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Arthritis MattersFebruary 2016

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The Power of One Determined father runs seven marathons in seven days to raise awareness for juvenile arthritis (read more in National Features page 4)

ADVOCACY IN ACTION: Tackling pharmaceutical issues

HYDROTHERAPY: The benefits for pregnant women with Arthritis

EXERCISE: How you can prevent fallswww.arthritissa.org.au

12 | Arthritis Matters – 2016 – February

Call: 1800 011 041Email: [email protected]: www.arthritissa.org.au/how-can-you-help/membership

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Contents

National Features | iii

IV CHIEF EXECUTIVE UPDATE

1 ADVOCACY FOCUSES ON PHARMACEUTICAL ISSUES.

Arthritis Australia’s Franca Marine reflects on the major national advocacy campaigns of 2015.

4 THE POWER OF ONE: 7-YEAR-OLD GIRL INSPIRES A

MARATHON EFFORT. The story of one father’s determination to run seven marathons in seven days to raise awareness of juvenile arthritis.

6 PATIENT-CENTRED CARE: AUSTRALIA SETS THE

BENCHMARK AT ASIA PACIFIC SUMMIT. An insight into the attitude shift towards better patient engagement and outcomes in the Asia Pacific region.

8 THE SPIEL ON PILLS: ORAL METHOTREXATE THERAPY

FOR RHEUMATOID ARTHRITIS. What you need to know including how it should be taken and the common side effects.

10 HYDROTHERAPY CAN HELP PREGNANT WOMEN

WITH ARTHRITIS. Many pregnancy guides advise against hot tubs, spas and saunas, but hydrotherapy can be helpful for pregnant women with arthritis.

12-15 HEALTHY RECIPES

Quick and easy recipes for breakfast, lunch, dinner and dessert.

16 EXERCISE: HOW YOU CAN PREVENT FALLS.

Understand your risk factors and learn what you can do to prevent falls.

17 WHAT’S YOUR GUT TELLING YOU?

Laura looks at research into how our gut ‘bugs’ influence our long-term health and whether there’s a link between bacteria and arthritis.

Next Issue: April 2016

CONTENTSFebruary 2016

Arthritis Matters

Call: 1800 011 041Email: [email protected]: www.arthritissa.org.au/how-can-you-help/membership

BECOME A MEMBER TODAY;IT’S EASY AND AFFORDABLE!

We can improve the quality of your life, a loved one or a friend.

National Features

Chief Executive Update

For information and support

Arthritis Helpline

1800 011 041 Arthritis MattersArthritis South Australia

A: 118 Richmond Rd, Marleston SA 5033

T: 08 8379 5711

F: 08 8379 5707

W: www.arthritissa.org.au

Contributors

Manu Arora, Jacqui Couldrick, Rebecca

Davey, Franca Marine, Celia Painter and

Laura Vincent.

Contribution and advertising

closing dates:

April 2016 Issue: 12 February 2016

July 2016 Issue: 13 May 2016

To advertise in Arthritis MattersP: 02 9857 3300 or

E: [email protected]

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Products and services advertised in Arthritis Matters are not necessarily recommended or endorsed by Arthritis South Australia or other state Arthritis affiliates. Some readers may assume that anything advertised in these pages has been cleared, vetted or in some way approved by the charity. This is not so. Arthritis South Australia is not equipped to test and approve products and services that are available to the general public. Please exercise careful judgement about whether the item or service is likely to help you personally, and where appropriate, take professional advice from your doctor or specialist before making a purchase.

Whilst all reasonable care has been taken to ensure the accuracy of information inside Arthritis Matters, no warranties or guarantees are given nor any responsibility accepted by the publishers, its agents or anyone else involved in its production for any errors which may occur. Nothing contained inside is intended as medical advice – always consult your doctor regarding treatment or medicines.

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Keeping you in the loop

Julie’s Update

Welcome to the first edition of our national magazine. We hope you

enjoy the new format and articles.

Working together with other state representatives we have tried to create a very informative magazine for our readers particularly with those who suffer from Arthritis.

This year promises to be a busy and exciting year with all areas in the organisation off to a good start.

In particular, our Paediatric Rheumatology Nurse, Tracey Rose, has been recruited for the role at the Adelaide Women’s and Children’s Hospital. Tracey will work closely with our Health Services staff to ensure that our children with Juvenile Idiopathic Arthritis are well supported. Tracey will also play a key role in providing education and resources to children newly diagnosed with arthritis.

I am also delighted to report that our Health Services team has put together an exciting education program for 2016. We will hold monthly consumer education sessions and regular Take Charge of Pain courses and other activities throughout the year. Please visit www.arthritissa.org.au for further information. Our courses and workshops are free to our members and always receive excellent evaluations.

In addition, our support groups will commence meetings this month. Support groups are a wonderful way to meet other people with arthritis and make new friends, as well as receive information and education.

