Arthritis, the swelling and tenderness of one or more joints resulting in pain and stiffness, affects four million Australians and is the leading cause of chronic pain and second most common cause of early retirement due to ill health, according to Arthritis Australia.
The peak body, whose mission is ‘freedom from arthritis’, says the chronic health condition accounts for about 13 per cent of the total burden of disease in Australia.
Of the many types of arthritis, the most common are osteoarthritis (OA), rheumatoid arthritis (RA) and gout.
According to the Mayo Clinic, OA leads to the breakdown of cartilage, RA is a disease in which the immune system attacks joints, and gout is a condition caused by the build-up of uric acid crystals in the joint(s).
The Mayo Clinic lists the common symptoms of arthritis as including pain, stiffness, swelling, redness and a reduced range of motion.
It lists the risk factors as including family history (genetics), age (risks increase with age), gender (women are more likely to develop RA, while men are more likely to develop gout), previous sports injury and obesity.
Pharmacist and herbalist Gerald Quigley says most risk factors for developing arthritis are related to inflammation.
“Now, that doesn’t happen in all instances,” he said, “but it certainly is an underlying fact. So, if you can control or reduce the level of inflammation and the cause of that inflammation, you can increase a person’s quality of life enormously.”
Underscoring the importance of lifestyle measures, Mr Quigley says these need to be identified and addressed to manage arthritis.
Elaborating on the main causes of arthritis, he says OA is “essentially a degenerative disease” that can occur from overuse injuries or joint trauma, or from “being overweight, which puts extra pressure on knees and hips”.
“RA is a different thing,” Mr Quigley said, “it’s an autoimmune disease. This is where, essentially, the body attacks itself, and the reasons for that can be multiple. It could be a food allergy, an injury, a stressful event where your immune function gets turned inside out.”
Regarding gout, he says that because it’s related to uric acid levels, certain foods should be avoided to reduce the production of uric acid.
The role of diet and lifestyle
Experts agree that a major role in reducing inflammation to help ease the pain and discomfort of arthritis is played by diet – eating healthy foods while limiting highly processed, high-fat, and high-sugar foods.
With one of the risk factors for arthritis being obesity, maintaining a healthy weight through healthy diet and lifestyle measures is also important.
Mr Quigley says that while reducing fat, salt and sugar intake is important, he also advises that certain vegetables, particularly those from the nightshade family, such as potatoes, may also contribute to arthritis-related pain. An acute flare-up of pain, he adds, “could be linked to something you’ve eaten, and it’s worth investigating”.
“We’re just beginning to understand a lot more about this,” he said. “So, being as healthy as you can be and controlling stress as well as you can and getting adequate sleep regularly – these are fundamental in controlling inflammation. It’s all about controlling that fire.”
Dr Joyce Haddad, Accredited Practising Dietitian and Director of ‘A Dietitian’s Mission’, an online and face-to-face consulting business, says diet and the quality of the food we eat are “definitely a priority” when it comes to managing chronic conditions such as arthritis.
She points to certain foods that fight against pathogens and oxidative stress, which causes inflammation, and emphasises the importance of focusing on ensuring that one’s diet is “high quality”.
“A high-quality diet isn’t anything new,” she said. “The same foods on an anti-inflammatory diet are generally considered the healthy foods that we hear promoted all the time. What we need to do is be focusing on a whole range of fruits and vegetables in our diet [and] lowering our intake of processed foods.”
In terms of specific anti-inflammatory diets, Dr Haddad recommends the Mediterranean diet.
“The Mediterranean diet has definitely been the most studied, and has shown the most consistency with reduced disease risk, including inflammation and having any chronic disease or any type of diseases causing inflammation in the body,” she said.
“There’s research to show that the Mediterranean diet is linked to lower inflammation, and that’s joint health. This is because it’s really high in fruits, vegetables, nuts and wholegrains, fish and healthy oils … [It’s] a good starting point.”
