April 5, 2021

Living with Osteoarthritis: Management and Lifestyle Recommendations

Written by: Iris Tabangcora, M.D.
Reviewed by: Mubashar Rehman, PHD

Joint failure, as such when all joint structures undergo damage (e.g. cartilage loss, joint-bridging muscle weakness, sclerosis of bony plates), is the biggest thief of independence.

Joint injury in the setting of failure of protective mechanisms has robbed off people of their ability to perform daily activities and lead satisfying, productive lives. Osteoarthritis is the most common type of joint failure and is the leading cause of disability worldwide.

By 2040, an estimated 78 million (26%) adults aged 18 and above in the United States are projected to be diagnosed with arthritis. Its rise is unstoppable considering the aging population and the increasing prevalence of obesity, one of its major risk factor. Analyzing the projections, more and more people will be living with osteoarthritis, which makes it an important health challenge.

Seeing as it is inevitable, several concerns are raised: how do we manage osteoarthritis? How can people get by living with osteoarthritis? Are there special diets and prescribed physical activities for people living with osteoarthritis? This article aims to answer all of these questions.

 

Background 

Osteoarthritis is the most common type of arthritis. It is characterized by cartilage loss, reduced lubrication in joint spaces, and generalized weakness of the joints. This makes the joint vulnerable to even slight weight of loading. Understandably, it often affects the large, weight-bearing joints of the body like the hip, knee, and spine. Usually spared are the wrist, elbow, and ankle. 

Diagnosis is usually made through clinical and radiographic evaluation. Osteoarthritis frequently presents with pain, stiffness, and limitation in mobility. Sometimes, swelling around the joint can be observed. Careful examination must be done to determine which type of arthritis it is, as the other types require different treatment. In x-rays, loss of joint spaces and osteophytes (bone spurs or projections forming along the joint caused by accumulation of trauma) indicate osteoarthritis. 

 

Management of Osteoarthritis

Aiming to alleviate pain and to minimize loss of physical function, osteoarthritis management takes a multimodal approach consisting of nonpharmacologic, pharmacologic, and surgical approaches. 

Nonpharmacologic approaches include avoidance of activities that precipitate pain, application of splints, and use of mobility aids like canes, crutches, and walkers. As for osteoarthritis exercise, the ones recommended include aerobic and/or resistance training and low-impact exercises.

Patients living with osteoarthritis should receive an individualized exercise program. On the other hand, pharmacologic therapy includes non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, opiates, and intraarticular injections of steroids. Lastly, the surgical approach depends on the structural problem identified. 

 

Lifestyle Recommendation for People Living with Osteoarthritis

 

Osteoarthritis and Diet

The most important thing to remember here is that maintaining a healthy weight unloads the joints and reduces pain. Studies show that reduction of 10% of weight provides significant relief from symptoms. Osteoarthritis is also linked to development of cardiovascular problems and diabetes so maintaining normal weight through balanced diet reduces these risks too. 

A twice-a-week intake of long-chain omega-3-polyunsaturated fats found in oily fishes like salmon, sardines, and mackerel provide anti-inflammatory effects to the joints. Monounsaturated fats found in olive oil and rapeseed oil may be used as substitutes for cooking as the other ones are considered pro-inflammatory. Collective dietary measures to reduce cholesterol should also be instituted. These measures include intake of soluble fibers, oats, nuts, and soy protein. A daily vitamin D supplement, with the guidance of a doctor, may also be helpful for bone and cartilage health. Lastly, consuming rich dietary sources of antioxidants like Vitamins A, C, E, and K is also recommended. 

 

Osteoarthritis and Exercise

Centers for Disease Control and Prevention (CDC) recommends this guideline for exercising safely with people living with osteoarthritis. It is abbreviated as SMART: 

  • Start low, go slow.
  • Modify activity when arthritis symptoms increase, try to stay active.
  • Activities should be “joint friendly.”
  • Recognize safe places and ways to be active.
  • Talk to a health professional or certified exercise specialist.

Furthermore, they added that for the type of activities that should be done, “low-impact aerobic activities do not put stress on the joints and include brisk walking, cycling, swimming, water aerobics, light gardening, group exercise classes, and dancing.” It is recommended to do 150 minutes of moderate-intensity activities or 75 minutes of vigorous-intensity activities a week. 

In addition to low-impact aerobic activities, other recommended osteoarthritis exercises include muscle-strengthening exercises (e.g. yoga, use of resistance bands, and lifting), flexibility exercises (e.g. stretching, yoga), and balance exercises (e.g. tai chi, walking backwards, standing on one foot). According to CDC, if one is at risk of falling, doing balance exercises three times a week can significantly help. 

 

Osteoarthritis and Alcohol 

In general, alcohol proves to have anti-inflammatory properties. It has been shown to reduce the biomarkers of inflammation. However, if the person is already diagnosed with osteoarthritis, alcohol intake may be harmful. Alcohol interacts with pain medications given to people living with osteoarthritis and poses them to greater risk for bleeding stomach ulcers and liver damage. Alcohol can even trigger a gout attack which is another type of arthritis. 

               

Conclusion

Osteoarthritis is a common chronic health condition that limits the mobility of people of any age, compromising millions of people worldwide with their jobs, social interactions, and leisure. It also increases the risk of other medical conditions like cardiovascular problems and diabetes. 

Managing osteoarthritis involves a multimodal approach aimed at providing symptomatic relief and prevention of loss of function. Physical aids and therapy, pain and anti-inflammatory medications, and surgery are several treatment options to consider, depending on the severity of osteoarthritis. 

Aside from the standard treatment approach, existing dietary and exercise guidelines are made to promote wellness among people living with osteoarthritis. The key is to maintain a healthy weight by reducing cholesterol intake and taking in more soluble fiber. As for exercise, low-intensity aerobic exercises are recommended. Lastly, moderate intake of alcohol is beneficial unless already diagnosed with osteoarthritis and actively taking in medications. 

References:

  1. https://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm
  2. https://www.bda.uk.com/resource/osteoarthritis-diet.html
  3. https://www.cdc.gov/arthritis/basics/physical-activity-overview.html
  4. https://www.arthritis.org/health-wellness/healthy-living/nutrition/foods-to-limit/alcohol
  5. Jameson, L., Fauci, A. et. al. 2018. Harrison’s Principles of Internal Medicine 20th Mc-Graw Hill Education.
Article written by Iris Tabangcora, M.D.
Iris is a Philippine-based physician currently training in Emergency Medicine. She has been writing for various health websites for the last 10 years. Also a Nursing degree holder, she has spent her energy in educating nursing students on Research and Pharmacology. Her interests lie in medical education, research, and public health.

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