Social media will be a major focus for us in 2016, so please follow the Arthritis SA Facebook page to receive up to date information on coming events and reports on daily activities. We also use this forum to promote emerging news items and research reports.

Another important form of communication is our eNews, which is circulated once a month via email. You do not have to be a member to receive this and it is as simple as emailing us on [email protected] to subscribe.

We have a dynamic and committed board led by our President, Colette Smith. Board members will be meeting later this month to work on our next strategic planning phase, 2016-2019, with our mission to empower people with arthritis to achieve the best possible quality of life through advocacy, education, self-management and the support of research. I look forward to updating you on this process in the coming months.

Warm regards,

Julie BlackChief Executive Officer

iv | National Features

Pharmaceutical issues have been at the forefront of advocacy efforts by Arthritis Australia and the state and

territory arthritis foundations in recent months. Key issues with major implications for people with arthritis have been the delisting of paracetamol from the Pharmaceutical Benefits Scheme and the introduction of biosimilar medicines for autoimmune forms of arthritis to the Australian market.

Subsidies for paracetamol to be removedIn April 2015, the Minister for Health, the Hon Sussan Ley, foreshadowed that a number of over the counter medicines, including paracetamol, would no longer be subsidised by the Pharmaceutical Benefits Scheme. She claimed that people could buy these medicines more cheaply from the supermarket.

Analysis by Arthritis Australia, however, found that the Minister’s claims about paracetamol were misleading and that people with arthritis on concession cards would end up paying up to three times more for their pain relief medication.

National Features

Advocacy focuses on pharmaceutical issues Arthritis Australia’s Franca Marine reflects on the major national advocacy campaigns of 2015

“The bulk of PBS scripts for paracetamol are for the ‘osteo’ slow release formulation, which can only be purchased at a chemist,” explained Ainslie Cahill, CEO of Arthritis Australia.

“Many people with arthritis and chronic pain already struggle with the costs of doctor’s visits, medications…They just can’t absorb additional costs…”

National Features | 1

“Most of these scripts are for concession card holders who currently pay $6.10 for two boxes of 96 tablets.

“To buy the same quantity without a script costs at least $10 and up to $18, which adds up to an extra $50 to $140 over a year. People who need lots of medicines will be even worse off as these medications will no longer count towards their Safety Net.

“Many people with arthritis and chronic pain already struggle with the costs of doctor’s visits, medications, supplements and other services they need to manage their condition,” Ainslie added. “They just can’t absorb additional costs that may seem minor to others.”

Making the voices of their members heard, state and territory arthritis foundations together with Arthritis Australia raised their concerns with the Minister, the Pharmaceutical Benefits Advisory Committee, and the Department of Health.

We encouraged our members to share their stories and write to Sussan Ley, and worked with other organisations to publicly highlight the impact on people with arthritis.

Unfortunately, while acknowledging that some people would indeed pay more for pain relief medication, the Minister has decided to proceed with the delisting in order to free up funds for new medications. The delisting of paracetamol takes effect from 1 January 2016.

National Features

The introduction of biosimilarsAs the government introduces measures to support the uptake of biosimilars, Arthritis Australia is actively working to ensure that safety and efficacy issues for consumers are given paramount importance.

The first biosimilar medicine for the treatment of autoimmune forms of arthritis – a copy of the biologic infliximab – is now available in Australia, heralding a new era in biologic therapy for these conditions. Other biosimilars are expected to come onto the market in the next couple of years.

The advent of biosimilars is exciting because they will reduce the cost of expensive biologic medicines and increase treatment choices for doctors and consumers. However, the complex nature of biologic medicines suggests the need for caution around some of the measures being adopted to support their uptake.

A key focus of our advocacy efforts has been the Government’s decision to allow the option of pharmacy-level substitution for biosimilars. This means your pharmacist may ask you whether you would consider a biosimilar medicine (if one is available) rather than your usual biologic brand, as they do with generic medicines.

Consumer and clinician groups however are wary about allowing pharmacy level substitution for biosimilars.

Associate Professor Susanna Proudman, Medical Director of Arthritis Australia, explains why we need to tread carefully when considering pharmacy-level substitution for biosimilars.

“Biosimilars are copies of biologic medicines but they are not generics. Biologic medicines are grown in living cells and are extremely complex,” explained Susanna. “They are virtually impossible to copy exactly, unlike generics of simple small molecule medicines such as aspirin.

“We know biosimilars are safe and effective in patients who are new to that therapy and we support their use in these cases.

“At present, however, less is known about about whether biosimilars and biologics can be used interchangeably in people who are stable on their current therapy, as could happen if pharmacy-level substitution was allowed.

“Switching and especially multiple switching between a biosimilar and a biologic may affect patient safety by triggering an immune response or it may make the medicines less effective,” Susanna warned. “If something does go wrong, it also makes it much harder to work out which product is causing the problem, because an immune response can take a while to surface.”

