Osteoarthritis: Treatments

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 and similar conditions that affect the joints (i) 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 (i).

There are more than 200 different types of arthritis, the main one being osteoarthritis (ii). According to the National Institute of Health and Care Excellence (NICE), 8.75 million people in the UK over the age of 45 are thought to have requested treatment for osteoarthritis – this includes a third of women and almost a quarter of men aged 45 - 64 and almost half of those aged 75 and older (iii).

Osteoarthritis is a degenerative condition where the cartilage, the smooth layer that covers the bone surfaces in the joints, has become damaged. According to NICE, 18 percent of those requesting treatment for osteoarthritis (around 4.7 million people) complain of knee joint pain, while eight percent have had treatment for osteoarthritis of the hip. Other joints commonly affected include the hip, hand, wrist, foot and ankle.
 

Types of arthritis

Other types of arthritis include the following:

Rheumatoid arthritis

The second most common form of arthritis, rheumatoid arthritis is thought to affect more than 400,000 people in the UK (iv). 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

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.

Fibromyalgia

Causing pain in the muscles, tendons and ligaments, fibromyalgia is more common in women than men too (according to Versus Arthritis, up to one person in every 25 may be affected (v)).

Lupus

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.

Gout

Affecting an estimated 1.4 percent of UK adults (vi), 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.

Psoriatic arthritis

As its 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.

Cervical spondylosis

A form of osteoarthritis, this affects the joints, bones and tissues in the neck and back. It’s very common, with an estimated two thirds of people having some degree of neck pain at some point or other, with women being slightly more affected than men (vii).

Reactive arthritis

Usually the result of an infection, reactive arthritis can affect the joints, eyes and urethra, and usually develops in young adults (though it can affect people of any age, including children). It’s not very common but is widely thought to be linked to an inherited gene called human leukocyte antigen B27 (HLA-B27) – a gene that’s carried by one in 10 people in the UK. The good news is this type of arthritis tends to clear up within six months without leaving any lasting problems (viii).

Polymyalgia rheumatica

Causing symptoms in the muscles around the shoulders, neck and hips, polymyalgia rheumatica develops in 84 in every 100,000 people each year in the UK, with most cases affecting the over-50s (particularly the over-70s) (ix). It’s more common in women than men, and affects more people of a northern European origin.

For more information on the different types, see our guide to understanding arthritis.

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.

Practical solutions

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:

Lose weight

According to the NHS, being obese puts extra strain on your joints, particularly the ones that are weight bearing (such as your knees and hips) (x). It is also thought that being overweight may increase levels of inflammation in the body (xi).

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. Not only does that carrying excess weight 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 (xii).

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.

Wear trainers

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 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:

Pain relief

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 or gel 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 Versus Arthritis, this is an effective and very well-tolerated painkiller that you apply up to four times a day (xiii) – though the NHS adds that you may have to use it for a while before it has an effect (xiv). 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.

Corticosteroids

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.

Surgery

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 osteoarthritis 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:

Hot/cold therapy

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).

Fish oils

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 study that followed 202 human participants found those who took fish oil supplements reported improvements in pain and joint function (xv).

If you’re a vegetarian or vegan you can still benefit from an omega-3 supplement, thanks to the availability of products that contain the natural triglyceride (TG) form of omega-3, which is sourced from plant organisms called microalgae rather than fish oils.

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 (xvi) compared with taking either one or the other.

Rosehip

According to experts at Versus Arthritis, there is evidence to suggest rosehip – a herbal remedy – may be effective in relieving some symptoms associated with osteoarthritis as well as rheumatoid arthritis (xvii).

Devil’s claw

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 (xviii). A review of nutritional supplements also suggests devil’s claw seems to be effective as a treatment for hip and knee osteoarthritis, and that it’s safe with low adverse effects (xix).

Turmeric

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 (xx). A review of 15 studies also concludes that curcumin is a potential candidate for the treatment of osteoarthritis (xxi).

High-strength multivitamin and mineral

Multivitamin and mineral supplements that contain antioxidants such as selenium as well as beneficial levels of vitamins C, D and E may also help support the joints as well as overall health.

Zinc

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 (xxii).
 

