Arthritis Treatment in Five Dock: What Your Options Are

Arthritis treatment in Five Dock rarely sits with one practitioner. A GP makes the diagnosis and manages medication. A rheumatologist may be involved if the arthritis is inflammatory. An orthopaedic surgeon enters the picture for some people, years later, for some joints. Exercise physiology covers the part that runs between all of those appointments: keeping the joint loaded, the surrounding muscle strong, and daily activity manageable.

This piece explains what the options actually involve, so you can work out which ones apply to you.

Osteoarthritis and inflammatory arthritis are managed differently

Osteoarthritis is the common one. It affects the knee, hip, hand, base of the thumb, big toe and spine most often, it builds over years, and it tends to be worse after activity and better with rest, with stiffness in the morning that eases within about half an hour.

Inflammatory arthritis, including rheumatoid arthritis and psoriatic arthritis, behaves differently. Morning stiffness lasts longer, often more than an hour. Joints can be hot, swollen and symmetrical. Fatigue and general unwellness are common. This group needs medical management from a rheumatologist, and disease-modifying medication is the main treatment. Exercise runs alongside it, not instead of it.

If you have not had a diagnosis, that is the first step, and it belongs with your GP.

What medical treatment usually includes

For osteoarthritis, a GP will typically discuss simple analgesia, topical anti-inflammatories, and sometimes a short course of oral anti-inflammatories. Imaging is often not needed, because X-ray findings correlate poorly with how much pain someone reports. Corticosteroid injection is offered for some joints. Joint replacement is considered when pain and function stop responding to everything else, and surgeons generally want to see conservative management tried first.

The RACGP guideline for the management of knee and hip osteoarthritis lists exercise, education and weight management as the recommended first-line approach for those joints. That is the reason a GP often refers to an exercise physiologist before anything else.

What the assessment involves

A first appointment runs about an hour. We go through which joints are affected, how long it has been going on, what medication you are taking, what your GP or specialist has said, and what you have stopped doing because of it. That last question usually tells us the most.

Physical testing depends on the joint, but commonly includes:

• A 30-second sit-to-stand test, counting repetitions from a standard chair, as a measure of lower limb strength and a baseline to re-test against.
• A timed 40 metre fast-paced walk, used in the OARSI core outcome set for hip and knee osteoarthritis.
• Grip strength with a hand dynamometer if hands or wrists are involved.
• Range of motion at the affected joint, and strength testing of the muscles around it.
• Balance screening, since people who have reduced activity because of hip or knee pain often lose balance capacity too.

We write the numbers down. Re-testing at six to eight weeks is how we tell whether the program is doing anything, rather than relying on memory.

What a session looks like

Sessions run 45 minutes to an hour in the clinic, or at home if getting out is difficult. Most programs are built around resistance training for the muscles supporting the affected joint, graded so the load increases as you tolerate it. For a hip or knee, that means squatting patterns to a depth you can manage, step-ups, leg press, hip abduction and calf work. For hands, it means graded grip and pinch work with putty or bands. For the spine, it means loaded carries, hip hinge patterns and trunk endurance work.

We add walking, cycling or pool-based work for cardiovascular fitness, and balance work if the assessment flagged it.

The pacing rule we use is simple. Some discomfort during exercise is usually acceptable, and we look at how the joint feels the next morning. If it has settled by then, the load was reasonable. If it is still elevated 24 hours later, we pull the load back and rebuild.

Flare-ups

Arthritis flares. Programs need a plan for that written in advance rather than improvised. Usually it means reducing range, dropping load, moving to a non-weight-bearing version of the same movement, and keeping frequency up while intensity comes down. Stopping entirely for a fortnight tends to make the return harder.

What it costs and what funding may apply

If your GP considers your arthritis a chronic condition, you may be eligible for a GP chronic condition management plan, which subsidises up to five allied health visits per calendar year. A gap fee usually applies. Private health extras cover exercise physiology on most policies. DVA clients can be referred by their GP, and NDIS participants can use plans that include improved daily living or health and wellbeing supports.

When to see a GP sooner

A single joint that becomes hot, red, swollen and very painful over hours needs same-day medical review. So does joint pain with fever, unexplained weight loss, or morning stiffness lasting well over an hour. New night pain that wakes you should also be checked.

If you would like an assessment of how arthritis is affecting your strength and daily activity, you can book an appointment at the Five Dock clinic or request a home visit.