Dr Sarah Jarvis
My Weekly’s favourite GP from TV and radio writes for you
Most of us get joint pain at some point. If it persists there’s a good chance it’s arthritis – the medical term for inflammation of the joints.
Rules about treatment have changed, but there’s lots you can do to protect yourself.
Arthritis can affect any of the 360 joints in your body. Osteoarthritis (OA) most commonly affects the joints which see a lot of action – hips, knees, spine and hands. The older you are, the more worn your joints are likely to be – OA causes joint pain for 8.5 million people in the UK, and most of them are over 50.
If you’re over 65, there’s an odds-on chance you have OA somewhere, although it may not be causing symptoms. Over-use of your joints (perhaps due to a physical job) also increases your risk. Genetics plays a part – some families are more prone to OA, as are women.
If you’re overweight, you’ll put more strain on your weight-bearing joints like hips and knees, and this can wear down the cartilage which covers the end of many bones at the joints. It is constantly being worn and repaired. If repairs can’t keep up, the cartilage gets worn and the space between bones shrinks. In addition, bony “spurs” can build up at the edge of the joint. This means the bones in the joint grind together when they move.
The main symptoms of OA are pain, stiffness and reduced movement particularly first thing in the morning. But it doesn’t mean you’re sentenced to ever more pain – many people have OA for years without knowing it, and symptoms can flare up and settle down.
If you’re getting pain from your hip or pain at night despite taking painkillers, your doctor may recommend you think about joint replacement.
Painkillers often become less effective with constant use and can cause side effects. Keeping your weight to healthy limits makes a huge difference, as does exercise.
While it’s natural to worry that exercise will worsen pain, the opposite is true. Arthritis can lead to a vicious cycle of pain and stiffness, less exercise and more stiffness. Regular exercise will also strengthen surrounding muscles, protecting joints as well as cutting the risk of falls.
A combination of low impact aerobic exercise (brisk walking, cycling, swimming, dancing) and strengthening exercises for muscle groups (using light weights – biceps curls holding a tin of beans is a great example!) is best.
There’s lots of interest in “natural” alternatives to painkillers. The evidence for most isn’t strong – but often they’re made by small companies which can’t fund major studies. Glucosamine is safe, but most brands showed no benefit for patients with OA; omega-3 fish oils help in many cases of rheumatoid arthritis but don’t appear to in OA. See the boxes below.
The spine is made up of a series of vertebrae, connected by intervertebral discs with a tough outer layer enclosing thick fluid which acts as a shock-absorber. But there are also numerous “facet joints” connecting these joints, as well as ligaments providing support. This keeps your spine stable while letting you bend.
Inflammation, sprains and strains at any of these points can cause back pain. Pain going down your leg suggests a possible prolapsed disc pressing on a nerve in the spine. Weakness, numbness around your bottom, change in bladder or bowel function or feeling generally unwell should always prompt a visit to your doctor. For most, building up activity gradually should have you back to full function in weeks.
In rheumatoid arthritis, your immune system attacks your joints. Early treatment to damp down your immune system can reduce long term problems.
Next week: Understanding antimicrobial resistance
‘‘ Genetics plays a part – some families are more prone to osteoarthritis, as are women’’