Millions of adults suffer from chronic joint pain and stiffness known as osteoarthritis (OA). It’s the most common type of arthritis both in the U.S. and around the globe, and it’s affecting more than 32.5 million Americans alone.
OA is a degenerative joint disease that typically develops as a result of injury or overuse. It involves the bone, cartilage, ligaments, fat, and tissues lining the joints. It breaks down cartilage, misshapes bones, and creates inflammation that leads to pain, swelling, stiffness, and a loss of mobility. OA will also affect a person’s hands, knees, hips, neck, and lower back. While it most often occurs in older adults, it can also affect those who are younger. Unfortunately, the damage caused by OA is irreversible.
Gender can also affect a person’s chances of developing OA. It’s more common in males aged 50 and younger. But in people 50 and older, it’s more common in females, especially after menopause.
It’s important that you are aware of OA signs and symptoms so you can provide your patients with advice on pain management. With your advice and support, you can improve their quality of life. Noticing patients who have difficulty walking, hip or knee pain, or the appearance of stiffness and pain in their hands should alert you to the possibility of OA and the need for a referral to a physician to be diagnosed.
The first step in helping a patient with OA is asking the following osteoarthritis screening questions from the Osteoarthritis Action Alliance:
- Have you ever been told by a doctor that you have inflammatory arthritis?
- Did your joint pain start suddenly or abruptly?
- Does your pain or stiffness last longer than 30 minutes after rising from a sitting position?
- Do you have any of the following?
- Recent history of trauma (fall, car wreck, sports injury)
- History of osteoporosis (fragile bones)
- Fever
- Rash
- Muscle weakness
- Burning, stinging, tingling, numbness around the painful joint(s)
- Red, swollen joint(s)
- Do you have more than 2 or 3 painful joints?
- History of inflammatory arthritis (i.e. rheumatoid or gout)
- Fibromyalgia
If they answered “yes” to any of the questions, their symptoms could be something other than osteoarthritis. It’s recommended they talk to a physician about the symptoms.
In the meantime, you can connect your patients to community programs, such as recreation centers, YMCAs, residential communities, or senior centers. The CDC Arthritis Program recommends programs that are evidence based and proven to improve the quality of life of people with arthritis, also known as Arthritis-Appropriate Evidence-Based Interventions (AAEBIs). Here are a couple of online OA exercise programs you can refer to your patients to get them started:
- AEA Arthritis Foundation Exercise:
aeawave.org/Arthritis/Arthritis-Foundation-Programs - My Knee Exercise Program:
mykneeexercise.org.au
Nonpharmacological Treatment Options
- Arthritis education
- Weight loss (if overweight)
- Increase physical activity
- Information regarding community-based resources
- Exercise (non-weight bearing on the affected joint(s))
- Assistive walking devices (e.g. cane)
- Corrective footwear
- Hot or cold therapy
- Referral to physical therapy and/or occupational therapy
(Source: Osteoarthritis Action Alliance)
Managing OA Through Diet
Many people with OA adapt their diet to include anti-inflammatory foods, such as fruits and vegetables, beans, whole grains, fish, and nuts. Also known as the Mediterranean Diet, studies confirm that eating these
foods have the following benefits:
- Lower blood pressure
- Protection against chronic conditions, such as cancer and stroke
- Helps curb inflammation
- Benefits joints as well as the heart
- Leads to weight loss, which lessens joint pain
Certain types of fish are good sources of inflammation-fighting omega-3 fatty acids, especially salmon, tuna, sardines, herring, anchovies, scallops, and other cold-water fish. Nuts and seeds are also great for inflammation. According to studies, we should consume 1.5 ounces of nuts daily. One study found that over a 15-year period, men and women who consumed the most nuts had a 51% lower risk of dying from an inflammatory disease compared to those who ate the fewest nuts. Nuts are jam-packed with inflammation-fighting monounsaturated fat. While relatively high in fat and calories, however, studies show that eating nuts promotes weight loss due to their protein, fiber, and monounsaturated fats.
Adding supplements to the diet is also a popular choice. However, supplements aren’t suitable for everyone with OA, and many doctors don’t recommend them to their OA patients due to a lack of clear evidence that they’re beneficial. However, the following supplements have been investigated by researchers to help in treating OA.
Curcumin. The active component of turmeric is curcumin, and it possesses potent anti-inflammatory and antioxidant properties. It can help reduce pain and inflammation in OA, which improves joint function.
