What is Arthritis?
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 (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 (ii), the main two being osteoarthritis and rheumatoid arthritis. Out of these, osteoarthritis is by far the most common. In the UK, nearly 9 million people are thought to be affected by osteoarthritis, with women and people with a family history of the condition most likely to develop it (i). Osteoarthritis can affect you at any age, but according to the NHS it most often develops in people in their mid-40s and older (i).
Osteoarthritis is a degenerative condition where the cartilage, the smooth layer that covers the bone surfaces in the joints, has become damaged. The most commonly affected joints are those in the hands, knees, hips and spine.
Rheumatoid arthritis, on the other hand, is the second most common form of arthritis in the UK, and according to the NHS it affects more than 400,000 people (i). Most often developing in people aged between 40 and 50 years old, it is more common in women than men (women are said to be three times more likely to develop rheumatoid arthritis than men) (i).
Like osteoarthritis, it causes pain, swelling and stiffness in the joints. But rheumatoid arthritis is a result of the immune system attacking one or more joints - which explains why it is referred to as an autoimmune disease. Sufferers may also experience periods when their symptoms become worse, which is called a flare-up.
Types of arthritis
Other types of arthritis include the following:
This 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 (according to the NHS men are twice as likely to develop ankylosing spondylitis than women (iii)). To learn more about ankylosing spondylitis, its causes and treatments, why not read our article.
Causing pain in the muscles, tendons and ligaments, fibromyalgia affects around seven times as many women as men (iv) (according to Versus Arthritis, up to one person in every 25 may be affected).
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&rss about nine times more common in women than men, and more common in certain ethnic groups such as those of African origin and women of Chinese origin (vi).
Affecting an estimated 1.4 percent of UK adults (vii), 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, especially those aged between 30 - 60 years old (vii).
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.
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 (viii).
Usually the result of an infection, reactive arthritis can affect the joints, eyes and urethra, and usually develops in men aged between 20 and 40. It's not very common - but if you have a gene called human leukocyte antigen B27 (HLA-B27), you may be more likely to be affected (about one in 14 people carry this gene, including about three out of four people who have reactive arthritis) (ix).
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) (x). It's more common in women than men, and affects more people of a northern European origin (xi).
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.
However in rheumatoid arthritis, damage to the joints is caused by the body's own immune system, though experts still don't know why this happens. Antibodies that normally fight off infections start attacking the tissues surrounding the joints, causing inflammation.
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.
If you have rheumatoid arthritis, you may also experience fatigue. So try to take it easy, even when you don't feel tired - by pacing yourself whenever possible (again, take regular breaks if you can).
Arthritis: 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 the Johns Hopkins Arthritis Center, being overweight is a clear risk factor for developing osteoarthritis, with studies consistently showing links between overweight or obesity and osteoarthritis of the knee (xii).
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:
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
Some experts believe what you eat is linked with arthritis, and that a having Mediterranean-style diet may help you to manage your symptoms (xiii). This 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.
Exercises that help you to focus on the present moment and become more positive - known as mindfulness may help with arthritis. According to the charity Arthritis Action, mindfulness has been shown in clinical studies to help some people with the pain and distress of arthritis, including the pain and stiffness of rheumatoid arthritis (xiv). Find out more about mindfulness by visiting https://www.bemindfulonline.com/, a Mental Health Foundation website.
How is arthritis treated?
There is no cure for osteoarthritis or rheumatoid arthritis. 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 if you have either of the two main forms of arthritis to relieve pain and reduce inflammation. 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.
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. In cases of rheumatoid arthritis, the corticosteroid injection may also be given, but you may be prescribed steroid tablets instead. The aim of corticosteroids in rheumatoid arthritis treatment is to provide short-term pain relief, such as during a flare-up.
Disease-modifying anti-rheumatic drugs are usually the first treatment offered to people newly diagnosed with rheumatoid arthritis. These medicines - which include methotrexate, hydroxychloroquine, sulfasalazine and leflunomide, aim to slow down the progression of the disease as well as relieve the symptoms.
Sometimes used alongside DMARDs, these include medicines such as adalimumab, etanercept, golimumab, infliximab, abatacept and rituximab. They are injections that prevent certain chemicals in your blood from triggering your immune system to attack your joints (they may also be given as intravenous drips).
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)
As they are a good source of omega-3 essential fatty acids, fish oils are thought to help fight inflammation in the joints by affecting the body's production of pro-inflammatory substances called prostaglandins. Omega-3s may also have a protective effect on joints. According to one study, women who ate the equivalent of one serving of oily fish a week had a 52 percent lower risk of developing rheumatoid arthritis compared to those who ate less (xv). Another study that followed more than 200 people with osteoarthritis of the knee found those who took fish oil supplements reported improvements in pain and joint function (xvi).
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 (xvii) 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 (xviii) and rheumatoid arthritis (xix). According to experts at Versus Arthritis, this herb may work because it contains the antioxidant vitamin C as well as polyphenols and anthocyanins, both of which are thought to relieve joint inflammation and protect joints against damage (xx).
High-Strength Multivitamin and Mineral
Multivitamin and mineral supplements that contain antioxidants such as selenium and zinc as well as beneficial levels of vitamins C, D and E may also help support the joints as well as overall health.
Some natural therapies may also be useful, including acupuncture, chiropractic, massage therapy and magnet therapy.
As tricky as it can be to manage, there are steps you can take to ensure that arthritis doesn’t stop you from doing what you love. To discover even more articles on a range of common health conditions, feel free to visit the health library.
Available online: https://www.nhs.uk/conditions/arthritis/
Available online: https://www.arthritiscare.org.uk/what-is-arthritis/faqs/arthritis
Available online: https://www.nhs.uk/conditions/ankylosing-spondylitis/
Available online: https://www.nhs.uk/conditions/fibromyalgia/
Available online: https://www.versusarthritis.org/about-arthritis/conditions/lupus-sle/
Available online: https://patient.info/doctor/gout-pro
Available online: https://www.nhs.uk/conditions/cervical-spondylosis/
Available online: https://patient.info/bones-joints-muscles/arthritis/reactive-arthritis
Available online: https://www.nhs.uk/conditions/polymyalgia-rheumatica/
Mitchet. CJ., Matteson EL., Polymyalgia rheumatica. BMJ. 2008 Apr 5;336(7647):765-769. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2287267/
Di Giuseppe. D, Wallin. A et al. Long-term intake of dietary long-chain n-3 polyunsaturated fatty acids and risk of rheumatoid arthritis: a prospective cohort study of women. Ann Rheum Dis. 2014 Nov;73(11):1949-53.
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
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.
Rossnagel. 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.
Willich. SN, Rossangel. K et al. Rose hip herbal remedy in participants with rheumatoid arthritis – a randomised controlled trial. Phytomedicine 2010; 17:87–93.
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.
Christine Morgan has been a freelance health and wellbeing journalist for almost 20 years, having written for numerous publications including the Daily Mirror, S Magazine, Top Sante, Healthy, Woman & Home, Zest, Allergy, Healthy Times and Pregnancy & Birth; she has also edited several titles such as Women’ Health, Shine’s Real Health & Beauty and All About Health.