Which patients below are at risk for developing osteoarthritis? select all that apply:

Although there’s no cure for osteoarthritis yet, there are treatments that can provide relief from the symptoms and allow you to get on with your life. These include:

• lifestyle changes
• pain relief medications
• physical therapies
• supplements and complementary treatments.

Physical activity

Many people worry that exercising will increase their pain and may cause further joint damage. However, while resting painful joints may make them feel more comfortable at first, too much rest can increase stiffness.

You shouldn’t be afraid to use your joints. If pain makes it difficult to get started with exercise, you could try taking a painkiller such as paracetamol beforehand. And if you feel you’ve overdone things a bit, try applying warmth to the painful joint – or if it’s swollen, applying an ice pack may help.

If you haven’t done much exercise for a while you might want to get advice from a physiotherapist. They’ll be able to help you work out a programme that works for you. The most important thing is to start gently and build up gradually.

You may want to give our exercises for healthy joints a try.

There are three types of exercise you should try to include:

Range of movement exercises

These exercises involve taking joints through a range of movement that feels comfortable and then smoothly and gently easing them just a little bit further.

Strengthening exercises

These are exercises performed against some form of resistance to strengthen the muscles that move and support your joints. You could use light weights, a resistance band or try exercising in water.

Aerobic exercise

This means any physical activity that raises your heart rate and gets you breathing more heavily. This type of exercise burns off calories, so it can help if you need to lose a bit of weight. It can also improve your sleep and help to reduce pain.

Walking, cycling and swimming are all excellent forms of exercise for people with arthritis. Or you could try an exercise bike or cross-trainer. Walking laps in the shallow end of a swimming pool is also great for strengthening leg muscles.

Hydrotherapy or aquatic therapy pools are warmer than normal swimming pools. The warmth is soothing and relieves pain and stiffness, while the water supports your weight but still offers some resistance for muscle-strengthening exercises.

Weight loss and diet

If you’re overweight, then losing even a small amount of weight can make a big difference to your symptoms – especially for weight-bearing joints (the hips, knees, back and feet).

The best way of losing weight is by following a healthy, balanced diet. Cut down on the number of calories you get from high-fat and sugary foods, but make sure that you’re including all the key food groups in your diet so you don’t miss out on essential nutrients. Gradually increasing how much physical activity you do will also help with weight loss.

There isn’t a specific diet that’s been proved to help with osteoarthritis. If you think a certain food might be making your symptoms worse then it’s best to test this by not eating the food for a few weeks and then reintroducing it. Be cautious about any diet that claims to cure arthritis or that suggests cutting out a particular food group completely.

There’s some research to suggest that oily fish, or oils produced from fish, may help with the symptoms of some forms of arthritis, especially rheumatoid arthritis. But increasing your intake of oily fish or taking a supplement might also be worth trying if you’re interested in using diet to manage osteoarthritis.

Medications

The drugs usually taken for osteoarthritis won’t affect the condition itself, but they can help to ease the symptoms of pain and stiffness.

NSAID creams and gels

Non-steroidal anti-inflammatory drugs (NSAIDs) are available as creams, gels or patches that you apply directly to the skin. Ibuprofen and diclofenac gels are available over the counter at pharmacies and supermarkets. Others, such as ketoprofen, are only available on prescription. Creams, gels or patches work well for some joints, especially the knees and hands, but may not work as well for joints such as the hips, which lie deeper below the skin.

Capsaicin cream

Capsaicin cream is made from the pepper plant (capsicum) and is an effective painkiller. It’s particularly useful for knee and hand osteoarthritis. It’s only available on prescription. It needs to be applied regularly three times each day. The pain-relieving effect starts after several days of regular use and you should try it for at least two weeks before deciding if it’s helped.

Paracetamol

Paracetamol is usually recommended as the safest type of pain relief tablet to try first. It’s best to take them before the pain becomes very bad. Paracetamol is readily available over the counter at pharmacies and supermarkets – and there’s no advantage in paying for more expensive brands.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAID tablets are generally stronger pain-relievers than paracetamol. The most common is ibuprofen, which is widely available over the counter in pharmacies and supermarkets. You can try these for 5–10 days – if they haven’t helped after this time, then they’re unlikely to.

If you need them, your doctor may prescribe:

• higher doses of ibuprofen
• stronger NSAIDs such as naproxen or diclofenac
• a newer type of NSAID, such as celecoxib or etoricoxib, designed to reduce the risk of ulcers and bleeding in the gut.

If your doctor prescribes an NSAID, they’ll usually prescribe a drug called a proton pump inhibitor (PPI) as well to help protect the gut. Examples of PPIs are lansoprazole and omeprazole.

Stronger pain relief

If you find that paracetamol or NSAIDs don’t give good enough pain relief, you should speak to your doctor about other options. Your doctor may suggest using:

• paracetamol in combination with an NSAID. However, you shouldn’t take ibuprofen as well as a prescription NSAID.
• a drug such as co-codamol, which contains paracetamol and codeine. These are normally only used for very short periods because they have a higher risk of side-effects.

Steroid injections

Injections of a long-acting steroid may be given directly into a particularly painful joint, especially the knee or thumb. The injection often starts to work within a day or so and may improve pain for several weeks or months. Steroid injections are mainly used for very painful osteoarthritis, or for sudden, severe pain caused by crystals in the joint.

