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Osteoarthritis (OA) is a major cause of pain and disability in daily life, and a heavy healthcare expense as well. Both of these can cause significant distress and psychosocial impact.

Image Credit: joel bubble ben / Shutterstock.com

People living with osteoarthritis often have to make significant changes to their lifestyle. These changes may include:

• Knowing about OA
• Proper diet and exercise
• Changes in the way they do things
• Obtaining medical care as needed
• Use support resources for living with osteoarthritis

Knowing about OA

Most people with OA feel their joints are undergoing progressive breakdown without recovery, and that joint replacement is the only way out. This is largely because of discussions with medical professionals where the words “wear and tear” are used. Thus, they feel they cannot do anything to help improve joint function. This acceptance of a flawed model of biomechanical degradation of joint structure prevented their even recognizing that they experienced periods of improvement with few symptoms, and other periods of flare-ups, which could not be explained by this model. This may account for the often-perceived need to rest, pace activity and protect the joints and the poor adherence to exercise- and lifestyle-mediated improvements that actually reduce joint pain and improve joint function. Moreover, pain does not occur in direct relation to the joint damage or the activity undertaken. Such wrong concepts should be addressed during health consultations.

Exercise

Patients with OA should be encouraged to keep physically active. Regular exercise helps to improve the strength of the muscles that support the bones, and to maintain normal body weight. Excessive weight can lead to worsening of symptoms due to the extra load that the bones are required to carry. For this reason, patients who are overweight should be encouraged to work towards weight loss goals. Gentle but effective exercises like tai chi help improve core muscle strength and coordination to prevent falls. The incorrect expectation that exercise inevitably reduces the life of the joint with OA should be directly addressed.

A physiotherapist often participates in caring for patients with osteoarthritis. These professionals can recommend stretches and exercises that may be beneficial. These exercises should be completed regularly by the patient, usually several times each day.

Diet

A healthy diet is important for patients with a health condition such as osteoarthritis. It can help those who would benefit from losing weight. As always, a healthy diet would focus on increased intake of fresh fruit and vegetables, reduced consumption of processed foods, and cooking at home whenever possible.

Occupational and social life

People with severe OA may find that their symptoms, especially when they come on acutely and unpredictably, interfere with their ability to do their jobs properly and with social interactions. It is important to realize that an occupational therapist can help adapt one’s technique or recommend devices to help patients with OA do the same jobs with greater ease and less pain. This applies to activities of daily living and housework as well. For instance, using the largest and strongest muscles to do a task is an excellent way to reduce strain on the damaged joints – such as lifting heavy things by slowly straightening from the knees up rather than in a stooping position.

Aids to help with occupational or daily tasks, such as walking aids, must be obtained by prescription to ensure proper fit and training in their use – as otherwise, they may cause a higher risk of falls.

Patients who earn their living by manual labor may find it difficult or impossible to continue in their line of work if arthritis has progressed significantly. In such a case, finding other work may be very hard. This can precipitate financial crisis especially in families. Social support systems are crucial in relieving such financial distress and making it possible for the patients and their families to cope while they look for alternative means of livelihood.

Medical care

Depending on the severity of OA, patients may be prescribed medication to be taken regularly or as-needed to manage the pain and reduce joint damage. It is important for patients to be clear about how they should take their medications so that they are more likely to be adherent to the management plan.

Regular checkups should be part of dealing with this chronic condition, to avoid long-term preventable complications and to adjust medications as required. If the patient takes over-the-counter drugs as well, the doctor should be kept in the loop to avoid drug toxicity due to overdosage and drug interactions.

The best care is possible only with constant review of the patient’s condition and management plan. A positive patient-practitioner relationship is also important so that the patient can feel comfortable discussing concerns with the practitioner in an honest and open way.

Patients with OA should also be advised to take their annual flu shots, and the pneumococcal vaccine may also be beneficial.

If sleep quality is poor because of pain, it decreases the capacity to cope. This can cause worse symptoms and mood the next day. This symptom should be taken seriously and addressed properly.

Financial and social struggles

The expenditure related to living with OA is not negligible. Many people have reported having to spend heavily on medication, professional visits, medical tests, all having to do with healthcare, as well as on direct nonmedical costs like altering the house, getting private or community-provided support staff, and buying special equipment such as support bars. Indirect costs such as loss of wages due to disability or illness must also be factored in.

Older women spent up to a quarter more on community provided services compared to younger women, but the latter spent more than younger men on special equipment and medication. Expenses are heavier for older people with OA compared to younger patients, overall. At a period when many people depend on their pension for their financial support, this can be a significant drain.

Patients with OA who cannot work should be informed of their entitled benefits such as statutory sick pay, employment and support allowance, or payments to support assisted or independent living. Many patients do not have such a safety net, however, and the financial stress coupled with the loss of self-esteem and social standing further affects their coping ability.

Several patients with OA say it affects their ability to engage in sporting or outdoor activity, to play with younger relatives, to take part in family activities, and be part of social programs.

About 55% of older women and 11% of older men required and received help with grocery shopping, heavy housework, carrying heavy things, and transportation. This discrepancy could be due to the higher expectations placed on women by themselves and others regarding care and management of the household irrespective of the physical status.

About one in five said they had to make some changes in their living arrangements to cope with OA, such as changing house, making some renovations, taking up rugs, or rearranging the furniture. Flat comfortable footwear is important. Keeping a list of heavy or dangerous (for people with OA) housework on hand is a good thing to do as it lets people who drop in to help contribute exactly where such help is most appreciated.

Psychological and social support

It is important for patients to have a strong support network, with whom they feel comfortable discussing their day-to-day struggles and successes while living with osteoarthritis. This support may come from friends and family, a support group for people with osteoarthritis, or a trained health professional such as a counselor or psychologist.

Psychological support may come in the form of recognizing and dealing with catastrophization (focusing on and exaggerating negative or threatening aspects of a situation, and feeling helpless), and encouraging self-efficacy (“I can do this”), which is shown to reduce pain and disability.

This is particularly important for people who have experienced significant lifestyle changes as a result of the condition, which has caused or worsened symptoms of depression or anxiety. Depression is directly linked to inflammation, fatigue and pain. Support and encouragement from the people around them can help patients to maintain positivity and stay active with tasks that they can take part in, which in turn helps to maintain good mental and physical health.

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Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.