Healthy Approaches to Managing Arthritis
Physical activity and diet are two important lifestyle factors over which you have control. This section explains how both improved nutrition and regular exercise can help you manage your arthritis while also improving your health and fitness.
Focusing on Nutrition
Maintaining an appropriate body weight decreases the risk of developing arthritis; it also helps lessen the pain if you already have arthritis. Experts speculate that decreased weight results in less force to the joint. If you are overweight, you can use exercise and proper nutrition to control your weight. A loss of as little as 10 pounds (4.5 kg) has been shown to decrease the pain associated with arthritis. Because obesity is a risk factor for arthritis, you may want to consult chapter 18, which focuses on weight management. Some nutritional supplements may be helpful and are discussed in “Influence of Supplements” later.
Focusing on Physical Activity
In general, the benefits of exercise are similar across all types of arthritis. A proper exercise program can diminish the associated pain and disability. Some studies have shown an immediate decrease in joint pain after gentle exercise, whereas participation in a regular exercise program results in more significant reductions in pain (10, 28). In addition to reducing the pain associated with arthritis, you may also be able to reduce the amount of medication you take to control pain. As noted in the section on medications, many medications have some associated risks, so reductions in dosage are considered a very positive benefit.
Decreased muscle strength and joint motion often result in functional limitations and disability. Regular exercise improves strength and joint motion, thus improving function. Additionally, some studies have shown that even low-intensity exercise slows the progression of functional loss, although more intense exercise confers, even more, benefits. A common myth is that those with arthritis should participate only in low-intensity activities. In reality, more intense exercise does not speed the joint degeneration or worsen symptoms as long as you have progressed your program gradually and are protecting your joints appropriately.
If you have one of the systemic forms of arthritis, such as RA, you have a higher risk of heart disease and other systemic complications. Participating in a regular exercise program will help decrease these risks as well.
Precautions for Arthritic Conditions Before Exercise
To maintain a safe and effective training program, you may have to make some modifications. One problem you may have is flare-ups—periods in which the joint swells more than it does normally and the pain are worse. These are more common with the systemic forms of arthritis. During a flare-up, you may need to alter your program, reducing the intensity or temporarily eliminating a specific activity if it makes your symptoms worse. Balancing activity and rest are important, especially with systemic arthritis, because of the involvement of the immune system. However, it is not good to stop all activity.
Another concern with arthritis is joint instability and laxity. As the joint becomes more degraded and the joint space narrows, the tissues that normally stabilize the joint become slack. When this happens, they are no longer able to properly control the joint movement. In addition, the joint often becomes slightly deformed and out of alignment. Instability is the sensation of the joint “giving way” when you are active and is not necessarily related to laxity, though it is related to a decrease in function.
You may need a brace to provide stability and alignment if you are engaging in activities that stress a joint prone to laxity or joint instability. If joint alignment is the primary problem, especially for the lower extremity, you may benefit from an orthotic, which is an insert placed in a shoe to correct the alignment of the foot. Correction of foot position has been shown to decrease knee pain.
If you are having any of these issues, consider consulting with a health professional with expertise in orthopedics or sports medicine. In particular, a professional evaluation is a good idea if you are experiencing your knee giving way with pain, clicking, or catching. Shoulders also are joint at risk for being unstable.
If you have arthritis in the lower extremity, proper shoes are a must. Your shoes should provide support as well as a cushion. Good shoes can help with minor alignment problems, whereas worn shoes can turn minor problems into major discomfort.
What type of shoes are recommended?
The right shoes can have a major impact on your enjoyment of exercise. A good shoe does not have to be the most expensive. These are some qualities to look for in a shoe:
- A sole that provides shock absorption and cushioning.
- Good arch support.
- A roomy toe box that accommodates toe deformities.
- A snug fit along the width of the shoe, especially in the heel counter. When purchasing, walk or jog around the store in the shoes—the heels should not slip.
- Secure closure. Lace-up is preferable, but Velcro may be necessary if you have trouble managing laces because of arthritis in your hands.
- A design appropriate for the activity.
Also, if you have orthotics, be sure to bring them along when you shop for shoes so you can try them in the shoes before making your purchase.
Influence of Medications
Acetaminophen is recommended for people with mild to moderate pain due to arthritis. The most common, though still rare, side effects are upper gastrointestinal (GI) bleeding and liver damage. Nonsteroidal anti-inflammatories (NSAIDs) are the next type of medication taken to help control the pain of arthritis. The strength ranges from medications that are available over the counter (aspirin and ibuprofen) to stronger forms that require a prescription and have different modes of action within the body. As with acetaminophen, GI bleeding is a possible side effect. Naproxen sodium also has the potential of raising blood pressure and lower extremity swelling. Some of the prescription anti-inflammatories have a decreased risk of GI bleeding but may have some cardiovascular-related risks.