Other pain relief treatments

Transcutaneous electrical nerve stimulation (TENS)

A TENS machine sends electrical pulses to your nerve endings through pads placed on your skin. It produces a tingling sensation and is thought to relieve pain by altering pain signals sent to the brain. The research evidence on the effectiveness of TENS is mixed, but some people do find it helpful. A physiotherapist will be able to advise on the types of TENS machine available and how to use them. Or they may be able to loan you one to try before you buy.

Hyaluronic acid injections

Hyaluronic acid, or hyaluronan, is a lubricant and shock absorber that’s found naturally in the fluid in your joints. Injections of hyaluronic acid have sometimes been used as a treatment for osteoarthritis of the knee. The treatment isn’t currently available on the NHS because research evidence on its long-term effectiveness is mixed. The treatment is, however, available privately.

Complementary medicine for osteoarthritis

Taking supplements

In many cases, there’s little research evidence to show that supplements and herbal remedies can improve arthritis or its symptoms, but many people feel they do benefit from them.

Below are a few of the supplements often used by people with osteoarthritis.

Glucosamine

Glucosamine is found naturally in the body in structures such as ligaments, tendons and cartilage. Supplements are usually produced from crab, lobster or prawn shells, although shellfish-free types are available. There’s some research to suggest it may have some benefit in painful osteoarthritis, especially of the knee.

Most trials have used a dose of 500 mg three times a day, and the evidence seems to suggest glucosamine sulphate may be more effective than glucosamine hydrochloride. It doesn’t help the pain straight away so you’ll need to take it for a couple of months. If it hasn’t helped after two months, then it’s unlikely that it will.

Chondroitin

Chondroitin exists naturally in our bodies and it’s thought that it helps give cartilage elasticity. The research evidence is limited to animal studies that suggest it might help to slow the breakdown of cartilage.

Don’t expect to see any improvement for at least two months. And if your cartilage is badly damaged, it’s unlikely that you’ll benefit from chondroitin.

Fish oils

Fish oils and fish liver oils are widely believed to be good for the joints. In fact, there’s not enough data available to say whether they’re effective for osteoarthritis, although there’s good evidence that fish oils can help with symptoms of rheumatoid arthritis.

Supplements made from fish livers often contain a lot of vitamin A, which can be harmful in large amounts. Supplements made from the whole fish usually contain less vitamin A, so are safer if you find you need a high dose of fish oils to get any benefit from them.

Complementary treatments

There are a number of different treatments available and they can generally be used alongside prescribed or over-the-counter medicines.

Some of the most popular therapies are listed here:

• Acupuncture claims to restore the natural balance of health by inserting fine needles into specific points in the body to correct imbalances in the flow of energy. There’s evidence that acupuncture is effective in easing some symptoms of osteoarthritis.
• The Alexander technique teaches you to be more aware of your posture and to move with less physical effort. There’s evidence that it can be effective for low back pain, though not specifically for osteoarthritis.
• Aromatherapy uses oils obtained from plants, which can be vaporised, inhaled, used in baths or a burner, or as part of an aromatherapy massage. There’s no research evidence that aromatherapy is effective for osteoarthritis symptoms, but some people find it helpful for relaxation.
• Massage can loosen stiff muscles, ease tension, improve muscle tone, and increase the flow of blood. A good massage can leave you feeling relaxed and cared for, though there’s only a little evidence that it’s effective in treating symptoms of osteoarthritis.
• Osteopaths and chiropractors manually adjust the alignment of the body and apply pressure to the soft tissues of the body. The aim is to correct structural faults, improve mobility, relieve pain and allow the body to heal itself. There’s a little research evidence that chiropractic is effective for spinal osteoarthritis. However, there’s no specific research evidence available on whether osteopathy is effective for osteoarthritis.
• T’ai chi is a ‘mind–body’ exercise designed to calm the mind and promote self-healing through sequences of slow, graceful movements. There’s good evidence that t’ai chi may ease osteoarthritis symptoms, particularly in the knee.

Finding a good therapist

Some therapies are available on the NHS, so it’s worth asking your GP about this. Private health insurance companies may also cover some types of therapy. However, most people pay for their own treatment, which can be costly.

Some therapies make bold claims – if you have any doubts, ask what evidence there is to back up these claims. The Institute for Complementary and Natural Medicine can help you find a qualified therapist.

Tell your therapist about any drugs you’re taking and speak to your doctor about the therapy you’re thinking of trying. Don’t stop taking prescribed drugs without talking to your doctor first and be cautious if any practitioner advises you to do so.

Surgery

Most people with osteoarthritis won’t need surgery, and it’s usually only considered once you’ve tried all other suitable treatments.

The options include:

• joint replacement surgery
• keyhole surgery techniques to wash out loose fragments of bone and other tissue from your knee – this is called arthroscopic lavage and is normally only available privately in the UK
• joint fusion – where the bones in a joint are fixed together surgically – this prevents movement of the joint, and therefore pain.

If you’re thinking of having surgery, take some time to find out what you can expect from it, what the possible risks are, and how you can best prepare for your operation and plan ahead for your recovery.

What are risk factors for developing osteoarthritis?

Which joint S is most often affected in osteoarthritis select all that apply?

Which of the following conditions or actions can cause primary osteoarthritis?

What are the 4 stages of osteoarthritis?