While there’s no cure for arthritis, simple lifestyle changes can significantly improve quality of life. Photo / 123RF
There is no cure for chronic joint pain, but it can be made more bearable. The experts advise on what really makes a difference.
The word “arthritis” describes pain, stiffness, and swelling in the joints. It can be a bit of a nuisance or extremely difficult to live with. While arthritis is generally associated with age, it doesn’t just affect older people.
Arthritis is not a single condition, many types exist. The two most common types are osteoarthritis, and rheumatoid arthritis.
More than half of osteoarthritis sufferers develop the condition in their knees, while many have arthritis in their hips. It can also commonly affect the hands and the spine.
The main symptom of arthritis is persistent pain. If left to progress without intervention, the end point of osteoarthritis is usually joint replacement.
It is important to get a diagnosis early, particularly with rheumatoid arthritis, because early diagnosis and treatment can markedly decrease disability and pain.
There is no cure for arthritis, but you can take steps to manage the symptoms, including addressing what you eat, as Martin Lau, a dietitian and services manager at Arthritis Action, explains.
“People often feel it is the end of the line when they are diagnosed, but there are so many things you can do to help yourself and take control of your condition.”
Arthritis is a general term for conditions that cause pain and inflammation of the joints.
It is a degenerative joint disease that can affect the different tissues of the joint. Historically, it was believed to be a “wear and tear” condition, and an inevitability of ageing.
However, it is now known that it tends to occur when the degradation of the cartilage within the joints exceeds the rate of repair. A range of factors is thought to cause this, including genetics, obesity, repeated stress on joints, age, smoking, and injury.
It initially affects the smooth cartilage lining of the joint, making movement difficult and leading to pain and stiffness. The cartilage lining starts to roughen and thin, making tendons and ligaments work harder. This causes swelling and the formation of bony spurs called osteophytes.
Severe loss of cartilage can lead to bone rubbing on bone, altering the shape of the joint and forcing the bones out of their normal position.
It is an autoimmune condition that often starts when a person is aged between 30 and 50.
It is triggered when the body’s immune system begins to target the outer covering, or synovium, of the affected joints, leading to inflammation, pain and swelling. It can then spread across the joint, leading to further swelling and a change in shape, and may cause the bone and cartilage to break down.
It is not known what causes rheumatoid arthritis, although there are several theories. There is some evidence that it can run in families, although the risk of inheriting it is thought to be low as genes are only thought to play a small role in the condition.
Rheumatoid arthritis is also more common in women, which may be due to hormonal imbalance, although this link has not been proved. Some evidence also suggests that people who smoke have an increased risk of developing the condition.
The symptoms can vary according to the type of arthritis you have – and loads of different types exist.
According to the United Kingdom’s health service, you might experience the following:
Once a GP has diagnosed osteoarthritis, the National Institute for Health and Care Excellence recommends that painkillers and topical non-steroidal anti-inflammatory drugs are taken at low doses.
Drugs should be accompanied by non-clinical management, which consists of the following:
Our expert emphasises the importance of exercise in people with arthritis. “Physical activity is important for helping the joints to repair,” Lau says. “Exercise can also retrain your nervous system to cope with persistent pain.
“There isn’t a best activity, just do something you enjoy, be it walking, tai chi or a tea dance. You don’t need to join a gym and lift weights. You can do strength-building exercises at home.”
If severe, people with arthritis may require surgery too.
People with rheumatoid arthritis are usually prescribed “disease-modifying anti-rheumatic drugs”, such as methotrexate, sulfasalazine or hydroxychloroquine, and steroids. They can also use painkillers and anti-inflammatories. Most people with rheumatoid arthritis will need to take some form of medicine for life.
Exercise is also recommended, the types of which will depend on the location and severity of the condition, but which will generally involve a mix of flexibility, range of motion, aerobic and strengthening exercises.
A 2023 paper by the European Alliance of Associations for Rheumatology recommends a healthy balanced diet for people with rheumatic and musculoskeletal diseases, such as arthritis. Small amounts of alcohol are generally harmless but may cause flare-ups in rheumatoid arthritis patients.
Lau explains: “There is no evidence to support any single dietary factor that will lead to a clinical or meaningful improvement in rheumatic disease such as arthritis. But it is important to have a healthy diet for weight and body composition. Don’t modify your diet hoping to cure it because there is no cure.”
Diet can, however, help with the main symptom of arthritis, which is persistent pain.
One Dutch study found that a mainly plant-based diet “may be just as effective as painkillers and anti-inflammatories in alleviating symptoms for patients suffering from rheumatoid arthritis or osteoarthritis”.
