- Causes of Fatigue in Arthritis
- Living with – Osteoarthritis
- Work and money
- Osteoarthritis Symptoms
- 7 Surprising Things That Can Make Knee Osteoarthritis Pain Worse
A successful treatment program for osteoarthritis may involve a combination of therapies tailored to your needs, lifestyle and health. Work closely with your health care provider to help create the most effective treatment for you.
In general, osteoarthritis treatment has three general goals:
Control pain through drugs and other measures.
Improve joint care through rest and exercise.
Maintain an appropriate body weight and achieve a healthy lifestyle.
In addition to the guidance of your primary health care professional, you may need care from a physical therapist, a rheumatologist (a physician who specializes in diagnosing and treating disorders that affect the joints, muscles, tendons, ligaments and bones) or a physiatrist (a physician who specializes in the diagnosis and management of injuries and diseases causing pain, loss of function and disability). Treatment plans often include the use of exercise, massage, heat, relaxation techniques, splints and braces and local injections to relieve pain.
Osteoarthritis treatment plans also often include ways to manage pain and improve function. Such plans can involve exercise, rest and joint care, pain relief, weight control, medications, surgery and nontraditional treatments.
If you are diagnosed with osteoarthritis, you may be prescribed a variety of medicines to eliminate or reduce pain and to improve functioning. Health care professionals consider a number of factors when choosing medicines for their patients with osteoarthritis. Two important factors are the nature of the pain and a drug’s potential side effects. You must use medicines carefully, and tell your health care professional about any changes that occur.
The following types of medicines are commonly used in treating osteoarthritis:
Nonsteroidal anti-inflammatory drugs (NSAIDs). Many NSAIDs are used to treat osteoarthritis. Patients can buy some NSAIDs over the counter (for example, aspirin, ibuprofen and naproxen). Other NSAIDs are available by prescription only. These drugs all reduce inflammation or swelling and relieve pain. However, each NSAID is a different chemical and can have slightly different effects in the body.
NSAIDs can cause stomach irritation or affect kidney function and blood pressure. Plus, there is the potential for cardiovascular events associated with the use of NSAIDS. The longer you use NSAIDs, the more likely you are to have side effects. Many other drugs cannot be taken with NSAIDs. NSAIDs are associated with serious gastrointestinal problems, including ulcers, bleeding and perforation. They should be used with caution in people over 65 and in those with any history of ulcers or gastrointestinal bleeding, congestive heart failure, renal insufficiency and hypertension. It’s important to ask your health care professional for safety information associated with pain relievers with your personal health history in mind.
A newer NSAID (called a COX-2 specific inhibitor) inhibits an enzyme (COX-2), which triggers pain and inflammation, while sparing an enzyme called COX-1, which helps maintain the normal stomach lining. Celecoxib (Celebrex) is currently the only COX-2 inhibitor on the market. Celebrex may increase the risk of heart attack and stroke; discuss these risks with your health care professional. For more information on the risks associated with Celebrex, visit www.fda.gov.
Recently, NSAIDs have become available in topical form in the United States. Such preparations are much safer to use because lower levels of medication reach the bloodstream, and they don’t pass through the stomach. They are less effective than oral NSAIDs, however.
Acetaminophen (Tylenol). This analgesic and fever-reducer (antipyretic) is not an NSAID and does not reduce inflammation. It is less likely to irritate the stomach than NSAIDs. Its availability over the counter, low cost and mild side effects make it a good choice for treating mild arthritis pain, but NSAIDS are usually more effective for patients with moderate to severe pain. Long-term use of acetaminophen taken multiple times daily may be associated with liver damage or inflammation of the kidneys (nephritis). Patients with liver disease and heavy alcohol drinkers should not use acetaminophen without first talking to a health care professional.
Health care professionals may prescribe several other medications for osteoarthritis. They include:
Tramadol hydrochloride (Ultram). Ultram is a prescription narcotic analgesic that provides pain relief for short-term acute flare-ups of osteoarthritis with fewer side effects than NSAIDs. Your health care professional may recommend tramadol in combination with acetaminophen for maximum pain relief.
Rubs and sprays (for example, capsaicin cream) applied directly to the skin.
Mild narcotic medications (opioids), which, while moderately effective, are potentially addictive and may have multiple side effects.
Corticosteroids. These powerful anti-inflammatory hormones are made naturally in the body or produced synthetically. Corticosteroids are typically injected into affected joints to relieve pain temporarily. This is a short-term measure.
