Osteoarthritis: TreatmentsIf you have arthritis, you already know how difficult it can be to live with. Indeed, the 10 million people in the UK who are affected by arthritis are all familiar with the symptoms: namely chronic pain, inflamed, stiff and swollen joints.
If you have arthritis, you already know how difficult it can be to live with. Indeed, the 10 million people in the UK who are affected by arthritis are all familiar with the symptoms: namely chronic pain, inflamed, stiff and swollen joints. And while it may be associated with getting older, arthritis can affect anyone, even the very young. In the UK, around 15,000 children and young people are estimated to have arthritis.
There are more than 200 different types of arthritis, the main one being osteoarthritis. In the UK, 8.75 million people are thought to have requested treatment for osteoarthritis, which includes 33 percent of people over 45 and 49 percent of women and 42 percent of men aged 75 or older (i).
Osteoarthritis is a degenerative condition where the the cartilage, the smooth layer that covers the bone surfaces in the joints, has become damaged. According to Arthritis Research UK, 18 percent of those requesting treatment for osteoarthritis (around 4.7 million people) complain of knee joint pain. Other joints commonly affected include the hip, hand, wrist, foot and ankle.
Types of arthritis
Other types of arthritis include the following:
The second most common form of arthritis, rheumatoid arthritis is thought to affect more than 400,000 people in the UK. It causes pain, swelling and stiffness in the joints, and is classed as an autoimmune disease, since it’s caused by the immune system attacking one or more joints.
Ankylosing spondylitis, a form of arthritis is an inflammatory condition that most commonly affects the spine (though other parts of the body can be affected, including the eyes, joints and tendons). It’s also more common in men than women.
Causing pain in the muscles, tendons and ligaments, fibromyalgia is more common in women than men too (according to Arthritis Research UK, up to one person in every 25 may be affected).
Systemic lupus erythematosus (SLE) – or lupus, as it is more commonly known – causes many symptoms, including joint pain and swelling, fatigue and skin rashes. Many sufferers have flare-ups, and symptoms can range from mild to severe. It’s more common in women than men, as well as in certain ethnic groups such as those of African origin.
Affecting an estimated 1.4 percent of UK adults, gout symptoms include sudden, or acute, attacks that cause excruciating pain in a joint, most commonly the big toe. It develops when a build-up of uric acid in the blood causes crystals of sodium urate to form in and around a joint, causing pain and inflammation. This type of arthritis affects more men than women.
As it’s name suggests, psoriatic arthritis is an inflammatory joint condition that can develop if you have the skin condition psoriasis.
Juvenile idiopathic arthritis
This is the most common form of arthritis in children, and there are several different types. The good news is many cases improve as affected children get older.
A form of osteoarthritis, this affects the joints, bones and tissues in the neck and back. According to the NHS it’s very common, with an estimated nine out of 10 adults having some degree of cervical spondylosis by the time they reach the age of 60 – though many may not have any apparent symptoms.
Usually the result of an infection, reactive arthritis can affect the joints, eyes and urethra, and usually develops in people aged between 20 and 40. It’s not very common – an estimated 2,500 people develop it every year in the UK – and it usually clears up within three to 12 months.
Causing symptoms in the muscles around the shoulders, neck and hips, polymyalgia rheumatica develops in one in 1,200 people each year, with most cases affecting the over-50s (particularly the over-70s). It’s more common in women than men, and affects more people of a northern European origin.
What causes joint damage?
Your joints are subjected to a lot of wear and tear during your lifetime, especially the load-bearing joints such as your knees, ankles and hips.
A joint consists of two or more bones that meet, the ends of which are covered in a layer of cartilage that helps to prevent the bones rubbing together. Holding the bones in place are ligaments, while muscles around a joint expand and contract, which helps the joint to move (these muscles are attached to the bones via tendons).
Surrounding the joint is a capsule made up of fibres that restrict the range of movement in a joint. The capsule is lined by the synovial membrane, which produces synovial fluid that lubricates the joint and provides nutrients for the cartilage.
With arthritis, several parts of the joint can become damaged, including the bones and cartilage. In osteoarthritis, this is widely believed to be caused by a gradual process of wear and tear. This can cause bony growths to develop in the joints, leading to inflammation inside the joints that irritates nerve endings, causing pain, stiffness and swelling.
If you have any pain in a joint, try to use that joint differently. Think about the way you normally use that joint, and ask yourself how you might protect it.
For instance, if carrying a heavy bag of shopping causes pain in your shoulder, elbow, wrist or hand, use two smaller shopping bags – one in each hand (or on each forearm) – to spread the load, or use a shopping trolley. You can also try using two hands to pour water out of a heavy kettle, hold large objects you’re carrying close to your body to allow the weight to be supported by stronger joints and avoid gripping things too tightly.