• Biologic: A complex medicine grown using living organisms. They have been used in Australia since 2003 to treat autoimmune forms of arthritis such as rheumatoid arthritis and juvenile arthritis. Biologics can reduce disability and improve quality of life for many. Familiar brands include Enbrel, Humira and Remicade.

• Biosimilar: A copy of a biologic medicine that is very similar, but not identical to, the original medicine.

• Conventional medicine: A simple, chemically-manufactured medicine such as aspirin.

• Generic medicine: An identical copy of a conventional medicine.

2 | National Features

National Features

In the case of the biologic infliximab, switching from the original brand (Remicade®) to the biosimilar brand (Inflectra®) has been shown to achieve comparable treatment results. However, less is known about the impact of switching between these products many times. For this reason we recommend you talk to your rheumatologist about which brand is right for you. Arthritis Australia has prepared an information sheet for consumers on biosimilar infliximab that provides information and advice on how to ensure you get the right medicine. This information sheet is available at www.arthritisaustralia.com.au/biosimilar_infliximab.

As a result of advocacy efforts by Arthritis Australia and other stakeholders, the Government is adopting a more consultative approach in developing and implementing its biosimilars policy, including an education campaign for consumers, prescribers and pharmacists.

By Franca MarineNational Policy & Government Relations ManagerArthritis Australia

Five things you can do to make sure you get the right medicine

1. Talk to your rheumatologist about your biologic medication and whether a biosimilar is available and might be right for you.

2. Decide in consultation with your rheumatologist whether you should keep taking the same brand of biologic/biosimilar medicine or whether it could be substituted.

3. If you and your doctor decide you need to keep taking the same brand of medication, make sure your rheumatologist ticks the “Do not substitute” box on your script. Tell your pharmacist you want the brand that is on the script and that you do not authorise substitution.

4. Check the package of your medication when you collect it from your pharmacist and keep a record of its name so you know what brand of medication you are taking.

5. Keep informed about this issue by visiting www.arthritisaustralia.com.au.

Add your voice to these issues. If you’ve been affected by these changes, call us on 1800 011 041 to share your story.


The pain of an only child has fired up a girl’s father to run an amazing seven marathons in seven days to raise

awareness for juvenile idiopathic arthritis and help other children with the condition.

The torment of electrical cabling company manager Simon Trott watching his daughter Lekeisha learn to crawl and walk, only to crumble in pain from juvenile arthritis, inspired the marathon fundraiser, which he completed in just seven days.

Simon ran the marathons – one for each year of Lekeisha’s life – between Yorketown on South Australia’s Yorke Peninsula and Arthritis SA’s Adelaide office.

“I wanted to test myself,” said Simon, “Even if that meant experiencing pain, because that pain would be nothing compared with the pain Lekeisha and many of these kids go through.

National Features

“I have always been a sporty type of person and I wanted to push myself both physically and mentally. It did prove to be the sort of physical challenge I expected, but it was much more of a mental challenge than I had thought it would be.”

Simon was wracked with pain by day five of his marathon. Knee pain from an old Aussie Rules footy injury was the least of his worries. Both knees were excruciating. His neck ached. His back was sore. His feet burned and were covered in plasters, and to top it off, three of his toenails were fast falling off. That was despite extensive preparation.

Simon had started training for his marathons two years beforehand. The old footy injury flared up and he couldn’t start until his knee had healed. The injury meant he had to rebuild strength in the affected leg by running on a level surface, so much of his training was restricted to nightly workouts on a treadmill in a gym.

The power of one: 7-year-old girl inspires a marathon effortThe story of one father’s determination to run seven marathons in seven days to raise awareness for juvenile arthritis


He was determined, running two hours every night after work. It was the thought of Lekeisha’s pain and determination to walk and enjoy a normal physical childhood that spurred him on.

“I think any parent will appreciate how I felt,” said Simon. “When you’re a parent and your child is in pain you feel so helpless. You would do anything you possibly can for them.

“If you can’t help them directly, apart from getting them treatment and giving them comfort, you can find another way to support them – big or small.”

Simon said he thought about what he could do and drew on his love of sport in designing his challenge. Turning it into a fundraising event was another challenge.

He established a goal to raise $10,000 and set up a Go Fundraise page. He canvassed support of family and friends, asking them to give to his cause.

Simon courted and secured media interviews, made special appearances, and then he ran.

He will be forever grateful to his dad who formed his lone road crew and family members who helped him from his launch outside the pub at Yorketown, along the way and then cheered him over the finish line.

When Simon arrived at the finish, exceeding his goal, he was given a hero’s welcome. Waiting for him just over the finish line was Lekeisha. Simon couldn’t stop hugging her.

At her age, he doubts Lekeisha can grasp the concept of how far he had run or the toll it had on his body but she did spoil him rotten – turning his bedroom into a quiet sanctuary with portraits, candles and fluffy toys, and even trying to help him walk!

The trophy cup in his lounge room, presented by Arthritis SA, is a reminder that dad did something really special.

“She looks at that and then looks at me,” said Simon, “and I can see it in her eyes. She knows this was really special and I think she sees me differently for it.”

