The 2023 Ultimate Guide to Arthritis

• Stay active: Low-impact aerobic exercises are an excellent choice for people with arthritis. They don't stress the joints while providing enough activity for managing arthritis pain and your overall health. Consider taking yoga classes or do stretches to protect your range of motion.
  
  Balance exercises are also very helpful, especially for people prone to falling. Incorporate backward walking, standing on one foot, or enroll in a tai chi class. Water workouts are also fantastic for arthritis because water absorbs the stress on your joints. Swimming or water aerobics are great options. 
• Start slow with activity: While staying active is one of the most important factors in managing arthritis, it's essential to gradually build your stamina and endurance. Do as much as your body allows you. If you start feeling pain, modify the activity to exclude the areas that hurt the most. Listen to your body signals. 
  
• Keep your weight in check: The bigger your body mass, the more strain on the joints. Regular exercise and a healthy diet will help you manage your weight. If you have difficulties finding the best way to manage your weight - including diet and type of exercise, consider taking a self-management education workshop. 
  
• Relieve pain by using hot or cold treatments: Hot treatments can help you relieve joint pain by easing the stiffness. Long, warm showers or baths during the day and electric blankets can provide pleasant warmth for your stiff joints during the night. 
  
  Cold treatments can help you manage the pain in your inflamed, swollen joints. Press a bag with frozen peas or a frozen gel compress on the achy joint shortly. 
  
• Explore herbal supplements: Although not enough scientific research has been conducted, many people with arthritis find that herbal supplements help them manage pain. Stinging nettle, turmeric, Boswellia, devil's claw, bromelain are just some options that help patients suffering from arthritis.  
  
• Talk to your doctor regularly: Update your doctor with your condition's development and ask them to help you determine the best diet and type of exercise. It would be best if you'd keep them in the loop. Let them know about the things you've tried and whether they were successful in your pain management. 
  

Addressing arthritis works best with an integrative approach, looking at sleep, diet, exercise, stress levels, and underlying health conditions that continue to perpetuate inflammation that sets up in the joints will keep recurring.

Practical advice for handling and improving arthritis:

Reduce Inflammation

• Sleep deep and restorative 7-8 hours: Sleep is how the body and brain power down and go into restorative mode. Lack of sleep can cause other body functions and inflammations to occur that can then lead to ischemic death (cell death).
  
  During the stages of sleep the body produces growth hormone (hGH). Low levels of growth hormone are linked to health issues such as fatigue, depression, mental fogginess and chronic pain. These symptoms are correlated with patients that have fibromyalgia and also have low levels of growth hormone.
  
  Growth hormone plays a role in repair of muscle, bone and the regulation of a variety or metabolic function including fat metabolism. 

Consciously do a body check and relaxation exercise to strengthen the mind body connection so that I can address any imbalances or aches.

• Stress relieving exercises, such as meditation: When you are stressed, the body releases stress hormones and other chemicals that trigger the nervous system into the fight or flight and inflammation. Mindfulness meditation can help bring calm and helps relieve inflammation in the whole body.
• Yoga and tai chi are mind body exercises that combine, mindfulness, movement, breathing, balance, stretching and coordination. They also address core strength and can be done by anyone.

Mobility and restoration of strength and function

• Exercise and movement: It is important to move your body for overall well being and keep ourselves coordinated and balanced. Exercise and movement helps to keep the muscle and tissue that support our joints to stay healthy. Studies show the benefits to exercise improves, sleep, mental, overall health and improves arthritis.
  
  Walking every day is a way to start. Work with a physical therapist or physiatrists that can give you specific exercises to target particular joints and you can measure improvement.
  
  The use of manual therapy. Mobilization, stretching along with strengthening exercises. Herbal and essential oils also can continue to relieve local inflammation.. 
  
• Acupuncture and acupressure: According to an NIH study one of the crucial benefits of acupuncture is that it can facilitate the release of certain neuropeptides in the central nervous system (CNS), eliciting profound physiological effects and even activating self-healing mechanisms. Acupuncture has also shown to provide immediate analgesic effect on pain, an increase in circulation and helps with tissue regeneration.
  In addition more acupuncture research has shown to help with immune regulation and an anti-inflammatory effect on the body.
  
  Studies have shown it to be beneficial in treating Rheumatoid Arthritis, because of the anti-inflammatory effect, antioxidative effect and regulation of immune system function.
  
  Extensive studies show acupuncture is very effective at treating pain and chronic pain conditions such as low-back pain, neck pain, and osteoarthritis/knee pain. 
  