Think about how you can use less effort to do lots of repetitive daily tasks that might be causing pain and further wear and tear, and when an activity that you do regularly causes a strain on a joint, try to spend less time on them – or if that’s not possible, try to take more breaks.
Osteoarthritis: five ways to help yourself
Having a healthy, positive lifestyle can help with the management of arthritis symptoms. Here are some of the things you can do:
According to Arthritis Research UK, people who are obese are up to four times as likely to develop osteoarthritis of the knee as they are to develop high blood pressure or type 2 diabetes. It is also thought that being overweight may increase levels of inflammation in the body.
One of the most effective ways to relieve the symptoms of osteoarthritis is to make sure your weight is healthy – which means shedding a few pounds if you need to. That’s because the more weight your body is carrying, the bigger the load on your knees, hips and ankle joints. Not only does that make you more susceptible to developing osteoarthritis, it can make the condition progress more quickly once you do have it.
Take regular exercise
People with arthritis may feel the last thing they want to do is something physical. However, exercise may help in a variety of ways:
Being active helps keep your muscles and bones strong
It can help keep your joints flexible and reduces stiffness
Exercise also boosts joint movement
Moving more may help reduce the pressure on your joints by keeping your weight down
There are three main types of exercise you should do regularly: aerobic fitness exercises, such as walking, swimming, cycling and keep-fit classes (avoid jogging as it may put too much pressure on your joints); strengthening exercises that keep your muscles strong, such as Pilates; and flexibility exercises that stretch your muscles, such are yoga.
Eat the right foods
Eating healthily may help you to manage your weight, which can have a significant effect on the symptoms of osteoarthritis. There is also some evidence that eating a Mediterranean diet may help people with osteoarthritis enjoy a better quality of life, as well as decreased pain and disability (ii).
Following a Mediterranean diet means eating plenty of vegetables, fruit, wholegrain cereals, peas and beans, and using olive oil or rapeseed oil instead of animal fats such as butter or lard. A typical Mediterranean diet also includes a moderate amount of low-fat dairy products as well as fish (especially oily fish such as salmon, pilchards, sardines and mackerel) and poultry.
Foods to avoid or limit include high-fat milk and dairy products, red meat, high-fat and high-salt processed foods (ready meals, cakes, biscuits, crisps etc), potatoes and sugary foods such as sweets and desserts.
Try to reduce stress
Any condition that causes chronic pain can be very stressful. And arthritis is no exception. But if you can learn to relax more, you may be able to manage your stress levels more effectively. Breathing deeply can help: inhale for a slow count of four and exhale for a count of six until you feel calmer. You could also have a 10-minute walk outside in the fresh air, listen to your favourite comedy programme or become absorbed in a new hobby.
If you have osteoarthritis in your feet, knees, hips or back, walking shoes with thick soles that act as shock absorbers for your feet – such as trainers – may help reduce the strain on your joints. Wearing high heels, on the other hand, can increase the pressure on your joints because they alter the angle of your hips, knees and big toe joints.
How is osteoarthritis treated?
There is no cure for osteoarthritis. But if you’re diagnosed with either condition and making the appropriate lifestyle changes hasn’t been effective enough to control your symptoms, you may also receive one or more of the following treatments:
Your GP may recommend medication to relieve pain. The type of painkiller you may receive will depend on how severe your pain is, and whether or not you have other medical conditions or health problems.
Pain relief medication may include paracetamol, a combination of paracetamol and codeine, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and diclofenac, or prescription drugs called COX-2 inhibitors (also part of the NSAID family), such as celecoxib and etericoxib. Some of these are available in cream form, which means they can be applied directly to the area of pain.
Your GP may also recommend capsaicin cream, which is made from the capsicum (pepper) plant. According to Arthritis Research UK, this is an effective and very well-tolerated painkiller that you apply three or four times a day. It can produce a warming or even burning sensation when you first start to use it, but this usually wears off in time. Only available on prescription, capsaicin cream is thought to be particularly useful for hand and knee osteoarthritis; however it can take up to a month to be fully effective.
Injections of corticosteroid – a medicine that reduces swelling and pain – may be given in severe cases of osteoarthritis, where taking painkillers has failed to manage symptoms effectively. The medicine is injected directly into the affected joints, and if it proves successful, you may be offered up to three intra-articular injections a year.
Hyaluronic acid injections
Also called viscosupplementation, injections of hyaluronic acid into the affected joints are sometimes available for those who have tried all other non-surgical treatments without success. According to the NHS there’s evidence this may help to temporarily reduce pain and improve osteoarthritis symptoms in some people. But others may not find it successful, and more research is needed about the long-term effects.