By Celia PainterMarketing & Communications ManagerArthritis SA

National Features

Simon’s story is a perfect example of how individuals are helping us to raise awareness and funds for arthritis. If you’re inspired to hold your own fundraising event for arthritis or want to support other campaigns like Simon’s, call us on 1800 011 041.


Patient treatment expectations and joint decision-making processes between doctors and patients with chronic

conditions such as arthritis, are becoming increasingly important.

These were key take-away messages and common themes at the Asia Pacific Immune Mediated Inflammatory Disease Summit 2015, held recently in Hong Kong. Among key speakers was Arthritis South Australia’s Chief Executive Officer, Julie Black, representing Arthritis Australia, who spoke about our evidence-based approach to the development of services.

She also spoke about our funding and other support for the appointment of a paediatric rheumatology nurse at South Australia’s Women’s & Children’s Hospital. Similar evidence-

based approaches are taken by other Arthritis Foundations throughout Australia.

Julie said there was a huge emphasis among speakers about efforts being made to support people in being better engaged with their treatment.

“There is work being done internationally to support people in seeking out information, asking the right questions, and helping people acknowledge and understand that their self-management can be critical to how they function and their quality of life,” Julie said. “This involves working closely with patients rather than just for them and enabling them to make informed decisions about their care in conjunction with clinicians.

National Features

An insight into the attitude shift towards better patient engagement and outcomes in the Asia Pacific region

Patient-centred care: Australia sets the benchmark at Asia Pacific summit


“Interestingly, it became clear that each country had different ways to engage, influence and educate patients and it was noted that social media was becoming a strong communication tool in many countries.

“In our fast-faced western world, with increasingly higher expectations among consumers and more and more communications technologies, we need to engage more than ever with people affected by arthritis to really understand how we can continue to support them and create new benchmarks for best practice in patient centred care.”

Julie said the opportunity to present at the two-day summit was a privilege and the highlight of her career. The summit was comprised of representatives from nine countries and delegates from seven chronic diseases, in particular rheumatoid arthritis and juvenile idiopathic arthritis. The overarching theme was “Engage and Empower for Patient-Centred Health Care”.

Julie said Australia was seen as a benchmark for patient engagement and programs being offered. Her presentation was about the Take Charge of Pain Program, which is now being offered in five Australian states and territories.Another highlight of the summit was a talk by Kin-ping Tsang, a governing board member of the International Alliance of Patients’ Organisations that represents 60 countries and 60 diseases (or 356 million patients!).

Mr Tsang outlined how all diseases had challenges but said the importance of enhancing patient treatment was clear. He added that it was important for patients to raise their voices to achieve better patient engagement and ultimately better outcomes.

Julie said that at home the Australian Consumer Health Forum addressed these issues and worked to ensure patient perspectives were considered in decision making processes, awareness programs and government lobbying efforts.

She said it was clear there was a great diversity in the way patients participated in their own health care and in how it was managed in the Asia Pacific region, with people in some countries extremely limited by the type of health care they could access.

By Celia PainterMarketing & Communications ManagerArthritis SAJulie’s attendance at this Summit was made possible with support

from Abbvie Pty Ltd.

In pictures: Photos from the Asia Pacific Summit in Hong Kong.

National Features


Methotrexate has been around as a treatment option for rheumatoid arthritis since the early 1970s. It is still one of

the most commonly prescribed drugs for treating rheumatoid arthritis today.

Rheumatologists agree that it is one of the safest drugs for managing the condition despite some reports to the contrary. The bottom line is to take the dose of methotrexate that has been tailored for you, accompanied by periodic follow-up reviews with your treatment doctor. What is it?Methotrexate belongs to a class of drugs known as disease-modifying anti-rheumatic drugs (DMARDs). These drugs curb the underlying disease process rather than simply treating the presenting symptoms. Methotrexate reduces the activity of the immune system (your body’s defence system), which is overactive in rheumatoid arthritis and other forms of inflammatory arthritis.

How should it be taken?Oral methotrexate comes in two strengths: 2.5mg and 10mg tablets. To avoid confusion, only one strength (usually 2.5mg tablets) is used.

Methotrexate is usually taken as a single weekly dose on the same day every week. The recommended dose may be taken all at once or it may be divided into equal separate doses taken on the same day every week, if necessary.

Treatment is usually started with a very low dose of 5mg (two 2.5mg tablets) or 10mg (four 2.5mg tablets) a week, increasing to an average dose of 20mg per week. The dose is adjusted by your doctor depending on your response and it may be increased up to about 30mg once a week. Therefore, additional visits may be required to the physician at the treatment onset to tailor the correct dose for you.

Things to discuss with your doctor before starting methotrexate• It is important to discuss any history of allergies to any

medications, or an allergy to any of the ingredients in methotrexate tablets. Ask your doctor or pharmacist for a list of the ingredients.

