Waking up with stiff and aching joints is a common sensation leading many patients to ask, “Do you think I have arthritis?” There are several types of arthritis including osteoarthritis and rheumatoid arthritis. According to the Arthritis Foundation of Canada, 1 in 5 Canadians suffer from arthritis of some kind. (1) In the US, 1 in 4 Americans report severe joint pain. (3)
What is arthritis?
The word arthritis simply means inflammation in a joint. Different types of arthritis have different causes and treatments. Many other conditions can cause or contribute to arthritis (joint inflammation) including ankylosing spondylitis and more. The various types of arthritis include:
- Juvenile arthritis
- Psoriatic arthritis
- Rheumatoid arthritis
- Septic (infectious) arthritis (9)
It’s important to note that while an x-ray or MRI may show damage in a joint, the imaging results are not always reflective of the amount of pain a patient may have. For example, nearly all adults have arthritis in the spine caused by carrying the equivalent of a bowling ball (our head) on top of the small bones that make up our neck, but not all of us have neck pain on a daily basis. When there is degeneration in a joint and it is causing pain, then we need to find an effective and safe way to treat the pain and slow down or reverse the degeneration of cartilage and other structures. (2)
What is osteoarthritis?
Osteoarthritis is caused by degeneration in the joint. Degeneration is wear and tear inside of the joints. We all have some degeneration in our joints as we age and that wear and tear doesn’t always cause pain. It’s important to understand that while an x-ray may show arthritis in the lower back, for example, this may not be the cause of a patient’s pain. It’s important to rule out muscular contributions to pain. Often times there is a combination of joint issues and muscular issues that can create pain. (2)
Risk factors for osteoarthritis
Carrying excess weight and previous joint injury can increase the risk of developing osteoarthritis. Any history of joint trauma or excess use of a joint can increase the risk of developing degeneration inside of that joint. (2)
Body composition and joint overloading
Obesity can contribute to the progression of osteoarthritis. Carrying extra weight can increase the load on joints and increase inflammation. Excess fat mass and high body fat percentage may both contribute to the development of osteoarthritis in knees, hips, and hands. (2) Obesity also causes an increase in the secretion of inflammatory chemicals called cytokines. These cytokines can contribute to the worsening of any inflammation in the body including joint inflammation. (13)
Previous joint injury
Injury to joint ligaments or other structures can increase the risk of developing osteoarthritis. Individuals with a history of anterior cruciate ligament (ACL) damage have a predisposition to the development of knee osteoarthritis. (13) Similar effects are noted in other joints that have suffered a previous injury. (2)
Physical activity is a great way to prevent osteoarthritis. Being active does not increase your risk of osteoarthritis.
The muscles that support our joints are important to maintain function. Physical activity can contribute to maintaining healthy body composition. Resistance activities (bodyweight or weighted exercises) combined with cardiorespiratory activities like walking, cycling, and swimming can be helpful to maintain a body composition that supports joint health. (6)
Individualized training plans should be constructed to support the unique needs of each patient. Working with a personal trainer or physical therapist can be incredibly beneficial to maintain strength and prevent osteoarthritis.
Complementary and natural treatments for osteoarthritis
When degeneration in a joint is severe enough that the cartilage is damaged and the joint is bone-on-bone, a patient may be recommended to have joint replacement surgery such as a hip or knee replacement. Natural and complementary therapies can help stop the progression of cartilage breakdown and can help manage pain. (2)
A variety of hands-on treatments that help with pain include acupuncture or dry needling, massage, hydrotherapy (hot or cold application), therapeutic ultrasound, and more. Corrective exercises can also be helpful in maintaining the health of joints. Physical activity does not worsen the degenerative process of osteoarthritis and can often improve the symptoms. (4)
The GLA:D program is a prescriptive exercise and education program originally designed for knee osteoarthritis that has been used to benefit both hip and knee patients. Participants attend two to three educational sessions and 12 weeks of supervised exercise. The program reported an average of 26% reduction in pain and over 30% of participants experienced an improvement in activities of daily living, sports, and recreational activities. (4) For patients who don’t have access to a local GLA:D program, a similar effect could be achieved through working one-on-one with a physiotherapist or corrective exercise specialist.
