Osteoarthritis

Summary
Many people with arthritis report that their pain is better if they have a diet that has more vegetables than protein, and some report that certain fruits can exacerbate their problem. Everyone is different and the evidence for the effects of diet on arthritis is mixed. It may however be worth trying different regimes for 3-4 weeks at a time to see if any help.

It is always important to have a healthy diet. This means a diet that includes enough vitamins and minerals, and plenty of fruit, vegetables and whole grains. The NHS Eatwell Guide shows that to have a healthy, balanced diet, people should try to:

• eat at least 5 portions of a variety of fruit and vegetables every day (see 5 A Day)
• base meals on higher fibre starchy foods like potatoes, bread, rice or pasta
• have some dairy or dairy alternatives (such as soya drinks)
• eat some beans, pulses, fish, eggs, meat and other protein
• choose unsaturated oils and spreads, and eat them in small amounts
• drink plenty of fluids (at least 6 to 8 glasses a day)

If you’re having foods and drinks that are high in fat, salt and sugar, have these less often and in small amounts.

Try to choose a variety of different foods from the 5 main food groups to get a wide range of nutrients.

Losing weight definitely helps overweight people with osteoarthritis. And most of us are overweight even if only slightly. Load-bearing joints in your hips, knees and feet are under particular strain if you are overweight. When joints are very worn, their ability to repair themselves is already reduced, and being overweight also puts extra pressure on them.

If you are overweight, you can slim down by doing more physical activity (though not that which will aggravate your joints) and cutting down on fats, sugar and carbs. This won’t lead to very quick weight loss but it will eventually pay off in the health of your joints and a huge improvement in your overall well-being. If your joint pains are bad and you are very overweight, ask your GP or physiotherapist to plan a suitable exercise programme with you. Your GP and practice nurse can also give you a diet plan to help you lose weight slowly and safely

Summary
Cutting down on alcohol and stopping smoking are likely to improve your health generally. Although the direct link with arthritis has not been identified the deterioration in the joints is likely to be reduced by these sorts of positive health measures.

Moderate drinking means no more than two drinks a day for men and one drink a day for women. A unit of alcohol is half a pint of ordinary strength beer, lager or cider or a small pub measure (25 ml) of spirits or a standard pub measure (50 ml) of fortified wine such as sherry or port (20% alcohol by volume). A small (125ml) glass of basic wine is 1 and a 1/2 units.

Evidence
Research suggests that alcohol and smoking are not directly linked to joint pain.

Safety
There are unlikely to be side-effects if you are cutting down from a moderate alcohol intake. If you are cutting down from heavy drinking you may experience side-effects, including loss of appetite and difficulty sleeping. If you are a very heavy drinker, it is a good idea to see your GP and ask for some help while you’re cutting down.

Cost
There are no costs. In fact you will save money.

Further information
For more information, see the NHS information alcohol support.

If you are giving up or cutting down on smoking you can order a Quit Kit from SmokefreeNHS. You can also phone the NHS Free Smoking Helpline on 0800 022 4332

Summary
Joint pain can make you avoid being active because you feel stiff and sore. You might worry that exercising could be harmful or painful. But don’t be put off. Keeping active builds up muscle, and this will gradually protect your joints and reduce pain.

Exercise will also relieve stress, make you more mobile, burn off fat and tone up your posture. A physiotherapist will give you an exercise plan to follow at home and/or in a group. Once you start to exercise, you will gradually get stronger and fitter. You will then begin to feel better and cope better with daily activities. So, whatever your age or fitness level, getting active is the most important thing you can do. Your plan should include exercises to make your muscles stronger as well as exercises that improve your general fitness.

You don’t have to use the gym to exercise. Even 30 minutes brisk walking, or other less weightbearing alternatives, every day is enough to make a noticeable difference to your mood and fitness level.

An ideal form of exercise for arthritis is in water, and technically known as hydrotherapy or aquatic exercise. Here you can move muscles and joints against the resistance of water without the problems of weightbearing. Supervised sessions are very useful in learning techniques that suit your needs but then you can carry on in any swimming pool.

Evidence
Research suggests that exercise is likely to help with joint pain and movement.

Safety
Supervised exercise programme are safe for most people. But at first you might feel more tired. If you are not used to being active, start off slowly and build up gradually, doing a bit more every other day. If you feel worse, cut back, and increase your activity more slowly. If you think it isn’t helping or that you are getting worse in any way, check with your doctor. Anyone with severe osteoporosis, acute back pain or recent injuries should first get advice about exercise from a doctor or physiotherapist.

Cost
You can exercise at home for nothing, although it is best get advice on the best exercises to do from a professional first. There will probably be a small cost (usually £5-£8 a class), if you join an organised programme. Exercising in a pool may entail additional costs.

Further information
If walking is possible on the affected joints, Natural England is one of several organisations that organise walking schemes designed to help people improve their health. Walk4Life Programme has about 600 local groups, and around 40,000 people take part in short local walks every week. Find out about Green Gyms where volunteers take on voluntary projects outdoors. Many local councils organise Health Walks for people who want to get active in company.

Check your local leisure centre for exercise classes or access to swimming pools. See also the Go See Someone section for more information.

Summary
Applying heat to a sore joint increases blood flow and so reduces stiffness and pain. Do not apply heat if the joint is already warm, swollen tender and inflamed. Cold helps decrease inflammation and pain by reducing the blood flow. Damp cold (using a wet towel between the skin and the ice pack) gets in deeper and faster than dry cold.

You might need to try both hot and cold to work out which is better for you. Switch between a bag of frozen peas, and a hot-water bottle. Always wrap the pack (whether hot or cold) in a thin towel or cloth so it doesn’t burn or freeze your skin.

Usually, applying heat or cold for about 20 minutes will allow your muscles to relax so that you feel less stiff. Then you might be able to try some slow stretches and get the blood flow back into tense muscles. You may find it more effective to alternate between hot and cold packs every few minutes.

Evidence
In research studies, cold packs seemed to help with swelling but hot packs did not seem to be so useful. Larger studies are needed to be certain of this.

Safety
There are no safety problems as long as you take care to wrap the hot or cold pack to avoid burning or freezing your skin.

Cost
You can buy special heat packs or use something you already have, like a hot water bottle. Other possible heat sources include: soft heated packs filled with grain, poultices, hot towels, hot baths, saunas, steam, heat wraps, heat pads, electric heat pads and infra-red heat lamps.

Summary
Stress increases your sensitivity to pain, including to arthritis. Relaxation training can make you more aware of how your body reacts to situations that make you feel pain more. Useful relaxation methods include slow breathing and muscle relaxation, self-hypnosis and imagery techniques. Each of these methods can be used on its own, or in combination with one or more of the others

Evidence
Muscular relaxation, imagery and meditation can help people cope with pain. More research is needed to be certain of how much these techniques can help with osteoarthritis.

Safety
Relaxation techniques are generally safe unless you have a severe or long-standing mental health problem.

Cost
Relaxation techniques can be learned from a book, CD, DVD or during exercise classes such as yoga classes. No costs are involved, although you may need to buy a CD, DVD or book.