The spiel on pills: Oral methotrexate therapy for rheumatoid arthritisWhat you need to know including how it should be taken and the common side effects

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• Some antibiotics, vitamin supplements and other medications can interact with methotrexate and may require a dose adjustment to avoid serious side effects. Therefore, it is vital to discuss with your doctor and pharmacist your list of prescription and non-prescription medications including vitamins, nutritional supplements and herbal products which you are currently taking or plan to take.

• If you have one or more of the following conditions, methotrexate may NOT be a suitable treatment option for you or you may require a lower dose and close monitoring: > Folate (a type of B vitamin) deficiency > Blood cell or bone marrow disorder > Liver disorder (especially, if caused by excessive alcohol

intake) > Kidney disease > Pneumonia or lung disease > Stomach ulcers > Any infection > If you are receiving radiation treatment

Common side effects and how to avoid themThe most common side effects associated with methotrexate are nausea, vomiting and diarrhoea. These can be avoided by dividing the recommended dose across the day instead of taking the tablets all at once. Taking the tablet dose after meals is also best.

NOTE: The divided dose is to be consumed on the same day. For example if the day’s dose is divided into 2, take after breakfast and dinner. Or if you divide it into 3, take each dose after every main meal if you have 3 meals per day.

Mouth ulcers and sores are other common side effects of methotrexate therapy. Many patients also complain of headaches, fatigue and an overall ‘blah’ feeling, sometimes called ‘methotrexate fog’. This happens more so on the day after you take the dose.

A 5mg folate tablet taken the day after your Methotrexate dose is the recommended treatment to manage these side effects. Folate tablets in 5mg strength can be purchased over the counter in most pharmacies.

Serious side effects can be reduced to a minimum by following these important instructions:

• Take the right dose, as directed by your doctor.• Take your dose of methotrexate on one day, once weekly, on

the same day each week.• Complement the methotrexate dose by taking a 5mg folate

tablet on the next day.• Ensure that you follow up with your treating doctor as often

as you need to or as advised by the doctor.

Methotrexate is still one of the most commonly

prescribed drugs for treating rheumatoid arthritis today.

Special precautions• Methotrexate should NOT be taken if you are pregnant or

planning to get pregnant or breast-feeding.• Methotrexate may be temporarily discontinued if you are

having surgery, including dental surgery. Inform your surgeon or dentist about the medication prior to the surgery.

• Methotrexate sensitises your skin to sunlight. Avoid unnecessary or prolonged sun exposure and wear protective gear. If you have psoriasis, your sores may worsen if you expose your skin to sunlight while you are taking methotrexate.

• Vaccinations, especially live ones, are not to be given while you are taking methotrexate. Discuss this with your doctor for safer options.

By Manu AroraProject CoordinatorArthritis & Osteoporosis NSW

National Features


For pregnant women with any form of arthritis, continuing hydrotherapy can be a vexed question with many

pregnancy guides advising against hot tubs, spas or saunas. However, these guides don’t generally discuss the benefits of hydrotherapy for people with arthritis. Many women find their arthritis improves during pregnancy. This is largely due to pregnancy hormones, which relax the ligaments around the joints to allow for childbirth.

All joints are affected, and this usually lasts for around 6 weeks after the baby is born. For women with systemic forms of arthritis such as rheumatoid arthritis, up to 70 percent will experience a significant improvement in symptoms during pregnancy. This holds true even if the mother stops taking arthritis-specific medication, which is sometimes necessary to ensure the safety of mum and baby during the pregnancy, birth and early postnatal period.

But for some women, withdrawing from this medication can lead to in increase in symptoms, particularly the pain they experience. Therefore hydrotherapy plays an important part in their lives during pregnancy.

Spas and saunas aren’t recommended during pregnancy, as the ambient air temperature is high and can lead your own body temperature to rise rapidly to a level that’s not safe for your baby. Hydrotherapy pools, however, are different.

The air temperature is significantly cooler than the water temperature and you’re generally not fully immersed for long periods of time, which allows your body to regulate its temperature.

Research has shown that women who participate in moderate intensity aqua aerobics for 35 minutes, followed by lower intensity exercise for 10 minutes, have a rise in body temperature of only 0.16 degrees Celsius in water of up to 33.4 degrees Celsius.

The benefits of hydrotherapy for arthritis have been well researched and proven. As well as the positive effects on your joints and pain levels, hydrotherapy during pregnancy increases the blood flow to the baby through the placenta while water works to dissipate exercise-induced body heat away from the body and into the water at a faster rate than exercising in air.

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Hydrotherapy can help pregnant women with arthritis


It is also proven to reduce common pregnancy side effects such as carpal tunnel syndrome, swelling in the ankles and varicose veins.

It is important to discuss your exercise regime with your midwife, GP, obstetrician and/or rheumatologist, as everyone’s bodies are different. It is also important to make sure you are comfortable and not feeling too hot during any exercise in pregnancy, and always ensure when undertaking any exercise that you have a bottle of water handy and keep yourself well hydrated.