Supplements for osteoarthritis
The data regarding nutrient supplementation for the treatment of osteoarthritis remains mixed. There is a potential benefit to supplementation of glucosamine sulphate combined with omega-3 fatty acids for pain and stiffness associated with knee and hip osteoarthritis. (12) Nutrients that aid in the maintenance of bone mineral density such as vitamin D3 may also be helpful in the prevention and treatment of osteoarthritis. (7)
Supplements that impact inflammation can be effective in reducing the pain and stiffness associated with osteoarthritis. Curcumin, for example, has similar efficacy to diclofenac, a non-steroidal anti-inflammatory drug (NSAID) for pain reduction. NSAIDs can cause stomach ulcers while curcumin can exhibit anti-ulcer effects. (11)(8)
The bottom line
Maintaining a healthy body composition, bone mineral density, and an active lifestyle can all help keep joints healthy. There are many natural treatments available for patients suffering from osteoarthritis. A multi-disciplinary approach combining physical therapy, exercise prescription, and natural health products can help reduce pain and improve function.
Using a combined approach is important to address the causes of osteoarthritis. Taking anti-inflammatory supplements may help with pain but it may not reduce the damage inside the joint itself. Combining supplementation with physical therapy and weight loss if needed reduces the load on the joints and can help with the pain. A combined approach truly addresses the multiple causes of osteoarthritis.
- Arthritis Community Research and Evaluation Unit (ACREU). (2019, August). The status of arthritis in Canada: National report. Retrieved from https://arthritis.ca/getmedia/13aff08f-f206-4c6e-a709-beb80b97bd51/ACREU_Arthritis-Society_National-Report-2019_final.pdf
- Arthritis Foundation. (n.d.). Osteoarthritis. Retrieved June 9, 2020, from https://www.arthritis.org/diseases/osteoarthritis
- Centers for Disease Control and Prevention. (2019, January 30). Arthritis. Retrieved from https://www.cdc.gov/chronicdisease/resources/publications/factsheets/arthritis.htm
- Fransen, M., McConnell, S., Harmer, A. R., Van der Esch, M., Simic, M., & Bennell, K. L. (2015, January 8). Exercise for osteoarthritis of the knee. Retrieved from https://www.cochrane.org/CD004376/MUSKEL_exercise-for-osteoarthritis-of-the-knee
- Gillis, J., Calder, K., & Williams, J. (2011). Review of thumb carpometacarpal arthritis classification, treatment and outcomes. Canadian Journal of Plastic Surgery, 19(4), 134–138.
- Long, H., Xie, D., Zeng, C., Wei, J., Wang, Y., Yang, T., … Lei, G. (2019). Association between body composition and osteoarthritis: A systematic review and meta‐analysis. International Journal of Rheumatic Diseases, 22(12), 2108–2118.
- Mabey, T., & Honsawek, S. (2015). Role of vitamin D in osteoarthritis: Molecular, cellular, and clinical perspectives. International Journal of Endocrinology, 2015, 1–14.
- Sah, A., Jha, R., Sah, P., Shah, D., & Yadav, S. (2013). Turmeric (curcumin) remedies gastroprotective action. Pharmacognosy Reviews, 7(1), 42.
- Senthelal, S., Li, J., Goyal, A., Bansal, P., & Thomas, M. A. (2020). Arthritis. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK518992/
- Shanb, A. A., & Youssef, E. F. (2014). The impact of adding weight-bearing exercise versus nonweight bearing programs to the medical treatment of elderly patients with osteoporosis. Journal of Family and Community Medicine, 21(3), 176.
- Shep, D., Khanwelkar, C., Gade, P., & Karad, S. (2019). Safety and efficacy of curcumin versus diclofenac in knee osteoarthritis: a randomized open-label parallel-arm study. Trials, 20(1), 214.
- Simon, D., Mascarenhas, R., Saltzman, B. M., Rollins, M., Bach, B. R., & MacDonald, P. (2015). The Relationship between anterior cruciate ligament injury and osteoarthritis of the knee. Advances in Orthopedics, 2015, 1–11.
- Wang, T., & He, C. (2018). Pro-inflammatory cytokines: The link between obesity and osteoarthritis. Cytokine & Growth Factor Reviews, 44, 38–50.