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Joint Efforts
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How to live a better life with arthritis
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By Stacey Colino
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MediZine's Healthy Living Summer 2009
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 If you’re among the 46 million people in the U.S. who’ve been diagnosed with some form of arthritis, joint pain and stiffness are probably a fact of life for you. But you don’t have to take these symptoms sitting down. “Most people with arthritis think there’s nothing they can do about it—and that’s a major myth,” says Patience White, M.D., M.A., chief public health officer of the Arthritis Foundation and professor of medicine and pediatrics at the George Washington University School of Medicine and Health Sciences in Washington, D.C.
Osteoarthritis (OA) is by far the most common type of arthritis, affecting nearly 27 million Americans. OA is a degenerative disease in which the cartilage that cushions the bones in a joint erodes. Rheumatoid arthritis (RA), by contrast, is an autoimmune disease in which the immune system causes the lining of the joints to become inflamed. It affects some 1.3 million people.
With both types, the more approaches you use to treat the disease and its symptoms, the better you may feel. “When you put different lifestyle measures together, they can have a synergistic effect on decreasing inflammation and pain,” says Vijay Vad, M.D., a sports medicine specialist and arthritis researcher at the Hospital for Special Surgery in NYC and author of Arthritis Rx. “Plus, they may cut reliance on anti-inflammatory and prescription painkillers.”
What follows are some safe, effective ways to reduce pain and joint damage, increase flexibility and strength and consequently live more comfortably.
Although no diet has been proved to affect the course of arthritis, a healthy, balanced diet that’s rich in vitamins C and D—which are important for joint health—and omega-3 fatty acids (found in cold-water fish such as salmon and tuna, as well as walnuts and canola oil) may reduce inflammation. In fact, the Mediterranean diet—which includes antioxidant-rich fruits and vegetables, as well as whole grains, healthy oils (such as olive oil) and fish—“may help with arthritis by reducing inflammation in the body,” says Jason Theodosakis, M.D., M.P.H., an assistant professor of family and community medicine at the University of Arizona College of Medicine in Tucson and author of The Arthritis Cure. Getting enough vitamin D is important because it may help inhibit the enzymes that break down cartilage, thereby slowing the progression of arthritis.
While the evidence regarding their effectiveness for pain relief is mixed, the dietary supplements glucosamine and chondroiton appear to slow the degradation of cartilage, especially in people with OA of the knee, says Dr. Theodosakis. But keep in mind that these supplements may take four to six months to take effect, and they must be taken in adequate daily doses (at least 1,500 mg of glucosamine and 800 mg of chondroitin), Dr. Theodosakis says. Supplements of avocado/soybean unsaponifiables (ASU), a natural vegetable extract, can also help reduce pain and inflammation and slow the progression of joint damage in OA sufferers.
If you’re overweight, losing even 10 pounds could cut arthritis-related knee or hip pain substantially. That’s because “for every pound you lose, there’s four pounds less pressure on the weight-bearing joints,” explains Dr. Vad.
Besides improving muscle strength, stamina and overall conditioning, “aerobic exercise can have an anti-inflammatory effect because of the endorphins that are released,” says Dr. Vad. Your best bet is 20 to 30 minutes a day of walking, biking, swimming or other low-impact exercises. If it’s hard for you to do weight-bearing exercises, an aquatics program can help you build strength and stamina, because “the water makes you more buoyant, and it’s soothing to the joints,” notes Dr. White.
What’s more, exercises that preserve balance and range of motion—such as yoga and tai chi—can help prevent joint injury and relieve symptoms. Research at Johns Hopkins University in Baltimore found that sedentary people with RA who participated in eight weeks of yoga classes had significantly fewer tender and swollen joints than before starting the class. A study at the Chungnam National University in South Korea found that after doing tai chi for 12 weeks, women with OA felt less joint pain and stiffness.
“If you get enough good-quality sleep, you’ll have improved energy and less pain,” says Scott Zashin, M.D., a clinical associate professor of rheumatology at the University of Texas Southwestern Medical School in Dallas and author of Arthritis Without Pain. So, dedicate ample time for shuteye, try to go to bed and wake up at the same times every day and avoid caffeine at night.
“Applying heat or cold can alter the sensation of pain,” Dr. Zashin explains. “Heat dilates blood vessels, increasing blood flow to the area, which helps with symptom relief. Cold constricts blood vessels and may decrease swelling.” And acupuncture has been found to be particularly helpful for OA of the knee. A recent study by the University Hospitals Birmingham NHS Foundation Trust in the U.K. found that 10 acupuncture treatments using manual and electrical stimulation significantly relieved pain and disability in those with OA of the knee.
For OA, the protocol calls for using the lowest effective dose of a pain reliever for the shortest possible time. Medications range from over-the-counter drugs such as ibuprofen and naproxen to COX-2 inhibitors for more significant pain relief and narcotics for severe pain. Injectable and topical agents may also be effective.
When it comes to RA, major progress has been made, thanks to disease-modifying antirheumatic drugs (such as methotrexate and hydroxychloroquine) and biologic agents (such as TNF blockers). “With some forms of RA, we can put the disease into remission and stop its progression—but it’s best to start treatment early,” says the Arthritis Foundation’s Dr. White. “This makes a tremendous difference in long-term outcome.”
Even if you’re in pain, try to stay socially and emotionally connected
to friends, family and others in your community. OA sufferers who are
depressed and socially isolated may experience more pain than an X-ray
would suggest, says Dr. Theodosakis. Joining a support group may help.
A recent study from the University of Missouri in Columbia of 30 people
with RA found that those who participated in an online education and
peer-support program benefited emotionally from the support and bonding
among participants. It’s also smart to find stress-relieving techniques
that work for you: Whether it’s meditation, massage or something else,
be sure to carve out time to relax, since unbridled stress can lower
your pain threshold, making you more sensitive to arthritis-related
pain. “Then sleep is affected,” says Dr. Theodosakis, “and if you can’t
sleep well, there’s a snowball effect.” |
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