Osteoarthritis – Will You Live With It?
“It is probably arthritis – you’ll just have to live with it”. We’ll probably all be told this at some point and it doesn’t matter how old you are, but is it true?
It is true that most of us will get the wear-and-tear type of arthritis, called osteoarthritis (OA, also known as degenerative arthritis, degenerative joint disease). OA is damage to the joints including cartilage and the bone next to it. Often it causes no pain at all but you merely notice a bit of stiffness, especially in the mornings or after a period of inactivity.
Often people are told that they have arthritis when in fact they have simple joint dysfunction and no wear and tear at all. Even if OA is present there is a lot you do to help the symptoms, prevent it getting worse or even prevent it coming on at all. Here we will show you how.
- Osteoarthritis Symptoms
- Diagnosis of Osteoarthritis
- Hip Arthritis Test
- Natural, Drug-Free Arthritis Treatment
- Diet and Supplements to Help Arthritis
- Anti-Arthritis Diet
We often get asked for advice about treating or preventing arthritis and we thought we would put together some of the best information to help you choose the best approach for you.
Symptoms of OA may include joint pain, tenderness, stiffness, creaking, locking of the joints, and sometimes local inflammation. These problems tend to improve with gentle activity. The causes—genetic, body chemistry and joint damage—may initiate loss of cartilage – a strong protein matrix that lubricates and cushions the joints. As the body struggles to contain ongoing damage, immune and re-growth processes can accelerate damage. When bone surfaces become less well protected by cartilage, the bone may be exposed and damaged, with re-growth leading to a proliferation of ivory-like, dense bone in areas of cartilage loss. Extra bone also grows around the edges of the joint so the joint gets bigger and more knobbly. This is often seen in the hands.
Muscle Weakness Can Cause Hip Arthritis
The causes of hip arthritis are many and varied but in our experience weakness of the buttock muscle (Gluteus Maximus) is common. This can occur because of low back, pelvic and even hip problems themselves. If the supporting muscles of the hip are weak or imbalanced then further osteo-arthritis can occur. Weakness of this muscle may contribute to the arthritis in the first place.
Did you know…
People with OA can often tell when it’s going to rain! The drop in atmospheric pressure causes slight swelling of our joints but only people with slightly sore joints already tend to feel it as uncomfortable.
The commonest joints to be affected by osteo arthritis are the weight-bearing joints, like the hips, knees spine and feet, and those that we use a lot like the hands and fingers. You may increasingly experience pain upon walking and standing. Due to decreased movement because of the pain, regional muscles may atrophy, and ligaments may become more lax. Some researchers think that muscle weakness may bring on the wear rather than be caused by it. OA is the most common form of arthritis and the leading cause of chronic disability and affects over 8 million people in the UK.
Osteoarthritis is derived from the Greek word “osteo”, meaning “of the bone”, “arthro”, meaning “joint”, and “itis”, meaning inflammation. Osteoarthritis is not to be confused with rheumatoid arthritis, an autoimmune disease with joint inflammation as a main feature. A common misconception is that OA is due solely to wear and tear, since OA typically is not present in younger people. However, it may just be that OA is a process that takes time to develop.
Arthritis is not inevitable though. There are many people in their nineties who do not have OA at all. They tend to have certain things in common. They often have remained active their whole lives, have not had any joint injuries, eg whiplash or broken bones. They have had a relatively stress free lifestyle and good nutrition.
There is no laboratory or pathological definition of osteoarthritis, and therefore no accepted laboratory tests to diagnose it. Diagnosis can often be made with reasonable certainty by a careful history and clinical examination. Imaging can show loss of cartilage, subchondral (“below cartilage”) sclerosis, bone cysts, narrowing of the joint space between the articulating bones and bone spur formation (osteophytes) which show up clearly on x-rays. X-rays, however, often do not correlate well with the symptoms and findings on examination of the affected joints. Usually other imaging techniques such as MRI are not necessary to clinically diagnose osteoarthritis.