Simran Grover, Accredited Practising Dietitian and spokesperson for Dietitians Australia, agrees, saying that when it comes to overall health and wellness, “holistic diets that are based predominantly on the Mediterranean diet and on traditional foods are the way to go”.
Addressing weight loss specifically, she says that for anyone with joint issues who is overweight/obese, “slow weight loss of half a kilo to a kilo is the key to success” because there’s a greater chance of keeping it off. The weight-loss mission, she adds, is all about staying focused and motivated with healthy lifestyle changes, and “not thinking of it as a race to get to the other end but more of a lifestyle choice”.
Pointing to specific nutrients, Dr Haddad says that when it comes to aiding inflammation, “omega-3 fatty acids have been thoroughly studied because of their anti-inflammatory properties”.
“The studies have shown that the intake of omega-3 fatty acids is associated with reduced disease activity,” she said, adding that healthy fats such as omega-3 fatty acids help to improve how joints feel, and reduce inflammation, redness and pain, leading to reduced “over-the-counter pain relief”.
Addressing the importance of antioxidants, Dr Haddad says that while these are abundant in fruits and vegetables, to achieve the level of antioxidant intake we need, dietary variety is required – including as much colour on our plates as possible.
“A different colour of plant-based food will give you a different antioxidant,” she said, “and the [bigger the] range of antioxidants you have, the more power they have to work together to fight off these pathogens that cause that oxidative stress.”
Looking at gout specifically, and foods that contribute to raised uric acid levels, Dr Haddad cautions against a high intake of meat, seafood and alcohol, particularly beer.
“It’s about finding that balance,” she said, adding that research has suggested that highly processed foods and sugar-sweetened beverages may lead to gout attacks as a result of the inflammation they cause in the body.
In terms of vitamins, minerals and supplements (VMS) for managing inflammation, Mr Quigley says turmeric is the “Rolls-Royce” of anti-inflammatories, and, based on research, it’s clinically proven, doesn’t have any significant interactions and “can be used with confidence”.
He also points to glucosamine’s role in helping “cartilage production”, while he advises that, for other joint issues, such as bursitis, MSM (methylsulfonylmethane) may help.
Diet comes first, but supplements can help top things up. Mr Quigley recommends capsules over tablets, as capsules are “more easily absorbed and easier to swallow”. He gives the example of glucosamine, and favours taking a 750mg glucosamine capsule twice a day, although he advises that personal preferences must be considered before such a course is adopted.
According to Dr Haddad, “supplementation is the cherry on top” of a healthy, well-balanced diet, but there are times when VMS are beneficial. She points to the benefits of vitamins A, B and C as antioxidants, along with garlic, onions, ginger, cinnamon and turmeric.
“These are all quite potent in their anti-inflammatory ability,” she said. “Then we’ve got a particular antioxidant, resveratrol [which is found in] purple foods like grapes, blueberries, or the skin of eggplant. That’s a good anti-inflammatory supplement.”
Adding to the VMS conversation, Ms Grover advises caution, and that one shouldn’t expect that a negative health condition will disappear simply through taking a supplement. VMS, she says, should just be “supplemental to your diet” and tailored to the individual.
“For example,” she said, “when I’m working with a frail client who’s doing her best [but she’s] undereating, then yes, I’ll tailor a supplement towards her and [suggest] a multivitamin,” Ms Grover said. “But if I see a man in his 50s, very capable of eating well, I would potentially say, yes you can have an omega-3 [if] you don’t eat fish [and I may suggest] glucosamine as it’s helpful, and vitamin D … but you don’t need a [blanket] multivitamin.”
How pharmacists can help
Commenting on the role of pharmacists in helping customers with arthritis, Mr Quigley encourages pharmacists to ask questions and get involved.
“If someone walks in and they complain about a sore joint, ask questions,” he said. “How long have you had the problem? What are you doing about it? What exercise are you able to do?”
Mr Quigley says it’s important to gain customers’ trust, ask for regular updates and help them regain their quality of life.
This feature was originally published in the October issue of Retail Pharmacy magazine.
