How to Manage Osteoarthritis and Prevent It From Becoming Debilitating
Although there is no cure and few treatments, with joint replacement as a last resort, there are ways to manage osteoarthritis. Photo: Silke Woweries/Getty Images
Linda Li, a 63-year-old Vancouverite, says she wouldn’t be surprised if she has osteoarthritis in her knees.
“It’s in the family,” she says,
Almost one in four Canadian women ages 60 to 64 have osteoarthritis (OA), and that number rises to one in three women aged 65 to 69. The OA rate is slightly lower for men, but still affects one in four men age 65 to 69.
It’s estimated that by 2035, one in four Canadians with be diagnosed with OA.
It’s the most common of 100 arthritic diseases that include rheumatoid arthritis, lupus, psoriatic arthritis and gout. It’s a progressive disease of a joint and most commonly affects the knees, hips, hands, feet, and spine.
Although there is no cure and few treatments, with joint replacement as a last resort, there are ways to manage OA and, in many cases, to prevent it from becoming debilitating.
Promoting a lifestyle that helps to regulate the disease is one of the reasons September has been deemed Arthritis Awareness Month.
Li knows all about how to manage OA and minimize its effects, and how to bring that information to Canadians.
She’s a professor and chair in arthritic diseases at the University of British Columbia medical school, a Canada research chair in patient-oriented knowledge translation and a senior scientist at Arthritis Research Canada.
“Being physically active is the first line treatment for knee osteoarthritis,” advises Li.
That may seem counterintuitive to people whose knees hurt even with minimal movement.
But the activity Li recommends is “anything that does not aggravate the pain for more than two hours afterwards.”
“It’s not uniform for everyone,” she notes. “For some people, if they’ve been jogging for a long time — or something they enjoy doing — they can jog, come home, and they may find their knees are more uncomfortable. But if two hours later the knees calm down, then that’s something they should continue to do.”
The best approach to staying active with OA, she says is to “do something you enjoy and use the pain as a guideline to judge whether that activity is good for you.”
Li enjoys walking. Her active lifestyle includes 45 to 60 minutes of walking almost every morning. Walking at any speed, she says, is helpful for knee OA.
It’s important to walk at a pace that is comfortable, she says. “Faster, where you work up a sweat is good aerobic exercise, good for the heart and lungs,”.
“But the important thing is that walking at any speed still works your muscles which support your joints.”
Also, walking helps to keep cartilage strong, she notes.
Cartilage is one of the first things that break down as we age because it doesn’t have a good blood supply. Working the muscles feeds nutrients into the cartilage, Li explains. “Putting pressure on the joint keeps the cartilage healthy.”
She also suggests that it’s not wise to wait for a diagnosis of OA before taking measures to manage it or to prevent its progress.
“We know that a lot of people are walking around with OA without knowing it, and only 40 per cent of people with OA actually have pain.”
It’s under-diagnosed because both ways of diagnosing it are problematic, Li explains.
“The first symptom you see on an X-ray is a bone spur. Before the joint starts to break down, the bone tries to repair itself, forming a bone spur. The joint gets bumpy and thick: those are bone spurs. But X-rays are two-dimensional and may miss it.”
Another approach to diagnosis is a set of self-reported symptoms, including pain. “It hurts when you use the joint but when you sit down, when you rest, the pain eases. Or when you get up in the morning, for the first five or 10 minutes you’re stiff. And later, if you don’t move for a long time, you get stiff. Those are classic complaints with OA.”
Li recommends the following programs for Canadians with osteoarthritis in the knee or hip joints:
The Canadian 24-Hour Movement Guidelines for Adults ages 65 years and older and the Canadian 24-Hour Movement Guidelines for Adults 18 – 64 years outline “an integration of physical activity, sedentary behaviour, and sleep.” They “offer clear direction on what a healthy 24 hours looks like for Canadian adults.” Li also suggests watching a short video on YouTube produced by Arthritis Research Canada about why it is a good idea to think about physical activity as something we do within a 24-hour day, instead of as a stand-alone entity.
The GLAD Canada program follows a successful Danish initiative. GLAD stands for Good Life with osteoArthritis in Denmark. It’s a fee-based education and exercise program that includes group training sessions and virtual sessions. Results, according to GLAD Canada, include a 15 to 29 per cent improvement in pain; over 30 per cent of individuals experiencing a marked improvement in activities of daily life and, sports and recreation; over 45 per cent of individuals experiencing a marked improvement in quality of life.