By Jane Elliott
Health reporter, BBC News
It can be harder for people with arthritis to form relationships
Dealing with the physical pain of arthritis can be exhausting.
But many people with the condition find it can also hamper their ability to form and maintain physical relationships.
When Homeira Khan, 31, of Middlesex, was diagnosed with rheumatoid arthritis at the age of 23, she became severely depressed.
She would avoid going out and had to be forced by her family to socialise.
And when she first met the man she was later to marry, she was too embarrassed to tell him of her condition.
But eventually, Homeira sat down and explained how it affected her.
"If you are in absolute agony you do not want to be cuddled or be intimate, but you have to explain that it is nothing to do with them and it is because you are in pain.
"Once I have taken my arthritis drugs I am OK. But there is no spontaneity - you have to plan your spontaneity."
The Arthritis Care charity has produced a booklet to help people with the condition find a relationship.
It explains how some people with arthritis find their libido dulled by their painkillers and medications.
Others may have low self esteem - worried that the steroids they take have made them feel too fat, or that they have such limited mobility that many traditional sexual positions are too painful.
"The book has got diagrams of lovemaking positions which people of differing physical abilities and movements have found possible," said Kate Llewelyn, of Arthritis Care, who was diagnosed with rheumatoid arthritis at the age of 13.
"If you've got problems with your spine, or hips, or knees, it makes sense to experiment with positions that place least weight or strain on the rogue joints."
About nine million people, in the UK, of all different ages have one of the 200 forms of arthritis.
Many have serious pain every day, and they often have a loss of mobility and suffer from extreme fatigue.
But Kate said this should not stop them forming and maintaining relationships.
"One of the reasons we produced the guide is to address issues people felt awkward discussing.
"It may be embarrassing to talk to your consultant rheumatologist, nurse or GP about emotional and sexual things, or matters of self-image and self-esteem - and they may be embarrassed to be asked.
But she added: "'Managing pain and other symptoms is exhausting, and it stops many people getting out and socialising.
"As a result, arthritis can be isolating, keeping you from making friends or seeing family, let alone dating and finding a partner.
"And maybe you are not very mobile, so can't dance, or play sport, or can't drink because of your medications.
"What's more, although anti-discrimination law means venues must now offer better access for disabled people, you still may find it harder to do things people without arthritis take for granted'.
She added that the young were particularly vulnerable - and 12,000 children have arthritis.
"Adolescence is a time of utter vulnerability and having to explain to someone you fancy that you've got arthritis is a real ordeal for many.
"Starting out socialising and dating can be tough - it's all a bit of a 'cattle market'.
"But if you have got anything that sets you apart from the crowd and stops you participating in things,' love's young dream' can soon become a bit of a nightmare'.
Retired consultant rheumatologist Dr Anne Nicholls said that if someone was in extreme pain and fatigued that often the last thing they would feel like doing was socialising and that this could leave them isolated and lonely.
"It can be very lonely for people with arthritis, but the more people appreciate the condition, and the more partners, family and friends appreciate the condition, the easier it will become."
The booklet will be available from the Arthritis Care website from Wednesday.