Osteoarthritis
Osteoarthritis commonly affects weight-bearing joints, such as the hips and knees, but it can also affect joints such as the hands. It is a complex condition involving changes to the joint and surrounding tissues, rather than simply being caused by ‘wear and tear’.
What are joints?
Joints are the areas of the skeleton where two bones meet. The end of each bone is covered with a tough, slippery layer called cartilage. Ligaments attach the two bones together, and tendons attach muscle to bone.
In most joints, the whole area is encapsulated in what is called the synovium. The synovial membrane (the inner lining of the synovium) manufactures and excretes proteins and other substances into the synovial fluid, as well as keeping the fluid in place around the joint. The fluid acts as a lubricant which becomes more viscous – or runny – with warmth and movement.
How osteoarthritis affects the joints
Over time, the cartilage in a joint can become thinner and damaged. Changes can also occur in the bone and other tissues within and around the joint, and bony growths called osteophytes may develop. These changes can contribute to pain, stiffness and reduced movement.
Who is at risk?
We know that there is a greater risk of osteoarthritis in the following groups:
- people over 65 years of age
- women
- previous joint injury
- repeated occupational stress on a joint
- some joint abnormalities
- family history or genetic factors
- overweight or obese.
What causes osteoarthritis?
Osteoarthritis can affect different structures within and around a joint, contributing to pain, stiffness and reduced movement. Everyone’s journey to a diagnosis of osteoarthritis will be somewhat different. Several factors can increase the likelihood of developing osteoarthritis, including:
- mechanical instability in the joint and/or abnormal joint shape
- previous joint injury
- repeated stress or injury to a joint
- ageing
- excess weight.
Symptoms of osteoarthritis
Whilst all arthritic conditions cause joint pain, they all have subtle differences in presentation. Some of the common symptoms of osteoarthritis include:
- morning stiffness that clears after 30 minutes of getting up
- reduced flexibility and mobility
- pain and grating sensation in the joint with movement
- warmth and/or bony swelling around the affected joints
- swelling.
Diagnosing osteoarthritis
Your GP will usually be able to diagnose osteoarthritis based on your symptoms and a clinical assessment. Tests or scans are not routinely needed but may be used if your symptoms suggest another condition.
NHS treatment options
Therapeutic exercise is a core treatment for osteoarthritis. If appropriate, weight management can also help reduce pain and improve physical function and quality of life. Manual therapy may be advised, and walking aids may be recommended alongside therapeutic exercise.
If the pain is affecting your quality of life, then you may be prescribed topical or oral anti-inflammatories. Find out more about the medication options offered by the NHS for osteoarthritis.
This article provides some practical steps you can take to support your diet and lifestyle if you – or a loved one – have a diagnosis of osteoarthritis. Before we dive into that, let’s take a look at a different sort of arthritis.
Inflammatory arthritis
There are several forms of inflammatory arthritis, including rheumatoid arthritis, psoriatic arthritis, reactive arthritis and ankylosing spondylitis.
Modern medications have significantly improved the quality of life and outlook of people with a rheumatoid arthritis diagnosis, and early diagnosis is important. Diet and lifestyle can also play a role, so keep reading to find out more.
Rheumatoid arthritis
Rheumatoid arthritis is an autoimmune condition that largely affects synovial joints (joints which are encapsulated in a synovial membrane). In contrast to osteoarthritis, it typically affects the small joints of the hands and feet and usually affects both sides equally and symmetrically.
It is a systemic disease and so can affect the whole body, including the heart, lungs and eyes. It is characterised by the presence of auto-antibodies – parts of the immune system that, instead of attacking intruders, start to attack itself. The two most common auto-antibodies are rheumatoid factor and anti-citrullinated protein antibodies, although individuals may receive a diagnosis of rheumatoid arthritis even without the presence of these auto-antibodies.
How rheumatoid arthritis affects the joints
With rheumatoid arthritis, the membrane lining of the synovium becomes inflamed. This inflammation is driven by the presence of various pro-inflammatory cytokines such as TNF-alpha and interleukins in the joint capsule. The inflammation causes heat and swelling and, over time, may lead to erosion of the bone, degradation of the cartilage and a narrowing of the joint space.
What causes rheumatoid arthritis?
