Healthy Aging and Osteoarthritis

Are you one of 500 million people worldwide with osteoarthritis ? Can you share any tips on managing the joint pain, stiffness and reduced range of motion? Well, I am dispensing self-care tips and therapeutic measures, to give you the confidence, in managing the symptoms and improving your mobility.
 

Physical activity, Exercise and weight loss

Physical activity is any movement that increases your heart rate, and includes everyday activities like vacuuming, gardening or walking around the mall. Exercise is more structured and repetitive, with endurance and strength as key outcomes.
Both physical activity and exercise boost your energy and promote better sleep. Building muscle, diverts weight and strain from your joints to the muscle. The increase in blood flow promotes the natural joint regeneration process.
Consider starting with chair exercises if imbalance is a problem. Then increase daily physical activity, by picking up the speed and distance covered. Then, dedicate 30 minutes for 5 days per week to an exercise regime. You may start with 10-minute sessions. A trained professional can customise an exercise program for you, and provide supervision especially for beginners.

Exercise recommendations include:

• Tai chi and yoga – improves balance and control of body position, reducing the risk of falls.
• Walking, swimming, water aerobics, use of the elliptical – these cardiovascular exercises promote weight loss and muscle toning.
• Stretching exercises with resistance bands or pilates – strengthen muscle, increase flexibility and are low impact. Stretch gently, hold for 30 seconds and repeat 2-3 times on each side.

Weight loss is so vague, and there is no single healthy weight. Set small targets to lose weight e.g a 10% loss of weight will help reduce the load on the weight-bearing joints of the hips and knees. A reduction in inflammatory molecules goes along with loss of the kilograms, which will in turn reduce inflammation in other joints e.g in the hands.

Assistive aids include a walking aid held at the correct height, and in the correct hand; thumb splints or spicas; or specific knee guards as recommended by your doctor. You can further reduce the strain on your joints with smart gadgets like a magnetic can opener, electric fruit and veg choppers, robotic vacuum cleaners etc.

Thermal therapy

Apply cold compresses for acute flares of pain. Heat therapy assists in improving blood flow to the joint to ease pain and stiffness.

Stay positive

Living with any chronic condition isn’t easy. To maintain your wellbeing, build a support system with family and friends. Let your doctor know about any feelings of low mood or anxiety. Developing relaxation and coping skills will also create the balance you need, and provide a more positive approach to health.

Pharmacotherapy

Supplements

Do your homework when it comes to supplements, as there could be interactions with other chronic medication you may be taking. Although there is no strong evidence base for use, they may be an option for patients who are at risk for side effects from our prescription therapies.

Glucosamine and chondroitin sulphate supplements:

These remain popular with patients across the globe. They have been evaluated in the GAIT trial, which showed mild benefits for knee OA. There seems to be a trend to a better response with grade 2 knee OA.

These supplements are generally safe. The most common side effects are gastro-intestinal. There is no contra-indication with diabetes, but we do encourage you to monitor the glucose and adjust diabetes treatment as required. Glucosamines should be used cautiously with shellfish allergies, asthma and warfarin therapy. Of interest, glucosamines are derived from the shells of shrimp, lobsters and crabs, whereas the source of shellfish allergies is in the muscle. Chondroitins can also interact with warfarin. Overall, it is reasonable to embark on a 60-90 day trial of these supplements, while your doctor monitors for side effects.

Omega-3 fatty acids, grape-seed extracts, MSM containing compounds can increase bleeding tendencies, especially when taken with any form of blood-thinner. They may provide symptomatic benefit for pain, but do not prevent progression of the OA. Omega-3 fatty acids have associated benefits for the heart, brain and the eye.
Curcumin is the active ingredient of turmeric, and has anti-inflammatory properties. It provides modest pain relief, but may also have gastro-intestinal side effects. It may also potentiate the effect of blood thinners.

Avocado and soyabean unsaponifiables work best for hip and knee OA, as there is more cartilage in these larger joints. They are safer to use with concomitant blood thinners. The mode of action is to prevent the breakdown of cartilage.

Collagen

Undenatured Collage Type II is the component of our cartilage lining. This particular form of collagen is derived from the breastbone of chickens. Therefore, they should not be used with underlying egg or chicken allergies. We are awaiting research studies to define its role in the management of OA.

Prescription therapies

Paracetamol – is a first-line option for pain relief. The maximum dose for patients > 65 years is 3 grams per day and for younger patients the maximum dose is 4 grams per day. It is used with caution in liver disease, and with other combination therapies that contain codeine and paracetamol.

Anti-inflammatories – ask your doctor if there will be any interactions with your current medication / supplements. Underlying medical conditions must be taken into account. Contra-indications to use are peptic ulcer disease, concomitant blood thinners e.g warfarin, hypersensitivity to any ingredients, deranged liver function, renal failure and cardiac failure. Your doctor may consider the more selective options, if you have a tendency to gastric side effects. Try to use the lowest dose possible for the shortest duration. If being used on a more chronic basis, then 6-monthly full blood count, kidney and liver function testing should be done.

Opioids – these can be prescribed in the form of low, medium or high potency compounds. I generally reserve this for severe osteoarthritis, or when the pain is refractory to other measures or for break-through flares of pain. Side effects include drowsiness, poor quality sleep, constipation, dizziness, dryness of the mouth. Of course, there is a risk of dependency on this medication.

Duloxetine – has a role for chronic OA pain, refractory to anti-inflammatories. Additional pain relief and functional improvement has been found with Duloxetine. Possible side effects include nausea, headache, constipation, fatigue.

Muscle relaxants may be of benefit should there be associated muscle spasm. Side effects include drowsiness, dizziness, dryness of the mouth, nausea.

The Future

If all these options don’t work for pain control, there is hope on the horizon. We have sought inspiration from our veterinarian colleagues, who are one step ahead of us. A monthly biological injection is due to be launched in South Africa to manage OA related pain in dogs. It works by inhibiting a nerve growth factor, which then interrupts transmission of pain signals. Phase III Trials for human use are in progress.

Conclusion

The WHO has highlighted the current decade of 2021-2030, as the “Decade of healthy aging”. This placed osteoarthritis under the spotlight, given its effect on quality of life and its chronic nature.
As we age, our bones and joints age with us. Certain activities can accelerate this process. However, once identified, both the patient and doctor can institute measures to ease the symptoms and try to prevent progression.