However, curcumin might interact with blood thinners, resulting in the risk of bleeding. It can also affect the absorption of iron, and when taken in high doses, it can cause digestive issues, such as stomach upset and nausea.
Boswellia serrata. It’s been reported by a 2020 study that a particular composition of Boswellia serrata, a gum resin extract known for its anti-inflammatory properties, can reduce pain and improve mobility in rats.
Boswellia is generally safe but can cause gastrointestinal symptoms such as acid reflux, nausea, and diarrhea in some people. It might also interact with anti-inflammatory and autoimmune medications.
Vitamin D. Crucial for bone health, vitamin D may help people manage symptoms of OA. Having adequate levels of vitamin D is associated with lower risk of progression in OA.
However, vitamin D can interact with many medications, including steroids and weight loss drugs. When taken in excessive amounts, it can also lead to hypercalcemia (high calcium levels). Hypercalcemia can cause nausea, weakness, and kidney problems.
Omega-3 fatty acids. Found in supplements such as fish oil and flaxseed, they have anti-inflammatory effects that can reduce joint pain and stiffness in arthritis. High doses, however, can cause gastrointestinal symptoms, such as bloating, indigestion, and diarrhea.
S-Adenosyl-L-Methionine (SAMe). Research from 2020 shows that SAMe may have anti-inflammatory, pain-relieving, and tissue-healing properties. It may improve joint health and reduce the symptoms of OA. However, SAMe can interact with antidepressant medications and may not be suitable for those with bipolar disorder. The most common side effects are nausea, diarrhea, and headache.
Glucosamine. This supplement may promote the formation and repair of cartilage. Some studies suggest it can reduce OA pain and improve joint mobility, particularly in the knees. There have been numerous studies on glucosamine and OA, and they’ve produced conflicting results. So, doctors now recommend against using glucosamine for knee, hip, and hand OA. Glucosamine may interact with blood thinners and insulin medication. Side effects are mild, but may include GI issues and allergic reactions, especially in people allergic to shellfish.
Pycnogenol. Extracted from French maritime pine bark, pycnogenol has anti-inflammatory and antioxidant effects. It may help reduce pain and stiffness in OA. However, pycnogenol can interact with immunosuppressants and diabetes medications. Side effects are rare, but they can include dizziness, gut problems, and headaches.
Avocado-soybean unsaponifiable, (ASU). ASU is known to reduce inflammation and prevent cartilage breakdown.
Collagen. Taking collagen supplements may help improve OA symptoms by supporting cartilage repair and reducing inflammation. Collagen is considered safe for most people, although some may experience mild digestive side effects. Allergic reactions can’t be ruled out, especially if the collagen comes from a source a person is sensitive to such as beef, pork, and fish.
It is possible for your patients to slow down the progression of osteoarthritis. They can do this by making healthy lifestyle changes. Keeping a healthy weight, getting exercise regularly, eating anti-inflammatory foods, and staying hydrated will help fight inflammation and pain.
Checklist for Pharmacotherapy Consideration
- Patient has tried non-Rx (e.g. weight loss, increased activity, thermal modalities), but pain persists
- Arthritis education has been provided
- Current medications and supplements have been reviewed
- Medication allergies have been discussed
- Medical history has been discussed
- Acetaminophen (mild-moderate pain): Maintain <4 grams per 24 hours from all sources
- NSAIDS (OTC) – Assess patient for appropriate use and risk factors (GI, renal, CV, asthma)
- Recommend referral to PCP for further evaluation
(Source: Osteoarthritis Action Alliance)
Depression and Social Isolation
- One-third of people with arthritis over the age of 45 suffer from depression or anxiety.
- People with OA are likely at greater risk for depression because of increased disability and fatigue associated with their pain.
- People with doctor-diagnosed arthritis report more days in the last month of poor mental health (5.4 days vs 2.8 days for people without arthritis).
- Social isolation and loneliness are often evident among people with osteoarthritis and other chronic musculoskeletal diseases. There appears to be a bi-directional relationship with pain impacting social isolation and loneliness and vice versa.
(Source: Osteoarthritis Action Alliance)
More articles from the September 2024 issue:
- Vaccine Overview 2024-25
- Peripheral Artery Disease
- PBMs Exposed
- Cybersecurity in Your Pharmacy
- Diagnosing Alzheimer’s Disease
- Patient Medication Reviews
- A New Direction for Continuous Glucose Monitors
- The Prevalence of Osteoarthritis
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