The exact cause of rheumatoid arthritis is not known. However, some factors are known to increase the risk of developing the condition, including smoking, family history, genetics, and being a woman.
Symptoms of rheumatoid arthritis
In addition to throbbing and aching pain in the affected joints, individuals with rheumatoid arthritis may experience some or all of the following:
- joint swelling and stiffness that are worse after a period of inactivity and usually last for longer than 30 minutes
- reduced flexibility and mobility
- general fatigue due to immune system activation
- dry eyes.
Diagnosing rheumatoid arthritis
Rheumatoid arthritis can develop at any age but is commonly diagnosed in middle age. A GP or rheumatologist will conduct a clinical assessment for inflammation of the synovial membrane. Blood tests for rheumatoid factor will be made, and following a diagnosis, anti-cyclic citrullinated peptide will be tested, as the latter can have a bearing on disease severity. Blood inflammatory markers – ESR and CRP – are also tested.
The NHS stress the importance of early diagnosis to reduce the impacts of joint destruction. X-rays are routinely conducted to see if bone erosions are present. Functional ability assessments are carried out to assess impacts on quality of life and ability to cope with the practicalities of daily life.
NHS treatment options for rheumatoid arthritis
The NHS treatment aim is to achieve remission or, if remission is not possible, low activity. Find out more about the medication options offered by the NHS for rheumatoid arthritis.
Diet, lifestyle and arthritis
Eating a healthy, balanced diet can support your overall health and may form part of managing arthritis alongside recommended medical treatment. The evidence for specific diets and their effects varies depending on the type of arthritis.
A focus on reducing inflammation
Eating a healthy, balanced diet can support your overall health when living with arthritis. A Mediterranean-style diet, which typically includes plenty of fruit and vegetables, wholegrains, beans and pulses, nuts and seeds, olive oil and fish, can be a healthy approach.
Rather than focusing on individual ‘anti-inflammatory’ foods, aim for a varied diet that provides the nutrients your body needs. If you are unsure what changes are right for you, a nutritional therapist can help you explore your individual needs alongside any medical treatment.
Balance your blood sugar levels
Food choices can significantly affect your blood sugar levels. Eating a balanced diet with plenty of whole, fibre-rich foods can help support more stable blood sugar levels throughout the day. Everyone is different, and a nutrition professional can help you find an approach that suits your individual needs.
Dysbiosis (gut microbiome)
Researchers are studying possible links between the gut microbiome and some forms of arthritis. Research in this area is still developing, so it is not yet clear how changes to the gut microbiome affect arthritis or whether targeting the microbiome can improve symptoms.
Eating a varied, balanced diet that includes plenty of plant-based foods can support overall gut health. Foods containing fibre, such as fruit, vegetables, wholegrains, beans and pulses, can form part of a healthy diet.
Weight management
If you are living with obesity, weight management can help reduce pain and improve physical function and quality of life if you have osteoarthritis. Even a small amount of weight loss may be beneficial, with greater weight loss generally associated with greater improvements in symptoms.
Maintaining a healthy weight can be particularly helpful for people with osteoarthritis of the knee. If you would like support with making sustainable changes to your diet, a nutritional therapist can work with you to find an approach that suits your individual needs.
Find out more about how working with a nutritional professional can help with weight loss.
How working with a nutrition professional can help
Everyone’s nutritional needs and circumstances are different. A nutrition professional can work with you to understand your current diet, lifestyle, health needs and goals, and suggest realistic changes that fit your circumstances.
If you are living with arthritis, nutritional support should complement, rather than replace, treatment or advice from your healthcare team.
Working safely with medication
If you are considering taking supplements, it is important to check whether they are suitable for you, particularly if you take prescription medication. Some supplements and herbal products can interact with medicines or may not be appropriate for certain health conditions.
A registered nutrition professional can offer guidance on nutrition and supplements within their scope of practice. Speak to your GP, pharmacist or another appropriate healthcare professional before making changes that could affect your medication or treatment.
If you are living with arthritis and would like personalised support with your diet, a nutrition professional can help you explore changes that suit your health needs, lifestyle and circumstances. Use our advanced search to find a nutrition professional near you.
All content displayed on Nutritionist Resource is provided for general information purposes only, and should not be treated as a substitute for advice given by your GP or any other healthcare professional.
