Supporting patient with arthritis

Community pharmacies can not only offer healthy living advice but also stock medication and supplements that give people relief from chronic pain.

Community pharmacists can be a source of knowledge to help individuals that may be suffering from joint complaints, this may be from the specific conditions such osteoarthritis, rheumatoid arthritis, gout or just general aches and pains that come from daily activities.

Osteoarthritis (OA) is the most common form of arthritis, affecting around eight million people in the UK. The condition is generally age-related, with joint pain and stiffness developing as the cartilage between the bones gradually wears away.

OA changes and the inflammation involved causes difficulty moving and considerable pain. Rheumatoid arthritis (RA) tends to affect younger people and is caused by the body’s immune system attacking the joints.

A recent report by the Health Foundation found that the cost of working days lost due to OA and RA was estimated at £2.58 billion in 2017 and is projected to rise to £3.43 billion by 2030.

With OA, the knee is the most often affected weight-bearing joint. OA occurs when the tissues in the joint become inflamed and the loads on the joint are excessive, resulting in degeneration of the cartilage and surrounding tissue. The result is pain, swelling and loss of motion. The condition is the leading cause of disability among adults and it affects nearly twice as many women as men with there is still no cure for it.

As a nation we tend to ignore our joints until they cause us problems, resulting in an increasing number of people taking long-term analgesics to control the pain or needing surgery to repair knees and hips.

Treatment guidelines followed by doctors in the UK recommend that people with arthritis are advised to maintain a healthy weight and keep physically active, while strengthening their muscles and protecting any damaged joints during daily activities.

Simple pain-killers are not without risk and the potential long-term side-effects of some of the most popular analgesics was recently highlighted by the UK’s National Institute for Health and Care Excellence (NICE).

While use of simple analgesics and non-steroidal anti-inflammatories (NSAIDs) can be reassuring and effective for those with muscular and joint pain, both groups of medicines may have side effects. For example, constipation and headache can occur with some analgesics, and indigestion and peptic ulceration with NSAIDs.

These side-effects can result in medicines not being taken correctly, limitation of dose or duration and, in some cases, lead to overt harm. Pharmacists can play a pivotal role in steering people with joint pain towards a prevention programme, promoting lifestyle and diet changes, including recommendation of clinically proven joint specific supplements.

Exercise

During a flare-up, the last thing a patient will probably want to hear from a pharmacist is for them to exercise.

However, experts suggest that whilst allowing your body to rest is essential when arthritis symptoms feel particularly intense, yet gently moving and continuing some form of activity is just as important.

The general advice is to focus on slow and gentle movement during a flare up, rather than stopping altogether. While everyone’s situation is unique, some activity will usually be better than none, and this could be something as simple as completing some light stretching each morning.

During a flare up, it’s important to advise patients to be gentle to their body and to avoid intense or impactful movement that can jar joints or put pressure on specific areas.

Diet

Versus Arthritis have funded over £5 million of nutrition-related research over the past ten years.

Their research shows that small changes to diet can lead to huge benefits for health and wellbeing. These changes can help people live well with arthritis and even reduce our risk of arthritis and other diseases.

Long-term studies by Verus Arthritis have found that a low intake of vegetables and fruits, or high consumption of red meat, increases the risk of developing rheumatoid arthritis.

Research has shown that eating a diet high in fibre such as vegetables and beans, and rich in healthy unsaturated fats like olive oil, helps keep our immune system healthy as we age. On the other hand, a diet high in processed meats and low in fibre makes our immune system age more quickly.

Eating high-quality protein from whole foods such as beans, dairy and fish is very important in maintaining joints and muscles. We know that as we get older, we need slightly more protein in our diet as our bodies find it harder to absorb it.

Living with obesity and being inactive make it even harder for older adults to build and maintain muscle, so keeping active is essential for healthy joints.

Versus Arthritis researchers found that eating enough of an amino acid called leucine (a building block of protein), is particularly important for musculoskeletal health. Good sources of protein that include leucine are foods like beans, corn, dairy, fish and meat.

Turmeric and ginger are often used for arthritis pain relief due to their anti-inflammatory properties. Curcumin, the active compound in turmeric, and gingerols in ginger, have shown promise in reducing inflammation and pain associated with arthritis. While research is ongoing, some studies suggest that turmeric and ginger, either individually or in combination, can be effective in managing arthritis symptoms.

Certain B vitamins found in dairy products and yeast have been found to be essential to reversing the effects of ageing in muscles.

Supplements

Joint health supplements are big business in the UK, with millions of pounds spent over the counter every year. People turn to these supplements for various reasons, but most are seeking relief from the symptoms of arthritis.

Omega-3 fatty acids have anti-inflammatory properties and are found in fish oils or formulated and sold as capsules or liquids.

Glucosamine and chondroitin are popular joint health supplements that are available individually or in combination products. The clinical evidence supporting the use of glucosamine and chondroitin is mixed with only marginal benefits observed in clinical trials. GP’s have therefore been advised not to prescribe these supplements on the NHS; some people however do feel they see benefits.

Vitamin D deficiency is common in patients with rheumatoid arthritis and can worsen their symptoms. For OA, vitamin D supplement has been shown to significantly decrease pain and improve function.