If you have severe pain or mobility problems in your knee or hip, you may be advised to have a joint replacement operation. A keyhole surgery procedure called arthroscopic lavage is also sometimes recommended for certain people with osteoarthritis of the knee.
Natural arthritis remedies
Conventional therapy for either of the two main forms of arthritis is based on medication. But there are gentler remedies that may also help to provide relief, used on their own or alongside conventional pain relief:
Applying creams, gels or sprays to heat or cool the skin around a joint may help to relieve the pain and other symptoms of osteoarthritis. Alternatively you could try heat packs that can be warmed up in the microwave or cold packs that can be kept in the freezer (or simply a hot water bottle filled with hot or cold water).
The omega-3 fatty acids found in oily fish are mainly associated with the treatment of rheumatoid arthritis. However, there is some evidence they may help people with osteoarthritis too (though most of the studies are animal rather than human studies). One such study suggests omega-3 fats may slow the progression of osteoarthritis as well as help prevent it (iii).
Glucosamine and chondroitin
Both are substances found naturally in the body, with supplements commonly sourced from shrimp or crab shell. They are thought to slow down the progression of osteoarthritis by building and repairing cartilage, thereby reducing wear and tear in the joints. Both substances have been the focus of many arthritis studies, which have produced a variety of results. One study, however, suggests that taking both glucosamine and chondroitin together may be beneficial (iv) compared with taking either one or the other.
There is also evidence to suggest that rosehip – a herbal medicine – may be effective in relieving some of the symptoms associated with osteoarthritis (v). According to experts at Arthritis Research UK, this herb may work because it contains the antioxidant vitamin C as well as polyphenols and anthocyanins, both of which are thought to protect joints against damage.
This herbal product is used for the relief of rheumatic pain as well as general aches and pains in the joints (based on traditional use only). There is some evidence it may be effective: for instance, one study included in a systematic review into devil’s claw suggests volunteers given the remedy saw significant improvements in pain compared with those taking a placebo (vi).
A common ingredient in curries, turmeric is a spice that grows in India and Indonesia. It contains an active ingredient called curcumin, which is often recommended as a treatment for reducing pain, inflammation and stiffness. One study notes that curcumin may help protect joint cartilage and relieve cartilage degeneration and inflammation (vii).
High-strength multivitamin and mineral
Multivitamin and mineral supplements that contain antioxidants such as selenium as well as beneficial levels of vitamins
Taken as a single supplement or as part of a high-strength multivitamin and mineral, zinc is thought to be helpful for maintaining the immune system, which may be affected when you have chronic pain. There is also evidence that zinc plays a causal role in osteoarthritis, with one study suggesting zinc levels inside cartilage cells cause osteoarthritis-related tissue damage (viii).
Some natural therapies may also be useful, including acupuncture, chiropractic, massage therapy and magnet therapy.
Osteoarthritis in general practice. Arthritis Research UK.
Veronese. N, et al. Adnerence to the Mediterranen diet is associated with better quality of life: data from the Osteoarthritis Initiative. Am J Clin Nutr. 2016 Nov;104(5):1403-1409.
Knott. L, Avery. NC, Hollander. AP, Tarlton. JF. Regulation of osteoarthritis by omega-3 (n-3) polyunsaturated fatty acids in a naturally occurring model of disease. Osteoarthritis Cartilage. 2011 Sep;19(9):1150-7.
Fransen. M, Agaliotis. M, et al. Glucosamine and chondroitin for knee osteoarthritis: a double-blind randomised placebo-controlled clinical trial evaluating single and combination regimens. Ann Rheum Dis. 2014 Jan 6.
Rossnage.l K, Roll. S, Willich. SN. The clinical effectiveness of rosehip powder in participants with osteoarthritis. A systematic review. MMW – Fortschritte der Medizin. 2007; 149(11):51–56.
Gagnier. JJ, Chrubasik. S, Manheimer. E. Harpagophytum procumbens for osteoarthritis and low back pain: a systematic review. BMC Complementary and Alternative Medicine. 2004;4:13.
Liu. J, He. X, Zhen. P, Zhou. S, Li. X. Inflammatory cytokines and oxidative stress markers in the inhibition of osteoarthritis by curcumin. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2016 May 25;45(5):461-468.
Kim. JH, Jeon. J, Shin. M, Won. Y, Lee. M, Kwak. JS, Lee. G, Rhee. J, Ryu. JH, Chun. CH, Chun. JS. Regulation of the Catabolic Cascade in Osteoarthritis by the Zinc-ZIP8-MTF1 Axis. Cell. 2014;156 (4): 730.
Disclaimer: The information presented by Nature's Best The Pharmacy is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.