One of the common tests for hip arthritis is called the Fabere test and you can do this yourself to test your own hips.
- Lie on your back
- Put the sole of your foot against the inside of the opposite knee
- Let your bent knee drop to the floor
The movement of your hips should be the same and not cause pain anywhere. If it does, come in and let us check it out.
Although there is no cure for OA the symptoms can benefit from several treatments. Because of the ongoing nature of the disease, treatment may need to be ongoing to offer lasting benefit.
NICE has several recommendations for treatment which include exercise, weight loss, paracetamol, anti-inflammatory creams and shock absorbing insoles. Recent advice from the looking at other studies show the use of stronger opioid pain-killers is not recommended because of the side effects.
Dr John Dickson, a former GP and community specialist in rheumatology, was clinical adviser to NICE for its osteoarthritis guidelines. He said: ‘There are few trials to show opioids are any good in osteoarthritis and I don’t use them much. But people tell us not to use NSAIDs and for GPs there is very little to offer these patients.’
Our approach uses the best evidence from some of the more recent studies too.
Chiropractors find joint dysfunction and damage through examination and muscle testing. Restoring or improving joint function can make a big difference to the pain and stiffness. We use joint adjustments, mobilisation and exercises to alleviate the symptoms of osteoarthritis, strengthening weak muscles and improving flexibility. We can advise on the whether insoles will be helpful and which ones would be best.
Moderate exercise has been shown to help OA. It leads to an increase in function and a decrease in the pain. Adequate joint motion and elasticity of joint tissues are necessary for cartilage nutrition and health, protection of joint structures from damaging impact loads, function, and comfort in daily activities. Exercise to regain or maintain motion and flexibility by low-intensity, controlled movements that do not cause increased pain are helpful. Muscle weakness around an osteoarthritic joint is a common finding. Progressive resistive/strengthening exercises load muscles in a graduated manner to allow for strengthening while limiting tissue injury.
Several studies have been conducted into the use of acupuncture to help with OA and the results are encouraging. More work needs to be done but many doctors are recognising that acupuncture is a useful additional tool in helping the pain and stiffness. We love it because it is safe and, in our experience too, can be very helpful in some. Liz, our acupuncturist is great too.
We use laser therapy to increase the speed, quality and strength of tissue repair, resolve inflammation and give pain relief. It can be effective in treating chronic and acute pain, inflammation and the joint damage of osteoarthritis.
Low level laser therapy, also known as cold laser therapy, is the application of red and near infra-red light over tissue injuries to improve soft tissue healing. Laser therapy is extremely safe with no known contraindications. A special inhibitory feature enables the therapist to reduce ongoing pain, allowing for beneficial manual treatment.
Low Level Laser Therapy sessions last 15 minutes, usually 6-8 sessions are required. Sessions are free with a physiotherapy appointment.
A recent trial comparing laser therapy with a placebo showed a significant improvement in pain, movement and swelling in knee osteoarthritis.
From the standpoint of arthritis the role of dietary fats cannot be avoided as some of these are converted in the body to inflammatory prostaglandins – substances which increase pain and inflammation.
Processed fats which have been ‘hydrogenated’ cause the formation of free radicals which can be damaging to joints. Therefore any foods containing hydrogenated fats should be avoided. However, many convenience foods contain hydrogenated fats, so make sure you read the labels and always try to eat fresh, organic produce.
Some fats in the diet are anti-inflammatory and may help to alleviate the pain in some arthritis sufferers. These are the essential fatty acids which are the Omega-6 and Omega-3 fats. They are found in unsaturated vegetable oils and oily fish such as herring, salmon and sardines. However, many people would benefit from taking supplements of borage, blackcurrant seed oil or stable fish oil.