Fibre was found to be particularly important. Compounds found in plants called phytochemicals have anti-inflammatory effects, and are antioxidants, which may lessen sensitivity to pain. Foods high in phytochemicals include broccoli, berries, pears, turnips, celery, carrots and spinach.
A Mediterranean diet has been found to modestly support people with arthritis, says Lau. This is likely to stem from the anti-inflammatory properties of common Mediterranean foods, such as berries, fish, and olive oil. The diet also limits red meat, sugar, and dairy, which have inflammatory properties.
A typical Mediterranean diet is largely plant-based, with wholegrains, healthy fats such as avocado, and moderate amounts of fresh seafood, poultry, and dairy.
The International Association for the Study of Pain recommends eating fruit and veg high in polyphenols, which can help reduce inflammation and protect the body from oxidant damage.
Vegetables with the highest polyphenol content are spinach, globe artichokes, red and green chicory, and red onion. Black beans, black olives, flaxseed and chestnuts are also packed with the compounds.
Shona Wilkinson, the lead nutritionist at supplement and nutrition brand Dr.Vegan, says: “Berries such as blueberries are arthritis-fighting powerhouses due to their high concentration of antioxidants, meaning they help to combat oxidative stress in the body. This means they often combat the root cause of inflammation before it occurs.”
Legumes such as split peas, lentils, and black beans are high in fibre, which is known to be beneficial. The current government recommendation for daily fibre intake for adults is 30g per day.
Curcumin is the active ingredient in the spice turmeric. There is some evidence to suggest it may help with arthritis symptoms.
According to one research review, there is scientific evidence that eight to 12 weeks of turmeric extract treatment (typically 1000mg a day of curcumin) can reduce arthritis symptoms. Experts recommend 500mg of high-quality curcumin twice a day can help but be aware that scientific research is limited.
Wilkinson says: “Curcumin is a natural anti-inflammatory, known for its potential to ease joint aches and swelling. With almost all joint aches involving some form of inflammation, reducing this can help relieve symptoms, so try adding this magical spice to your diet.
“If you’re buying a turmeric supplement, remember to check the label to make sure it includes curcumin – most standard turmeric supplements don’t contain a sufficient level of it to affect your joints.”
Several types of fish are rich in omega-3 fatty acids, which have anti-inflammatory properties. Good sources include mackerel, salmon and sardines.
Wilkinson says: “There are lots of studies showing the benefits of omega-3 for [sufferers], including an improvement in symptoms of stiffness and an increase in mobility. For those on a plant-based diet or wanting to avoid omega-3 from fish, you can get vegan omega-3 through algae in supplements.”
Walnuts, chia seeds, and flaxseeds are all rich in both omega-3s and antioxidants. “They’re also one of the easiest foods to incorporate into your diet by sprinkling them onto dishes or consuming them as an on-the-go snack,” says Wilkinson.
Our expert weighs in on some misconceptions about certain foods types and arthritis:
Tomatoes belong to a group of plants called nightshade foods, which also includes potatoes, aubergine, peppers, and goji berries. They contain a compound called solanine, which some believe may aggravate arthritis. There is no scientific evidence to support this claim. Indeed, they may even have anti-inflammatory properties.
Lau says: “In rare cases, they may induce the release of histamine in susceptible people but if you enjoy tomatoes and have no adverse effects, by all means eat them”.
These compounds are commonly found in health food stores in supplement form and are often marketed as a form of joint support.
Lau says: “Guidelines advise not to recommend glucosamine and chondroitin to arthritis patients. Some trials say they might work, some say they don’t. One review says it is not useful to rely on supplements for management of osteoarthritis. There are evidence-based approaches you can tap into first.”
Osteoarthritis is most common in people in their mid-40s or older and is also more common in women and people with a family history of arthritis. Obesity is also a risk factor, and weight loss can help reduce symptoms and slow the condition.
Studies show that rheumatoid arthritis has a higher incidence in women. A family history of it is also a factor, as is exposure to tobacco smoke.
Also more at risk are people with metabolic syndrome, which is a cluster of conditions that can include increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels.
While it is not possible to prevent osteoarthritis completely, you can minimise your risk of developing the condition by avoiding injury and living a healthy lifestyle.
It was previously thought that impactful activities such as running increased the risk but studies have disproved this. Indeed, regular running compresses and releases the cartilage in your knees, helping circulate synovial fluid that nourishes joints and removes inflammatory waste products.
Leg-strengthening exercises such as squats and lunges can also be advantageous, as evidenced by a study presented at the Radiological Society of North America conference in 2023.
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