Colchicine. This drug is often prescribed to treat crystal arthritis, which sometimes coexists with osteoarthritis. Colchicine may help people who have crystal arthritis (either pseudogout or gout), in addition to their osteoarthritis. People who have kidney or liver disease may be unable to use colchicines. Discuss benefits and risks with your health care professional.
Medicines used to treat osteoarthritis may have side effects, so it is important to learn about the drugs you are taking. Even nonprescription drugs should be reviewed. Certain patients may be at greater risk for side effects, such as those with a history of peptic ulcers or digestive tract bleeding, those taking oral corticosteroids or anticoagulants (blood thinners), those who smoke and those who consume alcohol. The risk of certain side effects in some osteoarthritis medications may be reduced by taking the drug with food. Some patients should avoid stomach irritants such as alcohol, tobacco and caffeine. Other medicines may be taken to protect the stomach lining by coating the stomach or blocking stomach acids. These measures help but are not always completely effective.
Other options for relieving the pain and damage caused by osteoarthritis include:
Viscosupplements. These medications use hyaluronic acid (or hyaluronate) to replace the synovial fluid that helps lubricate the joints, which is lost in patients with osteoarthritis. (Hyaluronic acid is one of the two natural lubricants in synovial fluid.) It is approved by the U.S. Food and Drug Administration for the treatment of knee pain in osteoarthritis patients who are unresponsive to nonpharmacologic measures and analgesic medications and who have significantly increased flares of inflammation or extensive inflammation. Even though FDA approved, controversy remains over the effectiveness of hyaluronic acid injections. The drugs, which include hyaluronan (Hyalgan) and hylan-GF-20 (Synvisc), are injected directly into the joint. These drugs are usually injected into the knee, but their use in other joints is being studied. Injections are typically given weekly over several weeks, and the pain relief may last for a few months. Because it is made from rooster combs, people with sensitivity to birds, feathers or eggs should not receive viscosupplements. Since the data on its effectiveness is mixed, hyaluronic acid is not recommended in most treatment guidelines.
Physical or occupational therapy. The goals of occupational and physical therapy are to preserve the use of your joints, restore lost abilities, maintain your fitness, help you adapt to new levels of activity and help you maintain the ability to partake in the activities you enjoy. Occupational therapy can teach you how to reduce the strain on your joints during daily activity, and physical therapy can teach you exercises designed to preserve and strengthen your joints. Some of the therapeutic methods available include rest during flare-ups; applying heat or cold; exercise, including water exercises, strength exercises and recreational exercise; specific exercise to help you prepare for or recover from surgery if surgery is prescribed; joint protection activities and exercises; and assistive devices, such as a bath stool in your shower or a shoe horn.
Surgery. A variety of surgical procedures are used to treat osteoarthritis including joint realignment, joint fusion, cartilage grafting and joint replacement. Surgeons may replace affected joints with artificial joints called prostheses, which can last about 20 years. These joints can be made from metal alloys, high-density plastic and ceramic material and can be joined to bone surfaces by special cements. A small percentage of these artificial joints may need revision, especially after years of use. Surgeons choose the design and components of prostheses according to their patient’s weight, sex, age, activity level and other medical conditions.
The decision to perform surgery depends on several factors: level of disability, intensity of pain, weight, interference with lifestyle, age, occupation and other medical conditions. Currently, the majority of osteoarthritis surgery cases involve replacing the hip or knee joint, but other joints can be replaced, including thumb joints, shoulder joints and elbow joints. After surgery and rehabilitation, the patient usually feels less pain and swelling and can move more easily.
When joint replacement isn’t an option, other types of surgery for osteoarthritis may involve realigning or fusing bones to increase stability and help decrease pain.
Discuss the benefits and drawbacks of surgery with your health care professional before you make a decision about whether it’s best for you.
Weight loss: Weight loss can reduce stress on weight-bearing joints, limit further injury and result in less pain and better function. A dietitian can help you develop healthy eating habits and a nutritional plan to promote weight loss.
Exercise. Exercise is frequently used to treat osteoarthritis, whether or not a patient is overweight. Exercise can improve mood and outlook, decrease pain, increase flexibility, improve the heart and blood flow, maintain weight and promote general physical fitness. It is also inexpensive and, if done correctly, has few negative side effects. The amount and form of exercise you can do will depend on which joints are involved, how stable the joints are and whether a joint replacement has already been done.