Various studies have been carried out looking into the effectiveness of essential fatty acids in helping improve arthritic joints. The results of which have been very promising. Other useful nutrients for helping with arthritic joints are antioxidant nutrients, vitamins A,C,E, selenium and zinc. These help to fight free radicals.
Antioxidants ‘Mop up’
Free radicals are very unstable molecules that react with other unstable molecules in the body and cause problems such as joint and cardiovascular damage. The antioxidant nutrients help to ‘mop up’ free radicals. Vitamin C is also a very important constituent of collagen which helps to build and maintain cartilage.
Glucosamine Sulphate is another supplement which many people with osteoarthritis find helpful. It is involved in joint maintenance and synovial fluid production. Glucosamine Sulphate has been compared to non-steroidal, anti-inflammatory drugs in various studies. Glucosamine Sulphate was shown to be as effective as the drugs in treating the pain and improving mobility of the joints. As well as improving joint mobility and relieving pain, Glucosamine Sulphate does not cause the side effects that many anti-arthritic drugs cause. Other forms of Glucosamine have not been as extensively studied and so cannot be recommended.
Minerals and Herbs – Bone minerals and herbs are also essential to prevent bone loss and to maintain bone density. Calcium, magnesium and boron are three important bone minerals which may be taken as nutritional supplements to enhance the dietary intake. Herbal preparations such as shave grass containing silica which is important for bone development and yucca, which has anti-inflammatory effects, may help.
Organic Sulphur – MSM (Methyl Sulphonyl Methane) is another preparation that is gaining a very good reputation in helping relieve joint pain and stiffness. It is a form of sulphur that is very well absorbed. Sulphur plays an essential role in the health of bones and joints, where it functions in the formation of cartilage, tendons and ligaments.
Reducing Inflammation through the Anti-Inflammatory Arthritis Diet
Inflammation is now considered to be at the core of many chronic disease states, not just joint pain and dysfunction. The standard diet has changed significantly over the past 100 years, including:-
- Increased consumption of animal products
- Increased consumption of processed foods
- High consumption of trans-fatty acids
- High ratio of omega-6 fatty acids
- Refined carbohydrates with a high glycemic index
All of these factors stimulate inflammation and result in increased levels of arachidonic acid. Changes in omega-3 and omega-6 ratios have resulted in a shift out of balance to a pro-inflammatory physiological state.
The goal of an anti-inflammatory diet is to decrease pro-inflammatory substances that cause an increase in free radicals and allergic stressors. The primary offender is foods high in arachidonic acid, a direct precursor to pro-inflammatory molecules [prostaglandin E2]. The anti-inflammatory diet is high in natural anti-inflammatories and antioxidants, including the phyto-anti-inflammatories: carotenoids, flavonoids, and isoflavones.
Good Fats/Bad Fats
The anti-inflammatory diet has the proper ratio of omega-6/omega-3 essential fatty acids that we must get from the diet. Essential fatty acids are in all cells, especially the nervous system and vascular cells.
There are three primary types of fat:
1) Saturated fats – These include most of the fats from animal products.
2) Mono-unsaturated fats – These are omega-9 fats. They include olive oil and canola oil.
3) Poly-unsaturated fats:
a) Omega-6 fatty acids – Linoleic Acid (LA) [corn, safflower, cottonseed, sunflower, soybean oils] Gamma Linolenic Acid (GLA) Arachidonic Acid (AA)
b) Omega-3 fatty acids – Alpha Linolenic Acid (ALA) [primarily flax seed oil] Eicosapentaenoic Acid (EPA) Docosahexaenoic Acid (DHA)
A healthy ratio of omega-6 to omega-3 is about 4/1. The ratio in the standard diet is about 25/1.
Trans-fatty acids are omega-6 fats that have been hydrogenated, producing a more stable and solid product like margarine. The metabolism of trans-fatty acids releases significantly higher amounts of free radicals.