By Rebecca DaveyChief Executive OfficerArthritis ACT

National Features

“Many pregnancy guides advise against hot tubs, spas and saunas, but hydrotherapy can be helpful for pregnant women with arthritis.”

References:

Brearley, A, Sherburn, M, Galea, MP, Clarke, SJ (2015) ‘Pregnant women maintain

body temperatures within safe limits during moderate-intensity aqua-aerobic classes

conducted in pools heated up to 33 degrees Celsius: an observational study’, Journal

of Physiotherapy, Vol 61 No 4 pp 199-203

For more information or to enquire about enrolling into one of our hydrotherapy classes, please call us on 1800 011 041.


© Recipe and image provided by the Grains & Legumes Nutrition Council

Lunch

Quick & Easy

Healthy

Red lentil beef burger Serves: 4Preparation time: 10 minutesCooking time: 30 minutes

Ingredients

Burger rissole• 1 cup of dried red lentils, washed and

drained• 750ml salt-reduced chicken stock• 200g lean beef mince• 2 cloves garlic, crushed• 1 egg• 1/4 cup dry breadcrumbs

To serve• 1 tablespoon olive oil• 2 onions, finely sliced• 2 ripe tomatoes, sliced• 8 slices canned beetroot• 8 baby cos lettuce leaves• Low salt BBQ sauce, to serve• 4 wholemeal rolls

Method

1. Place lentils in a medium saucepan and cover with stock, bring to the boil, cover and simmer for 10-15 minutes or until tender, drain if there is any excess liquid. Allow to cool.

2. Heat half the oil in a large frying pan over medium heat and cook onions until golden and caramelised. Set aside.

3. Combine cooled lentils with mince, garlic, egg, breadcrumbs and a little freshly cracked pepper. Form into four rissoles and refrigerate until ready to cook.

4. Heat remaining oil in the same pan onions were cooked in and cook rissoles over medium heat for 5 minutes each side or until cooked through.

5. Toast rolls and assemble with rissoles, onions, tomato, beetroot, lettuce and sauce.

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Serves: 4Cooking time: 15-20 minutes Ingredients • 2 tsp olive oil*• 1 onion, sliced• 2 1/2 cups reduced fat milk* • 2 1/2 tbs cornflour• 2 tsp wholegrain mustard• 1/2 cup reduced fat tasty cheese*• 400g broccoli, cut into small florets• 425g can tuna chunks in spring

water, drained and flaked*• 1/2 cup frozen green peas*• 8 sheets filo pastry* • Olive oil spray*• Garden salad, to serve

Method

1. Heat oil in a medium saucepan, add onion and sauté until light golden. Stir in 2 cups of the milk and heat to just below boiling point.

2. Mix cornflour to a smooth paste with the remaining 1/2 cup of milk, add to pan and stir constantly until sauce boils and thickens. Remove from heat and stir in mustard and cheese.

3. Steam or microwave the broccoli until just tender. Gently stir broccoli, peas and tuna through sauce. Divide mixture into 4 x 375ml capacity ovenproof dishes. Preheat oven to 200°C (180°C fan-forced).

4. Lay 1 filo sheet on a clean surface, apply cooking spray and top with another filo sheet. Cut layered filo into quarters. Gently scrunch up the filo pieces, place over filling in one dish and reapply cooking spray. Repeat with remaining filo to cover all four pies.

5. Place pies on an oven tray and bake for 15-20 minutes until filo is golden.

6. Serve with garden salad.

Recipe and image reproduced with permission. © 2015 National Heart Foundation of Australia.

*Products available with the Heart Foundation Tick. Remember all fresh fruit and vegetables automatically qualify for the Tick.

For other healthier recipe ideas, visit www.heartfoundation.org.au/recipes or phone 1300 36 27 87.

Healthy & Perfect

For Dinner

Tuna and broccoli pies

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One-minute lemon, raspberry and yoghurt mug puddings Serves: 1

Ingredients

• 1/4 cup self raising flour• 2 teaspoons caster sugar• 1/4 cup milk• 2 teaspoons vegetable oil• 1 tablespoon lemon juice• 1/2 teaspoon lemon rind• 1 tablespoon fresh raspberries• 1/2 cup vanilla yoghurt, to serve • Honey, to serve

Method

1. Whisk together all the ingredients, except berries, with a fork, in a 1 cup (250ml) capacity tea cup or mug. Sprinkle with berries.

2. Microwave on high for 1 minute or until cake appears cooked through. Serve with vanilla yoghurt and a drizzle of honey.

Tips

If cake appears undercooked, add another 10 seconds of cooking. Recipe tested in a 1100W Microwave oven. Recipe cooking time may vary depending on wattage of microwave or thickness of mug or tea cup used. Substitute blackberries for the raspberries, if desired. Frozen berries can be used, but ideally should be defrosted before use.

Quick & Easy

For Dessert

Recipe and image courtesy of Dairy Australia. Visit www.legendairy.com.au for more delicious ideas with dairy.