Exercise can produce generalized improvement as well as specific effects. When it comes to osteoarthritis of the knee, the level of muscle strength in the thigh muscle (quadriceps) and perhaps in the muscles around the hips are important. Strengthening these muscles can relieve symptoms. Walking can result in better functioning and increased walking distance.
In addition, there is evidence that yoga and tai chi can help reduce osteoarthritis pain. These alternative forms of exercise combine gentle exercises, stretching and deep breathing.
Ask your health care professional or physical therapist what exercises are best for you. Ask for guidelines on exercising when a joint is sore or if swelling is present. Also, check if you should use drugs, such as analgesics or anti-inflammatories, to make exercising easier, or if you should use ice afterward. An exercise plan should also include regularly scheduled rest. Learn to recognize your body’s signals, and know when to stop or slow down to prevent pain caused by over-exercising.
Supportive devices. Osteoarthritis pain can be so bad that you need a cane or splints to protect your joints and to take pressure off them. Splints or braces provide extra support for a weakened joint and keep the joint in proper position during sleep or activity. An occupational therapist or a health care professional can help fit you properly with a splint. Braces have been shown to be effective for knee osteoarthritis.
Alternative Therapies for Relieving Arthritis Pain
Relaxation techniques. Stress reduction and relaxation techniques, such as deep breathing, guided imagery and visualization (where you focus on “seeing” pleasant pain-free scenes or activities in your mind), may provide some pain relief.
Acupuncture. Acupuncture is an important component of traditional Chinese medicine. It involves the insertion of thin needles at specific points, which are mostly along the body’s nerve pathways, to improve health. According to the Arthritis Foundation, acupuncture may be useful as an adjunct treatment or an acceptable alternative treatment option for arthritis pain, working to help release tightened muscles, regulate the body’s nervous system to stimulate natural endorphins and alter the body’s perception of pain. Indeed, a clinical trial showed that acupuncture, when used along with conventional therapy, improved function and reduced pain in osteoarthritis of the knee. Individuals who want to use acupuncture should discuss their interest with their health care team and should receive treatment only from a licensed acupuncturist.
Nutritional supplements. Many studies have carefully evaluated the role of nutritional supplements in osteoarthritis.
Two supplements that have received a lot of attention regarding their potential benefits in people with osteoarthritis are glucosamine and chondroitin sulfate. Both are substances naturally produced by the body. The supplements are derived from animal tissue, specifically from crab, lobster and shrimp shells (glucosamine), and from animal (shark) cartilage (chondroitin). So far, studies on these supplements—when used alone and together—have shown few, if any, benefits. Therefore, the American College of Rheumatology does not recommend chondroitin or glucosamine for initial treatment of osteoarthritis. However, the College recommends that patients who are currently taking these supplements and experiencing improvements should not stop taking them.
The FDA does not regulate glucosamine/chondroitin or other food supplements, as it does over-the-counter medications and prescription drugs. If you are considering trying one or both of these supplements, check with your health care professional first. Side effects associated with these supplements include increased intestinal gas and softened stools. If you experience these problems, you might want to try another supplement brand before you stop using them altogether.
Certain vitamins have been linked to joint health, particularly vitamins C, D and K. There is no good evidence that vitamin C slows the progress of osteoarthritis, but more research is needed on vitamins D and K.
In addition, some controversial studies show oils found in avocado and soybeans, called avocado-soybean unsaponifiables (ASUs), may slow cartilage loss and actually help repair cartilage in hip and knee joints when taken orally.
Products and reports about nutritional supplements claiming to provide pain relief should be viewed with caution until more studies can be conducted. Discuss your interest or questions about such products and reports with your health care professional.
Transcutaneous electrical nerve stimulation (TENS). TENS is the application of electrical stimulation from a small device to the nerve endings that lie below the skin for pain relief. The use of TENS in people with osteoarthritis is controversial. A 2015 Cochrane Review concluded that TENS can reduce pain “over and above that seen with a placebo.” Other past studies have not shown a benefit.
Biofeedback. Biofeedback is a way to enhance a body signal so that you are aware of something that usually occurs at a level below consciousness. An electronic device provides information about a body function (such as heart rate) so that you can learn to control that function. If you have arthritis, biofeedback can help you learn to relax your muscles. In this case, an electronic device amplifies the sound of a muscle contracting, so the arthritis patient knows that the muscle is not relaxed. The therapy is typically learned with the help of a health care professional and then practiced at home, either with the use of a biofeedback machine once the patient has mastered the technique, or without one.
