30+ things doctors wish you knew about arthritis

If the word makes you think about older people with creaky knees and jumbo bottles of ibuprofen, you need an update. Arthritis now strikes an estimated 1 in 6 people have arthritis in Australia, according to Arthritis Australia. The most common type is osteoarthritis, while others include rheumatoid arthritis, gout, fibromyalgia and lupus. There is no cure for any of them, but science has made several breakthroughs in understanding how to treat the inflammation and pain that come with the condition as well as how to halt the underlying joint damage. The first line of defence: Educate yourself.

“You can’t see the cartilage wearing away with an X-ray, but you can see the bones touch, which is usually enough to make a diagnosis,” says Dr Alexis Colvin, an orthopaedic surgeon. Indeed, a Washington University study noted that X-rays can diagnose osteoarthritis as accurately as magnetic resonance imaging (MRI) – and they do it faster and more cheaply.

But remember: “Just because you don’t have it on the X-ray doesn’t mean you don’t have it,” notes Dr Colvin. Your doctor can do blood tests and a physical exam to determine whether you have arthritis. Identifying it early is key because it gives you time to turn to lifestyle changes before irreversible damage is done to your knees (the most common pain point) or other joints.

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The customary treatment for OA is nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. The medications don’t repair joints, but it can make them less stiff and achy. Though NSAIDs can be effective at getting you through the day, says Kelli Allen, PhD, a researcher at the Thurston Arthritis Research Center, they don’t protect joints from progressive damage and may have serious side effects. Using a cane or crutch can make getting around easier without any side effect, says Dr Colvin.

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“When you use a topical it gets absorbed through the skin so it has to penetrate far to get to the cartilage,” says Dr Colvin. “Topicals may not help as much as oral NSAIDs, but they’re good for people who don’t want to take a pill, and they have fewer side effects like gastrointestinal bleeding.” And research shows they can help: In one study, when people with osteoarthritis used NSAID gels, drops, or patches, half said their pain fell by 50 per cent or more over 12 weeks.

“I would 100 per cent never advise taking opioids for arthritis pain,” says Dr Colvin. Why that’s good advice: A study published in JAMA involving 240 osteoarthritis patients showed that those who took opioids were in slightly more pain after a year than those who took non-opioid medication. The researchers aren’t sure why, but given that these drugs can be very addictive, they recommend against opioids.

Arthritis hurts your heart by contributing to chronic inflammation, reducing physical activity, and increasing NSAID use – all factors in cardiovascular risk, says Dr Colvin. Researchers estimate that OA boosts your odds for heart disease by 24 per cent. (Psoriatic and rheumatoid arthritis raise the odds even higher.)

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Dr Susan Blum, author of two books on arthritis, suggests several herbal supplements for arthritis. Top among them: Boswellia, which can help with pain, and curcumin, which can ease inflammation. “Taking them together makes them more effective, so look for a supplement that contains both compounds as well as a fatty acid such as phosphatidylcholine, which helps with absorption,” says Dr Blum. If pain keeps you from getting quality sleep, she suggests taking the supplement right before bed.

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“A single shot can ease pain,” says Dr Timothy McAlindon, chief of rheumatology at Tufts Medical Center. But the relief is typically only temporary, and injections aren’t a long-term solution. A recent study found that repeated shots of cortisone, a steroid, not only didn’t control pain but actually led to more joint damage.

Dr Colvin recommends having no more than three cortisone injections over a lifetime. “They can be very helpful if someone has arthritis and nothing else is helping, or for someone who isn’t ready for surgery, or whose arthritis isn’t bad enough to need surgery yet,” says Dr Colvin. But remember, “anything you do that’s not surgery isn’t changing the underlying process of the cartilage wearing away,” she says.

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Hyaluronic acid injections are designed to add more shock-absorbing fluid to joints, but research on their effectiveness is mixed. Similarly, new injectables using your own fat, bone marrow, platelet-rich plasma, or stem cells promise relief, but Dr McAlindon says “the research isn’t sufficient to show if they actually work” to ease pain and rebuild joints.

“When you don’t sleep well, your cortisol levels go up,” says Dr Blum. In other words, you’re feeding stress which can increase the inflammation linked to arthritis. A lack of sleep can also intensify sensitivity to pain, a problem for arthritis patients, she notes. One solution: Cognitive behavioural therapy, which helps people change the distorted thinking that can worsen pain levels. The practice has been shown by research to increase the amount of time osteoarthritis sufferers slept – and presumably decreased their pain.

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