Osteoarthritis

The word arthritis is used to describe pain, swelling and stiffness in a joint or joints. Arthritis isn’t a single condition and there are several different types. You can read about the main types of arthritis here. This blog is just about osteoarthritis. We used to think of this as a problem just in a joint (often referred to as “wear and tear”) but now we know it is a mild, whole body inflammatory process, which can show up in any joint.

We frequently see patients with osteoarthritis in clinic and they are nearly always worried about their arthritis and pain getting worse. I can see why; who doesn’t know someone who has had a joint replacement? Well-meaning friends and family often tell you to “be careful” and to “take it easy” and, unconsciously, use language that plays into your fears. These beliefs are often deep-rooted and, as a clinician, it can be really hard to counter them.

The diagnosis of osteoarthritis can be done via a thorough case history. Often you will feel more stiff in the morning or after inactivity and you feel better once you are up and about. Scans or X-rays are often not very helpful; they usually show findings that are normal for age and they do not correlate well with pain levels. Someone else’s X-ray may look “worse” than yours, but they may have less pain and manage daily activities better. Scans do not determine what you are capable of.

We need to be kind to ourselves and each other when talking about weight. People with osteoarthritis are often told to lose weight, but with limited guidance on how to do so. Weight does matter, but perhaps not how you think. To cut a long story short, obesity increases the inflammatory processes in your body and this is what causes the problem, rather than increased load on the joints. In fact, cartilage loves loading and adapts in response to it – marathon runners have increased thickness of the cartilage in their knees, whereas astronauts have decreased thickness.

It’s helpful to understand how we perceive pain and there’s more on this in the podcast given below. Pain does not equal tissue damage (repeat that several times, out loud, it’s a tough one to get your head around). Our pain system is basically a danger detection system. It’s complex and it can be very sensitive. We know that people with arthritis have increased sensitivity in their pain system and this plays a significant role in the pain that they experience. The good news is that this can be changed.

The research shows that exercise/activity is the best treatment for arthritic pain. However, you will remain fearful of movement unless you understand that arthritis does not equal wear and tear; think of it more as wear and repair.

Activity has the following benefits, all of which promote repair (not tear!):
– it is anti-inflammatory
– it helps to reduce pain sensitivity
– it improves cartilage health and nutrition
– it improves mood
– it improves confidence
– it is something you can do for yourself

People with arthritis often find that low-impact activities, such as swimming, cycling, brisk walking and yoga, suit them. It’s important to find something you enjoy so that you keep doing it. Many people enjoy meeting up with friends or a group to keep them active.

You may feel some discomfort or pain when you exercise. This feeling is normal and should calm down soon after you finish. It is really important to know that, even if an activity causes some pain or discomfort, it can still be safe.

So where do we come in? We take the time to hear your story, examine you throughly and discuss your diagnosis with you. We can offer treatments for the symptomatic relief of your pain, as well as advice and reassurance to get you moving to help repair your joints and decrease inflammation.

Our role is to work with you to help you to manage and gradually increase your activity levels to find the “sweet spot” where you can load your joints to improve their health without provoking your pain system. We can also offer advice on simple dietary changes (blog to follow…) to help reduce inflammation and maintain a healthy weight.

Below I am sharing some of my favourite resources if you would like to delve deeper.