While many osteoarthritis risk factors—being female, older and having other diseases that affect the bones and joints—cannot be changed, you can work on several other risk factors to lower your risk of developing the condition:
Obesity. Losing extra weight and exercising can help people with osteoarthritis. Most importantly, weight loss may reduce the risk of developing osteoarthritis of the knee in overweight or obese people.
On-the-job injuries. Taking precautions to avoid repetitive joint use and resulting joint injury in the occupational setting can help prevent osteoarthritis.
Sports injuries. Using recommended prevention strategies (warm-ups, strengthening exercises and appropriate equipment) helps to avoid joint injuries and damage to ligaments and cartilage, all of which can increase your risk of osteoarthritis.
Causes of Fatigue in Arthritis
- Medication side effects. Several medications, including some you may take for arthritis, can cause drowsiness or fatigue. Common culprits include certain antidepressants; blood pressure medication; narcotic pain relievers; some prescription NSAIDs; and certain DMARDs, such as azathioprine and methotrexate. Corticosteroids may cause daytime tiredness by keeping you awake at night.
- Inactivity. The more you lie around, the more exhausted you feel. Unused muscles – including the heart muscle – can weaken, and you get tired more easily. A 2017 study published in Scandinavian Journal of Medicine & Science in Sports found that people with fibromyalgia who spent less time sitting and more time doing light physical activity had lower levels of fatigue and pain than those who were inactive.
- Anemia. Fatigue in arthritis may be caused by anemia – a shortage of red blood cells. Without enough red blood cells, your muscles get tired fast, resulting in fatigue. Up to two-thirds of people with arthritis have a condition called anemia of chronic disease, which occurs when inflammatory chemicals interfere with the body’s production of red blood cells.
- Lack of Sleep. Fatigue may be triggered by insomnia and unrefreshing sleep. Getting into a comfortable position or staying asleep can be a challenge when joints are swollen and sore. Tossing and turning in bed or waking up repeatedly is a reality for some people with arthritis pain. Sleep apnea, a condition in which breathing is interrupted during sleep, can also contribute to poor sleep.
- Obesity. Being very overweight can cause sleep apnea or other sleep problems, resulting in daytime fatigue. But studies show that obese people with no sleep disturbance are also fatigued. Lack of exercise, using extra energy to move more bodyweight and metabolic changes that often accompany obesity also contribute to fatigue.
- Poor nutrition. Not getting adequate and healthy food and fluids can be causes of fatigue that fly under the radar. Your body needs plenty of water, vitamins and minerals to operate efficiently. If you love junk food and don’t drink enough water or other healthy beverages, your fatigue could be from dehydration and vitamin deficiency.
- Depression. Arthritis pain can take you away from doing the things you enjoy, so it’s no surprise depression often goes hand in hand with the disease. Research shows depression may also result from changes in your hormones and brain caused by dealing with the stress of a chronic illness.
- Loss of muscle mass. When you lose muscle tissue, the remaining muscles have to bear the burden of moving your body. Loss of muscle can come from inactivity. But some people with severe inflammatory arthritis have a condition called cachexia, in which muscle mass decreases and fatigue increases.
- Other medical conditions. Having arthritis increases your risk of other health problems, such as heart disease, lung disease, diabetes and inflammatory bowel disease – all of which can be associated with fatigue. Other conditions not specifically related to arthritis may also lead to fatigue. These include infection, liver or kidney disease, thyroid disease and chronic fatigue syndrome.
Work and money
If you have severe osteoarthritis and are still working, your symptoms may interfere with your working life and may affect your ability to do your job.
If you have to stop work or work part time because of your arthritis, you may find it hard to cope financially.
You may be entitled to 1 or more of the following types of financial support:
- if you have a job but cannot work because of your illness, you’re entitled to Statutory Sick Pay from your employer
- if you do not have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance
- if you’re aged 64 or under and need help with personal care or have walking difficulties, you may be eligible for the Personal Independence Payment
- if you’re aged 65 or over, you may be able to get Attendance Allowance
- if you’re caring for someone with rheumatoid arthritis, you may be entitled to Carer’s Allowance
You may be eligible for other benefits if you have children living at home or a low household income.
