Tuesday, 28 September 2021

Is pain in the joints simply inevitable?

Is pain in the joints simply inevitable?

OUR joints are generally taken for granted. We put them through so much, with little care and attention, and then we are bitterly disappointed when they are not happy.

As we age, joint aches and pains are often a sign of osteoarthritis, particularly if you are over 50. Note that sudden significant pain and swelling after injury may be a cartilage tear or ligament rupture.

We have normal repair mechanisms that are going on all the time in response to the stress we put our joints through. Osteoarthritis is where there is a malfunction in this naturally protective process. This results in a thinning of the cartilage, which is a substance softer than bone that provides cushioning.

As your body’s way of trying to help, there is an increase in bone growth but this creates small spurs which can cause pain as they rub on other structures. The result is your joint becomes generally inflamed, causing swelling, pain and stiffness.

The most common symptom is pain after activity. This is worsened after periods of increased activity. In addition, the joint can swell and there may be stiffness after rest, most notably on waking, but in osteoarthritis this stiffness lasts less than 30 minutes. You may notice a creaking feeling at your joints and hear a crunching noise. It is most common in the knees and hands but can affect any joint.

A lot of people are concerned that osteoarthritis is a disease that gets steadily worse. In fact, it is different for everyone. More often it follows a rather irregular pattern with sudden flares which can then return to baseline without it steadily getting worse as feared.

Osteoarthitis can run in families and is more common with age. Avoiding excess weight is an important factor we can control. Just losing one stone can make a dramatic difference. Imagine putting on a rucksack and then loading it with three of those cumbersome two litre drinks bottles. That’s the equivalent of one stone. Your joints will certainly thank you for reducing the constant load they support.

X-rays are often not that helpful because they correlate poorly with symptoms. One individual may have an X-ray which shows terrible osteoarthritic change but they have no symptoms whatsoever, while another person may be troubled with frequent joint pain, although very little is seen on X-ray.

The best way to treat osteoarthritis is with physical therapy. Exercise helps improve the stability and range of motion at the joint with increased flexibility. Stronger muscles also reduce the likelihood of future trauma to the knee caused by twisting injuries and falls.

Pain relief is useful to help you through a flare. In instances where pain is ongoing it can be used regularly. Anti-inflammatory medications are particularly good, although these tablets come with the risk of stomach irritation so they should not be taken on an empty stomach and should be avoided by those with a history of bleeding in the gut. Short courses are generally safe but longer ones need discussion with your GP to weigh up the risks versus the benefits and whether a stomach protectant tablet is needed.

Anti-inflammatories also come in creams that are best suited for hand and knee osteoarthritis and do not affect the gut. Another cream available is capsaicin, which is derived from chilli peppers and stops the nerves sending pain signals, but it can take a few weeks to get the full effect.

Other useful measures include hot and cold compresses, TENS machines and wearing supportive footwear. Mobility aids, such as sticks and braces, decrease the risk of falls. Devices to help with everyday tasks such as tap-turners can help maintain independence around the house and reduce flares.

Steroid injections can be incredibly helpful in certain situations. They do not cure or improve osteoarthritis but decrease symptoms. They are useful to patients whose symptoms restrict their daily activities and where pain is not controlled by the other measures discussed. They do not work for all individuals but, when they do, they can bring relief of symptoms for months.

Where do joint replacements come in all this? The basic school of thought is that an artificial joint is not as good as your natural one and it does not last forever. Therefore, it is best to leave this as a “last resort” when symptoms are no longer adequately controlled by pain relief and physical therapy. In some instances, keyhole surgery to remove bits of bone or cartilage that are causing problems may be advocated instead.

Two supplements that get a lot of attention are chondroitin and glucosamine, substances found naturally in the body which help make up cartilage. There is little evidence for chondroitin but glucosamine has shown to improve function and pain in some studies.

If you are keen to try glucosamine you need to buy it over the counter — make sure you purchase glucosamine sulfate 1,500mg and take as a once-a-day dose (splitting the dose makes it less effective) for a minimum of three months.

Arthritiscare.org.uk has some excellent booklets, all available online free, with sensible practical advice and tips for living with osteoarthitis.

Arthritisresearchuk.org also has many useful free booklets, including targeted exercises for each joint.

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