limited. So the disease affected her quite badly, to the point that she was unable to move on her own and her limbs were deformed. Nagula s first reaction on hearing the news was unsurprisingly; denial and depression. Says Nagula, I kept asking myself, God and everyone else around me, Why me? Why? Though I had a family history, and it really should not have come as such a shock to me, I still found it very difficult to accept. Fear overwhelmed me that I too would suffer the same way my mother did. SOME ADVICE FROM NAGULA Be active and keep moving. People with RA must make it a point to get up and walk every 15 minutes even while watching television or sitting in an aircraft. While sitting, exercise the wrists and fingers, rotate the ankles and move the feet. It s about cultivating an active mindset. Mix with people. The tendency when we have problems is to withdraw into a shell. But it is important to talk about what we are going through and share our experiences with family and friends. Besides helping us cope with our feelings of loneliness and depression, it also helps us spread awareness. I have a very active social life. I am a committee member of the Arthritis Foundation Malaysia as well as the Inner Wheel Club of Subang. Accept that you have to do things differently. With RA, you tend to tire easily and not have as much energy as before. I love dancing and shopping. It s hard for me to do these things now and I have had to modify my expectations of my performance in these activities. While we travel, I now use a wheelchair in airports and while in the past we did walking tours, we now opt for sitting in a tour bus. Stay positive. Seek immediate and proper medical advice from a rheumatologist, stick to the recommended dosage and medication and please do follow-up regularly! 18 { But now, 18 years down the road, Nagula is a testament of how early diagnosis and treatment can contain the severity of the spread of the disease. At 63, Nagula and her husband travel the world regularly to spend time with their beloved daughters and their families who live in Australia and the UK. Though retired, she continues to pursue an active social life and does not let the disease get in the way of her appreciation of life. { But with the support of my husband and family, and the expert supervision of my doctor, I learned to cope with the condition. Early diagnosis and treatment helped ensure that the disease was managed well. Of course, some changes had to be made to my life. The high heels were exchanged for flats or walking shoes. Though I still continued to cook, I took breaks and hired help too as I tired easily and couldn t stand continuously for a long time. But I determinedly continued on with the life that I loved; to teach, to bring up my girls well, and to entertain. There were some rough times too. After many years of taking the medication Methotrexate, at one point, when her dosage was increased, she faced difficulty in walking even short distances. She realized something was very wrong. She went back to the doctor, was diagnosed with fibrosis of the lungs and had to have her medication changed immediately. Now signs of her knees being affected have begun appearing and she experiences constant dryness of her eyes. This has greatly affected her ability to read and watch television. But ever optimistic in her outlook, she is pro-active in dealing with her condition and constantly explores new treatments and options in dealing with the symptoms of arthritis. Nagula warns, Not all of them work well, and some have even resulted in severe side-effects making it impossible for me to continue treatment. But a series of Ayurvedic treatment courses in Kerala, India over a few years did bring a lot of relief. So, as cautiously as possible, I am determined to continue to seek options. Currently I am undergoing stem-cell treatment which is supposed to help my arthritic condition. JOINT EFFORTS / AUGUST APRIL _JE Final FA.indd 18

19 FROM THE EDITOR S DESK APRIL 2014 / JOINT EFFORTS 01-32_JE Final FA.indd 19 19

20 J I A AFM Junior Club for Kids with Arthritis Do you know that arthritis is not only a disease of the elderly? Children and young people can also suffer from a form of chronic arthritis called Juvenile Idiopathic Arthritis. AFM has long recognised that children and adolescents with arthritis have needs that are quite different from that of adults. With this in mind, the Arthritis Foundation Malaysia Junior Club (AFMJC) was first established in 2005 by the then AFM president, Dr Chow Sook Khuan and Malaysia s pioneer Paediatric Rheumatologist, Dr Tang Swee Ping. The AFM Junior Club (AFMJC) was successfully launched in October 2005 with an inaugural visit to the Breadtown Museum in Shah Alam. WHY DO WE NEED A JUNIOR CLUB? The AFM Junior Club serves as a social network for patients and families to meet and share experiences and also to lend support to one another. It is very important for children with chronic arthritis to know that they are not alone in this battle. In addition, it is an educational opportunity for patients and their caregivers to learn about their disease and treatments, and for them to have a chance to meet the healthcare professionals at a less formal platform. It is also an opportunity for families to experience some fun together and enable patients to realise that even with arthritis, most can and should try to live normal lives. JIA Family Day, Kuala Gandah Elephant Sanctuary, Hari Keluarga JIA, Santuary Gajah Kuala Gandah, 年 JIA 家 庭 日, 瓜 拉 甘 达 大 象 乐 园 Inaugural AFMJC Activity: Visit to Breadtown Museum Aktiviti Sulung AFMJC: Rombongan ke Muzium Breadtown 大 马 关 节 炎 基 金 会 少 年 俱 乐 部 成 立 之 初 的 首 项 活 动 : 参 观 面 包 城 博 物 馆,2005 年 JIA Family Day, Sungai Klah Hot Springs, Hari Keluarga JIA, Kolam Air Panas Sungai Klah, 年 JIA 家 庭 日, 双 溪 格 拉 热 水 湖 WHAT DO WE DO? Since 2005, numerous activities have been successfully organized by the AFMJC led by Dr. Tang Swee Ping and Miss Chan Li Jin, a volunteer with the help of doctors and nurses from Paediatric Department, Hospital Selayang and with the support from AFM and various other corporate bodies. The two main activities organized are the JIA Family Day and the Independence Camp. The JIA Family Day is a family event where entire families (including sibings of patients and even grandparents) are encouraged to come together as a family and learn about their disease Juvenile Idiopathic Arthritis (JIA) whilst having fun together. The Independence camps are weekend overnight camps which are specially designed for teenagers with arthritis. The aim is to educate, equip and empower them with knowledge and skills to handle their disease as they grow up so that they can become valuable and productive members of the society. A public forum entitled: JIA what every parent should know was also successfully organized in 2009 which was well-attended by parents and healthcare professionals. JIA Family Day, Klana Resort, Seremban, Hari Keluarga JIA, Klana Resort, Seremban, 年 J I A 家 庭 日, 森 美 兰 州 格 拉 娜 度 假 村 Independence Camp, Klana Resort Seremban, Kem Berdikari, Klana Resort Seremban, 年 自 立 生 活 营, 森 美 兰 州 格 拉 娜 度 假 村 WHAT S FOR THE FUTURE? The AFMJC hopes to reach out to more children and young people with arthritis and encourage them to benefit from our activities. So if you know of a child or young person less than the age of 16 years suffering from arthritis, please contact the AFM for more information. 20 JOINT EFFORTS / APRIL AUGUST _JE Final FA.indd 20 1/08/14 7:30 PM