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Joint Action
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The arthritis-easing lifestyle
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By Stacey Colino
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REMEDY Fall 2009
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If you’re among the 46 million people in the United States who have been diagnosed with some form of arthritis, joint pain and stiffness are probably a fact of life for you. But that doesn’t mean you have to take these symptoms sitting—or lying—down.
“Most people with arthritis think there’s nothing they can do about it—and that’s a 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. “There’s a lot you can do to relieve pain and prevent arthritis from worsening.”
By far the most common type of arthritis is osteoarthritis (OA). Affecting nearly 27 million Americans, OA is a degenerative disease in which the cartilage that cushions the bones in a joint erodes.
Another form of arthritis, rheumatoid arthritis (RA), is an autoimmune disease in which the immune system causes the lining of the joints to become inflamed. It affects an estimated 1.3 million people in the U.S.
In both OA and RA, the impact of the disease is highly individual. Two people who have “the same level of disease severity can have completely different outcomes and quality-of-life measures depending on their lifestyles,” says Jason Theodosakis, M.D., M.P.H., assistant professor of family and community medicine at the University of Arizona College of Medicine in Tucson and author of The Arthritis Cure.
With both OA and RA, “when you put different lifestyle measures together, they can have a synergistic effect on decreasing inflammation and pain,” explains Vijay Vad, M.D., a sports medicine specialist and arthritis researcher at the Hospital for Special Surgery in New York City and author of Arthritis Rx. “Plus, you may decrease reliance on prescription painkillers and anti-inflammatory medication.”
Here are some ways you can improve your day-to-day comfort level.
• Eat well. Although no diet has been proved to affect the course of arthritis, a healthy, balanced diet that’s rich in vitamins C and D, both of 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.
Meanwhile, vitamin D inhibits the enzymes that break down cartilage, which may help slow arthritis progression.
• Consider appropriate supplements. There’s mixed evidence regarding the effectiveness of the supplements glucosamine and chondroitin for pain relief, but they appear to slow the degradation of cartilage, especially in cases of OA of the knee, explains Dr. Theodosakis. Symptom relief can take four to six months. Effective doses are at least 1,500 milligrams (mg) of glucosamine and 800mg of chondroitin daily, Dr. Theodosakis says. Supplements of a vegetable extract called avocado soybean unsaponifiables (ASU) can help reduce pain and inflammation and may slow progression of OA joint damage.
• Move more—more often. Aerobic exercise improves muscle strength, stamina, and overall conditioning and “can have an anti-inflammatory effect because endorphins are released,” Dr. Vad explains. Aim for 20 to 30 minutes per day of walking, biking, swimming or other low-impact activities. Exercises that preserve balance and range of motion, such as yoga and tai chi, can also help prevent joint injury and relieve symptoms.
• Manage your weight. If you’re overweight, losing even 10 pounds could cut arthritis-related knee or hip pain substantially.
• Make sleep a priority. “If you get quality sleep, you’ll have improved energy and less pain,” says Scott Zashin, M.D., clinical associate professor of rheumatology at the University of Texas Southwestern Medical School in Dallas and author of Arthritis Without Pain.
• Try other remedies. “Applying heat or cold can alter the sensation of pain. Heat dilates blood vessels, increasing blood flow to the area, which helps with symptom relief,” Dr. Zashin explains. “Cold constricts blood vessels and may decrease swelling.” Acupuncture has been found to be particularly helpful for OA of the knee.
• Raise your spirits. Even if you’re in pain, try to stay socially and emotionally connected to friends, family and your community. Also, use stress-relieving techniques such as meditation and massage.
• Mind your meds. For OA, nonsteroidal drugs such as ibuprofen and naproxen can help ease pain and inflammation, but they can cause stomach ulcers and other problems. The COX-2 inhibitors may reduce pain and inflammation, but they’ve been linked with an increased risk of cardiovascular problems with continuous use. For severe pain, narcotics may be an option, but they carry their own risks.
That’s why the current protocol calls for using the lowest effective dose of a pain reliever for the shortest amount of time possible. “Use medications when you need them for short spurts, then stick with the dietary measures, exercise, weight loss and supplements for the long term,” Dr. Vad advises.
You’ve probably heard that C-reactive protein levels may be important
for heart health. Well, the same is true for joint health. CRP, as it’s
commonly known, is a marker of systemic inflammation, and it turns out
that in RA, it correlates with inflammation and may forecast the
severity of the disease over time. One study found that CRP levels can
help predict if a joint replacement will be needed in the next year. If
you have RA, make sure your physician periodically checks your CRP
levels.
That’s because “for every pound you lose, there’s four pounds less pressure on the weight-bearing joints,” explains Dr. Vad. |
Major progress has been made in treating rheumatoid arthritis (RA),
thanks to disease-modifying antirheumatic drugs (such as methotrexate
and hydroxychloroquine), and biologic agents (such as tumor necrosis
factor [TNF] blockers).
Indeed, researchers from Norway recently concluded that the health
status of people with RA improved consistently between 1994 and 2004
largely because they were taking advantage of the newer, more
aggressive treatments.
If you have been recently diagnosed, these meds are particularly
effective. “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.”
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