Arthritis, inflammation and how to avoid pain

One in 5 Australians over the age of 45 has osteoarthritis. The latest science reveals inflammation causes the pain, not wear and tear on the joints. Paula Goodyer explains the best way to tackle it.

By Paula Goodyer

Let’s reboot our thinking about osteoarthritis - it’s less about ‘wear and tear’ on our joints and cartilage and more about inflammation.

Or so say Tasha Stanton, a spokesperson for the Australian Physiotherapy Association and Associate Professor in Clinical Pain Neuroscience at the University of South Australia.

“We now know that a main driver of both osteoarthritis and pain is inflammation, and if we can tackle the processes that cause it, we can help prevent or reduce the impact of arthritis.”

If you’re feeling pain or stiffness in your hands, big toe, knees or hips or wondering why your joints make clicking noises, feel like they grate or have become inflexible, then it’s worth a trip to the doctor.. 

Only a doctor can diagnose osteoarthritis, but it’s a remarkably common condition.  

The trouble with inflammation - and why it’s a pain

Sometimes inflammation stares us in the face - like the swelling around a splinter or an injury.  
But the inflammation that contributes  to osteoarthritis is invisible: a chronic, low grade inflammation that simmers in the body over time, often triggered by things we can control - sedentary living, smoking,  poor diet, lack of sleep, stress and gum disease are some.

“There’s evidence that staying physically active, along with a healthy diet, helps reduce inflammation - and this can help reduce pain. High levels of inflammation can increase the sensitivity of the pain system so if we develop osteoarthritis, inflammation can make it feel more painful,” says Tash Stanton. 

“While it’s true that injuries to the joint can damage cartilage, we don’t think they alone always cause pain - there’s evidence that you can have changes to the joint that would be classified as osteoarthritis yet still have no knee pain.

“It’s likely that changes to your joint can predispose you to pain - but it’s inflammation that ensures you feel pain.”

Keeping off kilos helps prevent inflammation - and osteoarthritis

Being overweight is another cause of inflammation - and another reason to move more and stick with healthy eating. Read more in Citro’s longevity guide.

The extra load that weight puts on joints like knees is only one reason why being overweight causes joint problems. 

There’s also damage to cartilage caused by inflammatory chemicals produced by surplus fat around the waist, explains Professor Flavia Cicuttini, head of rheumatology at Melbourne’s Alfred Hospital and of Monash University’s Musculoskeletal Unit.

"We hear a lot about the need to lose weight but the emphasis should be on preventing weight gain in the first place,” she stresses. 
“On average, Australians gain around half a kilo a year up until the age of 55. It’s easier to avoid gaining that weight than to try to lose 5 or more kilos 10 years later. New obesity drugs are already changing how we deal with obesity, but by the time someone has developed knee pain and then tries to lose weight, there’s already been significant damage to the knee joint. 

Osteoarthritis develops slowly over decades, so tackling excess body fat and the damage it causes to joints needs to start early.”

What makes exercise so good for preventing and managing arthritis?   

“The idea that osteoarthritis is all about wear and tear can make people fearful of exercise - yet you can improve osteoarthritis pain by exercising", says Associate Professor Stanton.

“Cartilage has no blood supply so it needs to get a different form of nourishment from synovial fluid - fluid that also helps lubricate the joint - and exercise helps to transfer nutrients from the synovial fluid to the cartilage and help maintain it.”

“If you have an episode of pain, then try to reduce pain with a knee support or using walking poles or a walking stick -  but try not to stop being physically active, “ Professor Cicuttini adds. “It’s important to maintain muscles around the joint to help support it - but muscle wasting can happen quickly if we’re inactive.”

What kind of exercise is best for osteoarthritis?

“That’s still not clear - research so far hasn’t found that one particular exercise stands out.  I advise people to walk - it’s generally easy to do and it works,” she says.

Speak to your physiotherapist or trainer to find out more about the best type of exercise - often low impact exercise like swimming or cycling are recommended, but all physical activity will help. Citro also has a story on Nordic walking, which is also helpful for people with joint pain.

Running can be good - not bad - for knees.

The idea that running is bad for knees lingers on - but that’s not what the science says. 

“Studies have found that running may be protective against knee osteoarthritis and is linked to fewer knee problems. There’s also some evidence that running can improve the health of cartilage and joints,” Tasha Stanton says.

“But it’s still important for long distance runners to pace themselves because when we run it causes temporary changes to the cartilage. The cartilage becomes less thick as water is forced out by compression caused by running - but goes back to normal within 24 hours. This means that if you’re training for a big race it’s best to build up the distance slowly with plenty of rest in between runs,” she adds. 

Why caring for your heart is good for your knees 

There’s an intriguing link between osteoarthritis and blood vessel health - and it also explains why research by Professor Cicuttini found that taking cholesterol lowering medication slowed the progression of knee damage.

“Many studies have found that people whose arteries and smaller blood vessels are damaged, from a build up of plaque, for example, are more likely to have osteoarthritis",she says.

“It’s likely that this affects the circulation in small blood vessels in joints such as the knee, eventually resulting in damage to the joint. It’s similar to the picture we see with dementia where damage to small blood vessels in the brain contributes to vascular dementia.

“But if we can tackle the risk factors for heart disease and keep blood vessels in good shape with regular exercise and healthy food, we can probably reduce overall knee joint damage in the community.“

"The link between blood vessels and osteoarthritis also means that knee twinges could be a nudge to get a health check", she adds.

“See your GP and get blood pressure, weight and cholesterol checked as well as your knees because people with osteoarthritis have twice the risk of heart disease.”

Does inflammation cause hand arthritis too?

"Hand osteoarthritis can affect one in 2 women and one in 4 men by the age of 85, making it harder to do everyday things like preparing food and getting dressed. But despite a widespread belief that hand osteoarthritis isn’t an inflammatory condition, that’s not correct," says Flavia Cicuttini. 

“Studies have found that inflammation is common in hand osteoarthritis and that it’s associated with pain and joint damage” she explains. “One form of inflammatory hand osteoarthritis can also develop in women around menopause, although it’s not clear why.”

But there’s hope for relieving the pain of the condition. Professor Cicuttini and other researchers recently found that a medication for rheumatoid arthritis called methotrexate  improved pain in people with hand osteoarthritis.  

“Anyone interested in methotrexate should talk to their GP. We still need more research to find out how long it’s effective for, who’s most likely to benefit and whether it reduces damage to the joints,” she says.

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