National Features


Preparation time: 15 minutes Ingredients Muesli Mix• 1 1/2 cups rolled oats• 1/2 cup natural almonds, roughly

chopped• 1/4 cup sunflower seeds• 1/4 cup buckinis (buckwheat)• 1 tablespoon chia seeds or flaxseed

(linseed), or both• 1/4 cup goji berries• 1/2 teaspoon cinnamon

Method

• Mix all ingredients together in an airtight container and seal until ready to use.

To serve per person

• To serve, pour milk over a serving of muesli, dollop with yoghurt, fresh fruit and drizzle with honey.

Perfect

For a Healthy

Breakfast

Michael Klim’s muesli

Recipe and image courtesy of Dairy Australia.Visit www.legendairy.com.au for more delicious ideas with dairy.

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Falls can occur at any age but are more common as we get older, with around one-third of people over 65 falling at

least once per year. Falls can result in injuries, loss of confidence and a reduction in physical activity, but the most important thing to remember is that there are things you can do to prevent falls. Many risk factors are known including things such as advancing age, visual problems, muscle weakness and poor balance. A significant predictor of a future fall is a past history of a fall, particularly if it occurred in the last 6-12 months.

If you’ve had a recent fall or have noticed difficulty with walking and balance, it’s important that you discuss this with your doctor. Your GP can conduct a simple falls screen assessment to determine any risk factors that you might have.

6 things you can do to help prevent falls:

1. Attend group-based exercise programs2. Try home-based exercise programs3. Explore tai chi4. Make home safety modifications (if you have severe vision

impairment)5. Take vitamin D supplements (if you have low vitamin D)6. Consider cataract surgery Exercise as a single intervention has shown to be as effective as other interventions combined. In fact, up to 42 percent of falls can be prevented by a well-designed exercise program.

3 tips to ensure success:

1. Must provide a challenge to your balance. This should be progressed according to your individual progress.

2. Duration must be at least 2 hours per week over a 6-month period.

3. Must be continued because once it ceases the benefits are lost.

The program can be either group-based or home-based, and if you have other risk factors it’s important that you seek advice from your GP or a falls clinic.

By Jacqui CouldrickPhysiotherapist & Health Promotion OfficerArthritis ACT

References:

Sherrington C, Tiedemann A, Fairhall N, Close JC, Lord SR. Exercise to prevent falls in

older adults: an updated meta-analysis and best practice recommendations. New

South Wales public health bulletin. 2011;22(4):78-83.

If you are interested in starting an exercise program, call our Arthritis Helpline on toll-free 1800 011 041 for advice.

Exercise: How you can prevent fallsUnderstand your risk factors and learn what you can do to prevent falls

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Recent research has revealed how our gut ‘bugs’ or bacteria can influence our long-term health and can

contribute to our overall wellbeing. Dietitian, Laura Vincent, explores some of the research and tells us which foods can help to help maintain good gut health. Gutsy bacteriaYour intestine, also referred to as the gut, is home to tens of trillions of bacteria, weighing nearly 2kg. This community of bacteria, which contains a mixture of ‘good’ and ‘bad’ bacteria, is known as our ‘microbiome’. We evolved together with our microbiome over millions of years. One third of our gut bacteria is common to most people, while two thirds are specific to each one of us. Essentially, your microbiome is like an individual ID card.

Recent research has discovered that small changes in this finely balanced community can affect our immune system, metabolism, body weight and mood.

Let’s have a look at hoe the good bugs work to keep you healthy…

How good bacteria keep you well

They remove ‘bad’ bacteriaThey get rid of the nasty bacteria that enter the digestive tract, preventing them from multiplying and making us unwell. Good bacteria produce lactic acid and fatty acids, which lowers the acidity in the large bowel, making it difficult for bad bacteria to over-multiply. This helps keep a healthy balance of bacteria.

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They aid digestionGood bacteria break down fibre in the gut to produce nutrients for the cells that line the bowel, keeping your gut healthy.

They make vitaminsYou get most of your vitamins from food, but the healthy bacteria in our body make some too, such as certain B vitamins and vitamin K.

They attack infectionsAround 70 per cent of our immune system is in our digestive system. When we have a virus, our healthy bacteria leap into action, aiming to neutralise toxins that the virus makes, thus reducing the likelihood that the virus will progress.

Is there a link with bacteria and arthritis?A study published in 2013 in the United States found that people with rheumatoid arthritis were much more likely to have a bug called Prevotella copri present in their gut than people that did not have the disease. Another study, completed in 2014, found that patients with psoriatic arthritis had significantly lower levels of other types of gut bacteria.

These findings suggest that certain bacteria may be linked to triggering the autoimmune response that leads to joint inflammation. Studies have also found that ‘leaky gut syndrome’, or other gastrointestinal problems, could trigger flare-ups in conditions such as rheumatoid arthritis and lupus.

