Osteoarthritis: how to look after your joints
Reproduced from Issue 100 of Arthritis Today
By Professor Mike Doherty, Rheumatology Unit, City Hospital, Nottingham.
Disproving the old adage that a little knowledge is a dangerous thing, it's a proven fact that the more people with osteoarthritis know about their condition, the less pain they will have, and the better the outcome will be.
So one of the main messages we want to get across to the five million or so sufferers in the UK is – learn all you can about the disease. Osteoarthritis, or "OA", is by far the most common form of arthritis. Almost all of us develop it in at least some of our joints as we get older, and in retirement as many as one in four of us develop knee symptoms, and one in ten hip symptoms, relating to OA.
In OA the smooth shock-absorbing cartilage which covers the bone ends, becomes thin and uneven, and the capsule around the joint thickens and tightens. The bone ends at the margins of the joint enlarge, and the adjacent muscles become weaker and less able to protect the joint as it moves.
The end result can be a creaky, swollen joint which does not move as well as normal, and causes pain and limitation in daily activities. Once OA is established, however, worsening of pain and disability is not inevitable. Indeed, many people with OA have no pain and only mild problems. Also pain and poor functioning can often improve. Only a small proportion of people with OA do badly and eventually require an operation to replace a severely affected joint.
...it's never too late to start losing weight. While the structural damage of OA will never get back to normal, sufficient weight loss means it will not get any worse. The pain associated with OA, however, has a good chance of getting better. |
So that's what OA is – now what can you actually do about? There is much you can do yourself to improve the health of your joints, to reduce the risk of developing symptoms from OA and to improve any symptoms may have. Taking control of the arthritis, and not letting it control you doesn't just mean depending on your GP, rheumatologist or pharmacist to keep you supplied with pain killing tablets. Once you understand more about OA you will realise that most of the management is up to you.
There are a number of things which will help. Firstly, if you are overweight – lose it! It's been shown that people who are very obese – who are in the top 25% of the population for weight adjusted for height – have up to a seven fold increased chance of developing painful OA of the knees.
And it's never too late to start losing weight. While the structural damage of OA will never get back to normal, sufficient weight loss means it will not get any worse. The pain associated with OA, however, has a good chance of getting better.
The best way of losing weight is through a combination of diet and exercise. It's no good going on a diet and then stopping it when you have lost weight – there has to be a sustained lifestyle change. Which leads us into the next method of self-help, exercise.
Another tip is to wear decent shoes with a soft sole – trainers are ideal because they cushion the joints effectively. Avoid high heels. |
There are two forms of simple exercises that people with OA can benefit from. The first is exercise to strengthen the muscles that act around the arthritic joint. All joints and muscles were built to move, so if we don't use them, they become unhealthy, weaker, and eventually thinner. If the muscles are toned up, they will then support the joints, and help them stay healthy.
Seek advice from a physiotherapist, or practice nurse, about the best exercises for you, and your particular form of OA, then you can do them at home, or at work, without supervision. The important thing to stress is do them regularly, just taking a few minutes here and there; make them part of your everyday routine. Doing small amounts often is better than doing a longer strengthening routine less often, and is less likely to stir up your symptoms. Medical evidence has shown that simple, regular strengthening exercises done regularly on your own can reduce pain and improve function over a six month period.
The other form of exercise is aerobic, or fitness exercise. It puts your pulse rate up, and improves heart function by pumping blood all around the body, which, in turn, improves the sense of well-being. Plus, of course, it also encourages you to lose weight.
As most people with OA only have a problem with one or two of their joints, the advice is to try to avoid excessive and overly strenuous exercise that causes too much pain on the painful joints. If you have OA in one knee, you can still increase the exercise for the other leg, and also your arms. Put your painful joint through a range of exercises, but try not to strain it or make the pain worse.
Above all, try to combine exercise with something you enjoy so it doesn't seem like a chore. Some people enjoy swimming two or three times a week, using a keep fit tape, or going to the gym. Cycling is very good exercise but not particularly suited to those with knee OA. Fast walking on the flat is excellent exercise for anyone with OA.
The key is to pace yourself. If you know you've got a strenuous day ahead, break up any prolonged or large chore into smaller manageable periods with short breaks in between so as not to stress your joints unduly. Don't go at things too much all at once and wear yourself out – basically, avoid undue mechanical overloading on the joints – otherwise you will not accomplish much, and become disheartened.
Another tip is to wear decent shoes with a soft sole – trainers are ideal because they cushion the joints effectively. Avoid high heels.
If you do need to take medications for your pain learn all about them so that you can use them to your best advantage. Simple paracetamol and topical creams are safe and often effective when used properly.
In a nutshell, take control of your OA. It is easier said than done, but remember, a positive attitude is vital for you to Look After Your Joints.
- Osteoarthritis – Look After Your Joints was the subject of Education Week in January, coinciding with the launch of arc's new Osteoarthritis booklet.