• Exercise, especially non-aggravating exercise that takes the involved joint through its range of motion, has been shown to be beneficial in those with osteoarthritis.
• Manual therapy, for example mobilization, when provided by a trained health professional (e.g. chiropractor or physical therapist), can be effective for decreasing pain and increasing range of motion. 
• Weight loss is beneficial, as it reduces the stress on weight bearing joints of the lower extremity (e.g. the knee and hip).
• The use of non-steroidal anti-inflammatory drugs (NSAIDs), should be discouraged in favor of the aforementioned conservative options. In addition to complications from their use (e.g. gastrointestinal problems), NSAIDs may actually accelerate the progression of osteoarthritis in certain joints, for example the hip.

It is well recognized that chronic (long term) pain and depression are intertwined, so it is absolutely vital that an arthritis sufferer finds an activity they enjoy doing and CAN do regularly to help both the mind and body.
Everyone knows they SHOULD be doing regular activity but when you are faced with an increase in pain it must be a huge barrier to move more. Therefore if you love swimming, go swimming, if you enjoy walking then go walking but I also advocate mixing things up, so as you are swimming try a different stroke to normal, doggy paddle is a great stroke for adults to try! or when walking try a few sideways steps or longer steps than usual every now and then to encourage different areas of the body to be worked, which will ultimately help manage the arthritis.

As most arthritis is a hidden illness a massive part of the problem people face is the irregularity of the pain. The over activity/under activity cycle when pain levels are ok/poor really doesn't help long term management so forming good movement habits at home is key. I am a huge advocate of doing what you do but differently. So when you are sitting down watching your favorite Netflix series why not try squeezing your bottom cheeks together wherever you see the lead character! If you are walking to the toilet why not try walking backwards (be safe) or when on the toilet why not twist the opposite way to normal to wipe!! All these ideas serve to move the body in a different way to normal which is ultimately brilliant for the muscles and joints affected by arthritis. Movement variety is key in arthritis but always start little and often and see how your body responds before starting too many changes. 

An anti-inflammatory diet is an ideal diet for those living with RA. This is primarily due to arthritis being an inflammatory condition a diet rich in inflammatory foods can have significant implications. There are three primary food-types that should be avoided or reduced in the RA patient's diet; refined carbs and sugar, gluten, , and preservatives. Refined carbs and gluten are both highly inflammatory and can both trigger an arthritis flare or exacerbate the pain of a current flare up. One preservative in particular, monosodium glutamate (MSG), is a chemical added to many processed foods that is known to trigger arthritis flares as well.

Because rheumatoid arthritis is an inflammatory autoimmune disease it is easily exacerbated by consuming inflammatory foods like refined carbohydrates, sugar, and gluten. These foods and nutrients can create chronic inflammation of the body, especially the joints for RA patients, and can lead to painful flare ups of the condition. These food types are typically easily accessible processed convenience foods which are heavily relied upon in today's standard American diet, even those foods that claim to be healthy. By replacing these with unprocessed whole foods the RA patient can better mitigate their symptoms and reduce the likelihood of flare ups.

• Motion is Lotion: Quite simply one of the best ways to treat stiff arthritic joints is to keep them moving. Spending all day sitting or standing in one position is about the worst thing you can do for arthritis. Keeping the body active helps move the "joint juice" or synovial fluid in the joint. This fluid helps keep motions smooth and prevents structures from "sticking." In arthritis, this fluid can be harder to move around because the cartilage starts to wear down, making it look like "swiss cheese." The fluid can get stuck in the holes, and therefore make movement difficult. But remaining active will help circulate the fluid and prevent it from sitting in one spot.  
• Mobilize your Joints: Joint mobilization is different from normal motion. Joint mobilization is a technique used to manual glide the bones within the joint space to help stretch the joint capsule and other structures. This technique is best achieved when a professional, such as a physical therapist, applies the manual forces externally. By mobilizing the joint, it will then allow the muscles to move through more range of motion, allowing the joint to work at its full capacity. When we have arthritis, the joint can stiffen and motion is lost. But with a mobilization technique, motion can be regained and the muscles can be retrained to move through the new range. This will make the joints feel less painful and stiff.  
• Unload your joints: When we have arthritis the bones in the joints are closer together. Traction, or pulling them gently apart can unload the joint. This will help increase the fluid circulation, allow the bones to move smoothly, and help relieve pain. Traction can be done in many ways. One common technique used in physical therapy is long axis traction, when the PT literally pulls the leg while the person is lying on their back. This opens the joint and usually immediately provides pain relief. This traction can also be mimicked by walking in a pool with a floater belt. Letting the legs hang down while moving the legs in a walking motion can also often give relief of pain and stiffness.
• Don't Push Past Severe Pain: There is some truth in the statement, "no pain, no gain" but that is not always the case. When exercising with arthritis, pain may initially be felt in the beginning, but over a few minutes the pain should start to improve. If the pain continues or worsens, one should immediately stop the exercise. This pain could indicate a more acute injury within the joint and further inflammation in the area will worsen both the pain and the arthritis.  

Start with topical medications such as Bengay or Tiger balm something with menthol plus salicylate (Aspirin).