Trans-fatty acids are known to:
- Raise cholesterol
- Raise LDL cholesterol
- Lower HDL cholesterol
- Have adverse effects on cell membranes
- Have adverse effects on the immune system
A poor diet not only causes inflammation directly but obesity itself promotes inflammation. The anti-inflammatory diet recommendations include:
1) Whole foods are generally better than supplements.
2) The primary focus is eating whole grains, fruits, and vegetables.
3) Protein is primarily from eating beans, lentils, fish and poultry.
4) Minimise red meat.
5) The principle dietary fat is olive oil.
6) Eat no more than 4 eggs per week (egg whites are okay because they do not contain arachidonic acid).
7) For desert use fresh fruit.
8) Do not eat trans-fatty acids.
9) Decrease consumption of omega-6 fats, including margarine, corn oil, shortenings, etc.
10) Inflammation can be caused by immunoglobulins that are produced from food sensitivities. Common food triggers to immunoglobulin inflammation include wheat, gluten, dairy, refined sugars, corn, soy, shellfish, nuts, seeds, yeast, and caffeine.
11) Oxidative stress [the damage caused by free radicals] causes inflammation, which is nullified by anti-oxidants. Consume foods or supplement with vitamin C, vitamin E, carotenoids, zinc, copper, selenium, and polyphenols.
POLYPHENOLS are found in teas, fruits, dark chocolate, vegetables, and legumes.
ISOFLAVONES are found in soy, including tempeh, tofu, and miso.
CAROTENOIDS (carotene, lycopene, leutin) are found in orange fruits and vegetables (tomatoes, spinach, kale).
FLAVONOIDS (quercetin and anthocyanidins) are found in green tea, dark berries, citrus fruits, tomatoes and greens.
12) Increase omega-3 fatty acid consumption for fish and flax oils. Caution must be used to limit exposure to mercury by choosing a good quality supplement like EPA/DHA from Pure Bio. Recommended dosages for the omega-3 fatty acids are 1000 – 2000 mg daily.
13) Supplementation of omega-3 fatty acids greater then 1000 – 2000 mg per day must be coupled with appropriate supplementation of anti-oxidants. Omega-3 supplementation reduces prostate cancer, decreases sudden cardiac death, decreases overall cardiac events, and decreases overall mortality.
14) Probiotics neutralise harmful pro-inflammatory gastrointestinal flora. Supplementation should include a daily dose of 3 billion live active freeze-dried or living bacteria.
15) Increase fibre from whole grains, fruits, vegetables, legumes, and soy.
Foods to Avoid
The following foods should be avoided in the anti-inflammatory diet.
1) Foods high in arachidonic acid: red meats, pork, saturated animal fats, egg yolks.
2) Any more than one alcoholic drink per day stimulated inflammation.
3) More than one cup of caffeinated beverage (coffee, tea, cocoa, and cola drinks) increases several inflammatory markers.
4) Sunflower, safflower, cottonseed, and corn oils should be avoided, especially in processed foods.
5) No Trans-Fats or hydrogenated oils, which are found in processed foods with a long shelf life, such as snack foods, cookies and chips.
6) No high fructose corn syrup, found in many processed foods, including salad dressings, ketchup, and sugary drinks. They are very pro-inflammatory.
7) Some people should not eat nightshade foods (coloured peppers, tomatoes, potatoes and aubergine) because they are antigenic pro-inflammatory, and inhibit normal collagen repair or increase joint degeneration.
It takes 8 weeks to 6 months for these dietary changes to produce great results, but good results are often observed after 4 weeks. Usually you can begin a slow reduction of pain drugs while on this diet, including NSAIDs, COX-2s, muscle relaxants, steroids, and even opioids. Of course, do this in consultation with your GP.
The anti-inflammatory diet also provides additional health benefits such as a potentially lowered risk of cancer, cardiovascular disease and other chronic diseases such as atherosclerosis and diabetes.
We hope this has been useful. If you want more advice then give us a call or book online.
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St James’s Street, 01273 696414
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