PEA

Also known as palmitoylethanolamide, PEA is a type of fatty acid made naturally by the body and found in all cells, tissues and fluids including the brain (it’s also found in foods such as soya beans, peanuts, eggs, flaxseed and milk). Described as an endocannbinoid-like chemical that belongs to a family of fatty acid compounds called amides (xxiii), PEA is an alternative to CBD, since both substances are thought to have similar properties including the ability to reduce pain and inflammation. However researchers suggest PEA is safer than CBD, since it has been studied more extensively and has a more robust safety profile (xxiv) with no known side effects (xxiii). 

Your body naturally increases its production of PEA when your cells are damaged or threatened. But in certain situations – such as when your body is experiencing chronic inflammation – the level of PEA in your cells drops (xxiv). When this happens, PEA supplements may be helpful. One study has even suggested taking PEA supplements may help reduce pain as well as other associated symptoms of mild to moderate knee osteoarthritis (xxv).

Some natural therapies may also be useful, including acupuncture, chiropractic, massage therapy and magnet therapy.

Osteoarthritis is not always the easiest to manage, but we hope this guide helps to make it a little easier. For more information on a range of common health conditions, feel free to visit our health library.

 

References:

1. Available online: https://www.nhs.uk/conditions/arthritis/

2. Available online: https://www.medicalnewstoday.com/articles/7621.php

3. Available online: https://cks.nice.org.uk/osteoarthritis#!backgroundSub:1

4. Available online: https://www.versusarthritis.org/about-arthritis/conditions/rheumatoid-arthritis/

5. Available online: https://www.versusarthritis.org/about-arthritis/conditions/fibromyalgia/

6. Available online: https://patient.info/doctor/gout-pro

7. Available online: https://patient.info/doctor/cervical-spondylosis-pro

8. Available online: https://www.versusarthritis.org/about-arthritis/conditions/reactive-arthritis/

9. Available online: https://patient.info/doctor/polymyalgia-rheumatica-pro

10. Available online: https://www.nhs.uk/conditions/osteoarthritis/

11. Tuba Tulay Koca, Does obesity cause chronic inflammation? The association between complete blood parameters with body mass index and fasting glucose. Pak J Med Sci. 2017 Jan-Feb;33(1):65-69.Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5368331/

12. 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.

13. Available online: https://www.versusarthritis.org/about-arthritis/complementary-and-alternative-treatments/types-of-complementary-treatments/capsaicin/

14. Available online: https://www.nhs.uk/conditions/osteoarthritis/treatment/

15. Hill CL. et al., Fish oil in knee osteoarthritis: a randomised clinical trial of low dose versus high dose. Ann Rheum Dis. . 2016 Jan;75(1):23-9.Available online: https://www.ncbi.nlm.nih.gov/pubmed/26353789

16. 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.

17. Available online: https://www.versusarthritis.org/about-arthritis/complementary-and-alternative-treatments/types-of-complementary-treatments/rosehip/

18. 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.

19. Castrogiovanni P. et al., Nutraceutical Supplements in the Management and Prevention of Osteoarthritis. Int J Mol Sci. 2016 Dec;17(12):2042.Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5187842/

20. 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.

21. Kok-Yong Chin. The spice for joint inflammation: anti-inflammatory role of curcumin in treatint osteoarthritis. Drug Des Devel Ther. 2016;10:3029-3042.Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5036591/

22. 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.

23. Clayton P. et al., Palmitoylethanolamide: A Natural Compound for Health Management. Int J Mol Sci. 2021 May;22(10): 5305. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157570/

24. Clayton P. et al., Palmitoylethanolamide: A Potential Alternative to Cannabidiol. J Diet Suppl. 2021 Nov;28;1-26. Available online: https://www.tandfonline.com/doi/full/10.1080/19390211.2021.2005733

25. Steels E. et al., A double-blind randomized placebo controlled study assessing safety, tolerability and efficacy of palmitoylethanolamide for symptoms of knee osteoarthritis. flammopharmacology 2019 Jun;27(3):475-485. Available online: https://link.springer.com/article/10.1007/s10787-019-00582-9

 

Related Posts

 

Disclaimer: The information presented by Nature's Best 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.  

 

---