Aches and pains and osteoarthritis

I am sure many of you reading this will have had some stiffness, aches and pains when you got out of bed this morning.

Many people experience this when they get older and assume that it is due to wear and tear on the joints, causing arthritis and leading to a steady decline. But whether or not it is arthritis, this downward trajectory is not inevitable and there are many things that can be done to manage these symptoms.

There are many forms of arthritis but osteoarthritis is the most common form. In Australia, one in 11 people have osteoarthritis – some 2.2 million Australians in 2017–18. It is characterised by the breakdown of cartilage that overlies the ends of bones, resulting in bone rubbing on bone, causing pain, swelling and stiffness. The most commonly affected joints are the hands, knees, hips and spine.

Lots of risk factors contribute to osteoarthritis and veterans will probably recognise many of them. They include things we can’t do much about, such as age, gender, genetics, joint injury and joint shape and alignment. However, there are lifestyle risk factors we can address. In Western countries, obesity and overweight is a very important risk factor, with estimates that 25 per cent of osteoarthritis in Europe and the United States would not have developed if becoming overweight was avoided. This is due to more than just additional weight on the joint. Obesity causes low-grade inflammation in the joint. 

We know that physically demanding occupations such as military service, construction, firefighting, agriculture, fisheries, forestry and mining are associated with higher rates of knee osteoarthritis, particularly if the job involves a combination of heavy lifting (more than 25 kilograms) and kneeling, squatting or climbing stairs.

There is often a concern that physical activity will cause osteoarthritis and there is some evidence that higher paced and vigorous exercise may make osteoarthritis worse but there is no consistent evidence of risk from moderate daily activity or sport.

So if you have symptoms of joint pain that get worse with activity and are relieved by rest, or experience morning stiffness, swelling and fluid on the joint, or crackling and grating in your joints (crepitus), you could have osteoarthritis. There are things you can do to manage this, including medication and surgery as well as addressing lifestyle factors.

Studies have shown that losing 10 per cent of your body weight will reduce pain from osteoarthritis by 50 per cent and smaller amounts will still make a difference especially in weight-bearing joints such as the knee. Physical therapy and exercise will help and people who exercise regularly despite their arthritis will have less pain and better function. In-water exercise like aqua-aerobics can be very helpful for those with more severe osteoarthritis. In one study, tai chi twice a week was shown to be as effective for treatment of osteoarthritis as physical therapy. Exercise has a similar effect on pain and function as nonsteroidal anti-inflammatory medication (NSAIDS, such as ibuprofen, diclofenac, celecoxib).

 If medication is required, this usually starts with topical NSAIDS or topical capsaicin and if more pain relief is required then oral NSAIDS are prescribed. If pain from osteoarthritis is not managed by medications, exercise and physical therapy, surgery may be offered such as total knee replacement. This is major surgery and requires you to commit to rehabilitation after surgery for the best results.

Often people will take supplements to help their osteoarthritis symptoms. There is some evidence that glucosamine and chondroitin can reduce pain and improve function and for those who gain symptomatic benefit there is little harm in continuing to take this. Other supplements such as curcumin (found in turmeric), avocado and soybean that have been promoted for relief of osteoarthritis symptoms have limited evidence of effectiveness, especially in the longer term.

Diet can help both with weight loss and symptoms of osteoarthritis. Eating oily fish like salmon, mackerel and sardines have been shown to improve pain and function in arthritis. As does reducing saturated fats and increasing antioxidants in the diet (rather than supplements) – think carrots, citrus fruits, green vegetables, capsicums and blackcurrants, nuts and seeds. I think this could be summed up as eating a healthy diet!

Osteoarthritis is one of the commonest reasons for submitting a claim to DVA and veterans with this condition are able to access allied health care to support this, including chiropractic, physiotherapy, exercise physiology, dietetics and psychology as well as any medication or medical treatment that is required.

Like many health conditions the key to managing symptoms in osteoarthritis is to maintain a healthy weight, eat a healthy diet, do some regular exercise and see your doctor if pain persists.