If that doesn’t cut it I’d step up to a topical NSAID either a prescription for Voltaren gel (diclofenac) or this can be found now over the counter.

Tylenol would be the next logical medication to try. I’d recommend extra strength at least 650 mg but up to 1000 mg per dose, not to exceed 2000 mg in a day. Some natural remedies that may also help include Tumeric, Cinnamon, and Fish oils which all have anti-inflammatory properties. Also over the counter, one can try NSAIDs such as Aleve or Ibuprofen. With these, I’d suggest the lowest dose for the shortest duration as they do have side effects such as excess bleeding, stomach ulcers, high blood pressure, heart disease, electrolyte disturbances, and kidney problems to name a few.

Other things you could try would be numbing medicines like lidocaine patches or ointments, these can also be found as a prescription-strength through your medical provider. The numbing medicines work especially well for back pain. Before turning to opiate pain medicines such as morphine or something stronger one could try prescription strength nonsteroidal anti-inflammatory drugs like Celecoxib which might be a little bit safer than the over-the-counter nonsteroidal anti-inflammatory drugs, however still pose risks. Also there are adjunct pain medicines that are prescription strength such as Neurontin or Cymbalta to name a few. These work especially well for neuropathy type pain (shooting numbing electricity like) along with a prescription strength hot pepper ointment called Capsaicin that can be rubbed on.

Other remedies your doctor may be willing to try include mild immunomodulator‘s such as methotrexate, or even steroids like prednisone. It is also wise to work with your doctor to make sure you don’t have some thing else besides typical arthritis such as rheumatoid arthritis, gout or lupus arthritis.

Lastly, sometimes if it’s a single joint that’s affected, a simple shot of steroid steroid plus a numbing agent or even things like platelet rich plasma injections may be options. It’s always essential to speak with your physician or provider about all the options the risks and benefits of each and individualized therapy to meet your needs.  

When your body starts attacking its own joints, the resulting inflammation and pain are more than frustrating, the physical and mental side effects are often downright defeating. Although this chronic autoimmune disorder can’t be cured, the good news is that there are ways to manage the pain and other resulting issues. In addition to over-the-counter anti-inflammatory medication like ibuprofen, your physician may recommend steroids or other prescriptions to help ease the pain. Icing inflamed joints or applying a hot pack can also help reduce the associated discomfort. You may also find that massage and exercise help to relieve arthritis pain, talk to your doctor about creating a workout and massage routine that works for you.

Arthritis has mental health side effects as well as physical side effects, a fact that is too often overlooked. The first step in conquering negative emotions or depression associated with arthritis is to educate yourself about the disease and get it into remission. This helps stave off some of the original feelings of helplessness that are common with a new diagnosis. If you still experience depression as the result of immobility and changes to lifestyle, talk to your doctor about anti-depressants and therapy.

Generally, coping with arthritis is best accomplished with professional advice. Every patient’s symptoms and pain are unique, so your treatment plan should be just as personalized.

My advice for arthritic seniors is not neglect their body's need for exercise. Arthritis has a large correlation with sedentary lifestyles, and with it comes deconditioning and weakening of muscles and bones. Joints become arthritis because the body lacks muscular strength to stabilize and reinforce the joint. Without this active reinforcement, joints wear down faster and arthritis pain worsens. So my best advice is to keep the body strong by dedicating time each day to exercise and resistance training. If this seems too painful and difficult, enlist a physical therapist to gradually increase your exercise progression gradually. Every ounce of prevention counts.

Poor posture is the leading underlying cause as well as aggravating cause of many daily damages such as: Muscle Fatigue, Sprains/Strains, Joint Changes (arthritic changes), Nerve Irritation ( pain/ numbness & tingling/ neuropathy) Skeletal Changes ( reverse neck/text neck & Disc injuries/ Bone Spurs) and early degenerative arthritic changes to the body.

It is always important to take care of your posture. Many people do not pay attention to that of their body. The main thing I can recommend is to change your habits that affect your posture.

For example, always make sure to sit at a 90 degree angle while working on your computer, sit up straight and invest in a posture corrector. With every inch you slouch you add 10 pounds of pressure on your spine.  

Arthritic pain can be greatly improved with acupuncture care. By increasing the circulation of blood and reducing inflammation, acupuncture causes a relaxation in achy joints. Many insurance plans now cover acupuncture.

Home care advice for arthritic pain is all about keeping it warm-- from hot baths to foot soaks warming up arthritic joints also increases circulation and reduces pain. Try a simple soak with Epsom salts- about 1/2 cup in a bucket of warm water, you can add essential oils like marjoram and lavender of 3 drops of each to make it feel even better. Soak arthritic feet or hands in the warm water for 15 minutes.

Another option for home care is diet- reduce inflammatory foods to help arthritic pain. Sugar is one of the top inflammatory foods and found in everything. Consider checking labels for added sugar and stick to whole foods over processed for reduced inflammation and less pain in your joints.