If you have a systemic form of arthritis, you are likely to be on a disease-modifying antirheumatic drug (DMARD), glucocorticoid (steroid), or biologic drug). Possible side effects include liver and kidney damage and, with the steroids, a risk for infections. On the positive side, these drugs are the most effective for pain relief and for slowing the associated joint deterioration. Because these drugs affect the immune system, you may need to slightly decrease the intensity of your program. A summary of the benefits and possible side effects of common arthritis medications is presented in table
Influence of Supplements
A few nutritional supplements have been shown to decrease the pain associated with arthritis. A positive aspect of these supplements is that they do not have the health risks associated with some of the medications. For this reason, they could be worth trying. When considering the use of various supplements, it is recommended that you check with your health care provider regarding your particular situation. This section discusses glucosamine and chondroitin, fish oil, flaxseed, and antioxidants. Although other supplements have been identified in the popular literature, the research is still lacking on many. See Potentially Risky Supplements to Watch Out For to read about supplements that you may want to avoid.
Potentially Risky Supplements to Watch Out For
Dietary supplements are not tested as rigorously as medicines are and thus may have harmful effects. They are not necessarily labeled properly, and they may interact with medications you take. Some have been linked to heart irregularities, increases in blood pressure, seizures, and even death. Steer clear of the following risky substances:
- Ephedrine or ephedra (used in weight loss or energy supplements)
- Kava (purported to produce relaxation and reduce sleeplessness)
- Prohormones or herbal anabolic supplements, such as androstenedione or yohimbine
Even vitamins and minerals can be toxic if taken in excessive quantities. Consider the following:
- Vitamins B6 and B12 can cause liver damage.
- Vitamin C can cause stomach upset and interfere with copper and iron status.
Check with a knowledgeable person who is qualified to give you information about a supplement before you try it, such as a physician, pharmacist, or Registered Dietitian.
One of the most common nutritional supplement therapies is a combination of glucosamine and chondroitin. These compounds are normally found in body tissues, and it is thought that increased levels might protect and even improve the joint cartilage. Although the advertised promises are overwhelmingly positive, the research findings are varied. Some studies have shown decreased pain for those with OA, whereas others have not shown any benefit. Some of the studies reporting positive effects used supplements in addition to glucosamine and chondroitin, such as manganese ascorbate (a compound formed from ascorbic acid, or vitamin C, and the mineral magnesium). Typical daily dosage recommendations are 1,500 milligrams for glucosamine and 1,200 milligrams for chondroitin. Benefits are typically seen within a few weeks and may be related to the severity of arthritis and your body’s ability to respond to the supplement.
Fish oil, which contains omega-3 fatty acids, has been shown to reduce the pain associated with arthritis. In several studies, people were able to reduce the number of NSAIDs or other medications they were taking when they consumed fish oil. Another positive side benefit of fish oil may be a reduced risk for heart disease and reductions in blood pressure that are associated with omega-3 fatty acids. The primary side effect is GI discomfort, which one can address by reducing the dosage and taking the supplement with foods. The recommended daily dosage varies between 3 and 8 grams per day, usually divided into two or three doses (2.6 grams two times per day for RA).
Flaxseed contains both omega-3 and omega-6 fatty acids, but research related to arthritis has been limited, and there are some side effects. Flaxseed can alter the absorption of some medications and thins the blood, so you should check with your physician if you are considering this supplement.
Newer research has looked at the use of other antioxidants that can be found in different types of foods. Cherry juice has been shown to decrease inflammatory markers in the blood for some individuals. Supplementation of vitamin C (ascorbate) or vitamin E (α-tocopherol) reduced the progression of OA and had anti-inflammatory effects.
Exercise is important for people with arthritis. A balanced exercise program that includes aerobic activities, resistance training, stretching, and neuromuscular training (i.e., balance and agility) can help you maintain normal function. Medications used for arthritis can have side effects in addition to the intended benefits. Exercising may allow you to reduce the amount of medication you take to control pain. Although supplements are widely advertised, few have proven to be beneficial. Some people benefit from a combination therapy of glucosamine and chondroitin or from fish oil (omega-3 fatty acids). In addition to physical activity, a healthy diet helps to maintain an appropriate body weight; overweight and obesity are concerns related to the risk of developing arthritis as well as the pain associated with arthritis.