A senior client complained to me recently about pains and stiffness in his hips and knees. He said that he had these complaints especially during the nights when he got out of bed. He described the pain as 'deep within the joints', and 'like the living fire'. I recommended painkillers and suggested that if the pain persisted for longer than two weeks, he should consult a medical doctor. His doctor eventually diagnosed 'arthritis'.

Arthritis basically means joint (arthro-), inflammation (-itis). There are two major types of arthritis (osteo-arthritis and rheumatoid arthritis) and many, less common, arthritis-like conditions (for example, gout). Our focus will be on osteo-arthritis (OA), the most common type.

Breakdown of cartilage

Osteoarthritis is the result of a breakdown of cartilage, the strong rubbery material which cushions the ends of the bones. This breakdown results in friction in the joints, and the bone ends are not able to glide easily across each other when the joints move.

The joint becomes painful especially upon moving; movement becomes limited and swelling, warmth, burning, stiffness and joint deformity may be experienced. With further damage, the bones eventually scrape each other and the joint itself becomes damaged. Joints in the neck, lower back, hips, knees and fingers are most commonly affected by osteo-arthritis.

Treatment for osteo-arthritis is aimed at managing or eliminating the pain and discomfort, and minimising the deterioration of the joints. Surgery may involve replacing the joint (usually hip or knee) with artificial parts or cutting and resetting the bone.

Useful painkillers

Drug treatment includes the use of analgesics (painkillers) which are taken by mouth, applied in cream or gel form to the skin covering the joint or injected directly into the joint. They do not change the progress of arthritis but reduce inflammation, pain and swelling.

Two types of painkillers are commonly used:

1. Paracetamol, which reduces pain but not swelling, is most widely used and is relatively safe when used correctly.

2. Non-Steroidal Anti-Inflammatory Drugs (NSAIDS), include aspirin, ibuprofen, diclofenac, piroxicam, COX-2 Inhibitors such as celecoxib, etoricoxib and etolodac relieve pain, inflammation and swelling. The main side effects of NSAIDS are bleeding in the stomach, nausea and indigestion but taking them after food alleviates these effects COX-2 Inhibitors do not cause these side effects, sore throat, appetite changes, flatulence and slight increase in risk of heart attack recurrence have been seen.

Medication and surgery, though highly effective, are not the only measures. Here are some measures:

Eat properly and take supplements

A balanced diet including fruits and vegetables is beneficial to the health of joints. Taking supplements with vitamin D (such as cod liver oil), anti-oxidants such as vitamins C and E and selenium, may help to slow the progression of osteoarthritis and decrease pain. Glucosamine sulphate (500mg. three times per day) and chondroitin sulphate (400mg. three times per day) may be effective. But persons who are allergic to shellfish (a common source of glucosamine) and those allergic to sulphur should avoid these supplements.

Lose weight

Overweight persons with arthritis in weight-bearing joints such as the knees, hips and ankles should experience some relief in arthritis pain if they lose the excess weight.

Exercise

Rest is therapy for painful joints but too much is as bad as too little. Exercise is beneficial to arthritic joints and may cause increase in strength and flexibility of the joints. Injury is likely to occur if exercise is incorrectly practised.

A physiotherapist should be asked to design the appropriate exercise programme for the client. Methods to heat or cool the joints are also effective in pain relief and may be recommended by the physiotherapist.