The symptoms of OA vary from person to person. Some people may only have mild pain and swelling. Others may experience joint damage that significantly affects their quality of life. OA of the knees, in particular, is a major cause of disability in the United States.
For most people with OA, stiffness is worse in the mornings. It is usually also worse after periods of inactivity or rest. At these times, joints may feel:
- hard to move
Soreness and aching pain are common symptoms of OA. Muscle pain can also occur in the surrounding tissue. Usually, pain, like stiffness, is most intense after sleep or a period of inactivity.
Some people with OA feel more pain during movement of the joints and less pain when at rest. Over time, the pain may occur even when the joints are not used.
Joint tenderness, sensitivity of the joints to touch, can also occur in people with OA.
Pain and tenderness can be caused by:
- bones rubbing against each other
- inflammation in the joints
- bone spurs (bony growths)
- pinched nerves caused by swelling and displacement of joint tissue
Swelling is more common in people with RA than OA. However, people with OA also experience swelling. Swelling is the body’s reaction to irritants, such as bone on bone contact. It contributes to the stiffness and pain experienced by patients with OA.
Loss of flexibility and range of motion
According to the CDC, about 80 percent of people with OA have some problem with range of motion. About 25 percent need assistance with daily living activities. They may need help with:
- putting on shoes
- getting in and out of chairs
- climbing stairs
Bone spurs are small bony projections. They can occur naturally, but they may also be a response to inflammation in a joint. Bone spurs, also called osteophytes, can sometime be felt as hard little lumps around joints affected by OA. They are not painful in and of themselves. However, bone spurs can rub against nearby nerve and bone, causing additional pain.
People with OA often have to exert extra physical effort in order to carry out the basic daily tasks of living. This can cause fatigue.
Inflammation is caused by chemical mediators called cytokines. They can also cause fatigue.
Many people with OA hear sounds in their joints when they move. Their joints may make noises such as:
These noises are often accompanied by discomfort or pain.
Depression and/or anxiety
People who suffer from OA are at an increased risk for anxiety and depression. Chronic pain from OA can cause a great deal of stress, as can the disability that often results from OA.
Having healthy coping mechanisms in place can reduce the risk of depression and anxiety.
Fever is not generally a symptom of OA. However, extensive inflammation can cause a low-grade fever.
7 Surprising Things That Can Make Knee Osteoarthritis Pain Worse
When you live with osteoarthritis — the most common type of arthritis — knee pain and stiffness can seem difficult to avoid. Your knees and other joints may feel swollen, especially after being active, and the symptoms can worsen over time. More than just “wear and tear” on your joints, osteoarthritis is a joint disease.
Some of the factors that can worsen knee osteoarthritis pain won’t come as a surprise. For example, if you’ve had a long career working at a job that requires you to stand for extended periods of time, bend a lot, or lift heavy objects, this can impact your cartilage, or the connective tissue in the joints between bones. When cartilage wears away, this causes swelling, pain, and trouble moving the knee joint. Athletes who sustained injuries, even long ago, can also be at risk for faster cartilage breakdown and osteoarthritis.
As osteoarthritis progresses, the knee and other bones may break down and develop what are called spurs, which are growths around the bone’s edges. Little pieces of bone or cartilage can also break off and float around in the knee joint, according to the Arthritis Foundation. In the later stage of osteoarthritis, the cartilage between the knee bones wears away completely, causing bone to rub against bone, which can lead to even more pain as well as joint damage.
An important part of managing osteoarthritis knee pain is working with your doctor. Talk to your doctor about your symptoms and when you feel knee pain most often, such as first thing in the morning, or during or after being physically active. You will also want to speak up if your pain is worsening. Although there are medications and surgery available for osteoarthritis, the best treatment for you may be different than that of someone else with the condition.
What’s more, controlling pain from osteoarthritis of the knee may be easier than you think. In fact, it could be a simple as taking an honest look at your daily habits, some of which may be triggering your joint pain. “People with osteoarthritis have a lot of control over behaviors that can help to reduce pain symptoms,” says Matt Garver, PhD, an exercise physiologist and an assistant professor in the department of nutrition and kinesiology at the University of Central Missouri in Warrensburg. Often a mix of different approaches is most helpful for osteoarthritis.
Is your lifestyle contributing to your osteoarthritis pain? Find out if these habits may be harming your knee joints.