What’s your gut telling you?Laura looks at research into how our gut ‘bugs’ influence our long-term health and whether there’s a link between bacteria and arthritis


What is a ‘leaky gut’?A single layer of cells that make up the mucosal barrier lines the inside of the intestine. This barrier is effective at absorbing nutrients, but prevents most large molecules and germs passing from inside the intestine into the bloodstream and potentially causing widespread symptoms.

When poor diet or overuse of antibiotics results in an imbalance of good and bad bacteria, this barrier can become less effective by making the gut ‘leaky’, although this in itself is not generally thought to be sufficient to cause serious problems.

While there is currently little evidence to back up the theory of ‘leaky gut syndrome’ it is still important to maintain good gut health to keep your immune system strong.

How do I take better care of my gut health?Gut health is influenced by our genes, and while we can’t change our inherited genes, we can change our unique digestive system. We can do this by taking a look at what we’re eating and include more of the foods that help keep our good bacteria thriving.

Eat a healthy, high-fibre, balanced dietA diet which is healthiest for our body is likely to be healthiest for the good bacteria in our gut too. Meals should be based on wholegrain and plant foods such as wholemeal grainy bread, brown rice and a wide range of brightly coloured vegetables and seeds/nuts.

The latest research also recommends that animal fat (saturated fat) is to be kept low by including lean meats in your meals, for example, use extra lean mince rather than wagyu beef. Don’t forget that legumes and pulses such as chick peas and lentils make a great meat replacement and are very beneficial for our gut bacteria.

Rebalance with probiotics (the good bacteria)Probiotics are strains of healthy bacteria that can help balance out good and bad bacteria in the gut. There are many food items containing probiotics, such as yoghurts and drinks, as well as a variety of probiotic supplements. Look for the words lactobacillus and bifido bacteria on food labels.

Take antibiotics only when necessaryIf your doctor has prescribed antibiotics it is important that you follow this advice. However, antibiotics can cause an upset in the balance of good and bad bacteria, so when you’re on a course of antibiotics, consider taking a daily probiotic supplement and continue to take them for a month afterwards.

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Go with your gut feelingWhile more research is required to provide us with more evidence to link gut health and arthritis, adopting a healthy diet and adding probiotics into your daily eating routine can’t hurt your gut health. It may in fact, help you feel better overall.

If you need support and guidance with your diet, it’s a good idea to consult an Accredited Practising Dietitian (APD). An APD will help to ensure you are receiving adequate nutrition to maintain good health. Visit the Dietitians Association of Australia website, www.daa.asn.au, to find an APD near you.

By Laura VincentHealth Promotion Officer/DietitianArthritis & Osteoporosis NSW

References:

1. Conlon MA et al. (2014) The Impact of Diet and Lifestyle on Gut Microbiota

and Human Health. Nutrients. 2015, 7, 17-44.

2. Eckberg PB et al. (2005) Diversity of the human intestinal microbial flora.

Science. 308: 1635-1638.

3. Floch MH (2014) Probiotics and Prebiotics. Gastroenterology & Hepatology,

2014 Oct; 10 (10):680-1.

4. Scher JU et al. (2013) Expansion of intestinal Prevotella copri correlates with

enhanced susceptibility to arthritis. Elife. 2013 November; 5;2.

5. Scher JU et al. (2015) Decreased bacterial diversity characterizes the altered gut

microbiota in patients with psoriatic arthritis, resembling dysbiosis in inflammatory

bowel disease. Arthritis Rheumatology. January; 67(1):128-39.

6. Stewart A (2009) Leaky Gut Syndrome. Foods Matter, 2009 Feb: 8-9.


ARTHRITIS CAUSES CHRONIC PAIN, IMPAIRED MOBILITY, FATIGUE, DEPRESSION AND SOCIAL ISOLATION. IT CAN AFFECT ANYONE; KIDS, ADULTS, MEN AND WOMEN. BUT TOGETHER WE CAN MAKE A DIFFERENCE.

GIVING THE ULTIMATE GIFT

A bequest is a gift that keeps on giving long

after you are able to do so personally. It is the

ultimate, selfless gift. A gift made in your will to

a charitable organisation is called a bequest.

For organisations like Arthritis South Australia,

bequests play a vital role in enabling us to take a

major step forward in the fight against arthritis.

Bequests are personal matters and we respect your privacy.

I’ve lived with the pain of arthritis for years – I’d like to think that it doesn’t have to always be like that.

Although it is not essential, it would be helpful if we had

some knowledge of your plans. Not only will it help us to

plan ahead, it will give us the opportunity to thank you

personally and discuss how we will put your gift to work.

This information will be treated in the strictest confidence.

If you would like to discuss the possibility of leaving a

bequest to Arthritis South Australia, or to obtain a

copy of our bequest brochure, please contact the

Bequests Officer on 08 8379 5711.

Arthritis SA

118 Richmond Rd

Marleston SA 5033

Arthritis Helpline: 1800 011 041Phone: 08 8379 5711Fax: 08 8379 5707

www.arthritissa.org.au

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