While arthritis is almost a certainty if you live long enough, pain and disability are not. In fact, only one third of people whose X-rays show signs of arthritis actually feel its effects. And only a minority of them eventually needs joint-replacement surgery.

"Most people can and should be able to take care of arthritis on their own," says rheumatologist Kenneth Brandt, M.D., professor emeritus of medicine and orthopedic surgery at Indiana University School „ of Medicine.

The key to gaining control of your arthritis is to: Become an expert patient. To expand your menu, Keefe recommends starting with a few easy-to-learn skills that provide fairly quick results. Mastering these fundamentals of self-care will build confidence, which is an essential ingredient when you're dealing with a chronic condition such as arthritis.


While the physical source of your pain might be a rough-looking area in your knee or hip joint, your experience of pain happens at least partially within the larger real estate of your brain. That means you can use your head to lessen your symptoms. Here are some strategies for doing so.

* Learn to breathe: Learning to relax through deep breathing can take your mind off joint pain - and thereby ease it. Abdominal breathing is the most basic relaxation exercise you can do. To learn this skill, lie on your back or sit comfortably. Place one hand on your abdomen, just above your navel, and the other on your upper chest. Breathe in slowly through your nose and try to feel your abdomen rising. Your upper chest shouldn't move much at all. When you have inhaled fully, breathe out slowly through your lips and imagine a balloon deflating. Continue breathing this way for five minutes, and try to practice daily. You can use this skill whenever you want to relax.

* Get loose: Muscle tightness is a common side effect of arthritis pain. Releasing the tension in your muscles at least once a day can ease this tightness. To learn this technique, lie down with your legs uncrossed, and rest your arms at your sides. Take a few slow abdominal breaths, and with each exhalation, imagine your body sinking more deeply into the surface you're lying on as the tension drains out of your muscles.

Step two of this exercise is to alternately tense and release your muscles, one muscle group at a time. Begin by tensing and then relaxing the muscles in your feet and calves. Then continue moving upward to your knees, thighs, and buttocks; your abdomen and chest; your hands and arms; your upper back, shoulders, and neck; and finally your face and head.

When you are done, simply remain still and rest for a few minutes. Mentally scan your body and notice if there is a residue of tension anywhere. Let it go.

* Tune in to your body: Keefe advises taking 10 to 20minibreaks throughout the day, scanning your body for signs of tension and then letting go. Traffic jams and checkout lines are great opportunities to do this. It's also helpful to take a minibreak just before doing an activity that causes pain, such as climbing stairs.

* Put mind over matter: Deliberately distracting you I is a useful way to get through brief but painful activities, says Lorig. If you find stair climbing difficult, try counting backward from 100 by threes as you go up the steps. Or mentally go through the alphabet, one letter per step, thinking of a boy's or a girl's name that begins with that letter.

* Go into a daydream: Like mental distraction, guided imagery is a technique for consciously refocusing attention away from pain and toward something else - in this case, a physical setting that gives you a sense of peace or happiness. That setting could be the beach or the forest, a garden or a waterfall.

Close your eyes and take three minutes to bring the setting to life visually. Then put yourself in the picture and walk through the landscape you've created in your mind's eye. If you are imagining yourself at the beach, don't just see the sky and the sand and the sea. "Listen" to the cry of the seagulls and the laughter of children. "Smell" the salty ocean spray. "Feel" the warmth of the sun and the grittiness of the sand. "People absolutely love this exercise," says Keefe. "In just three minutes they can get a respite from their pain."

* Take positive charge: Ruminating over your aching joints won't make the pain go away, and it can make you feel helpless, anxious, or downright depressed. In fact, negative self-talk - what psychologists call catastrophic thinking - is one of the best predictors of declining function in arthritis.

Be alert to any self-defeating statement that repeats itself in your mind. When you notice yourself making a negative self-1 statement, write it down on an index card. Then flip the card over and write down an honest, accurate comeback - a positive self-statement that reflects your capabilities. "It may sound silly," says Keefe, "but the patients who use this say it really works."

* Get Moving: Once you've built your mental self-care skills, get your body in on the action. According to Lorig, the benefits of exercise are a well-kept secret for too many. "People with arthritis tend to think they're so delicate and that if they exercise, they're going to hurt themselves," she says. "In fact it's pretty hard for them to hurt themselves. The most dangerous exercise that people with arthritis can do is to do no exercise at all."

That's because cartilage, bones, and muscles all require movement to stay healthy. A well-rounded programme that includes stretching, strengthening and aerobic activity is the best way to reduce pain and ward off disability.

If you've been sedentary for a long time or have severe pain, consider seeing a physiotherapist before you get started. A PT can evaluate your strength, mobility, and balance and prescribe a customized programme to help you exercise safely.

* Stretch your range: A well-rounded flexibility programme includes stretches for your neck, shoulders, arms, wrists, hands, back, hips, knees, ankles, and feet. You may find it helpful to join an aquatic-exercise class or schedule a session with a physiotherapist or a yoga instructor who is knowledgeable about the needs of those with arthritis.

You may find it easiest to do range-of-motion exercises after a warm bath or a shower. You can also incorporate stretches into daily activities such as watching TV. To get the circulation-enhancing, flexibility-increasing benefits of stretching, do these exercises every day.

* Build muscle: "Anybody with knee arthritis who came to see me would get a talk about strengthening the muscles," says rheumatologist Brandt. The muscles that surround the knee help lessen the load on the joints. Weak muscles may mean more pain and damage.

If you have knee OA, exercises that strengthen the quadriceps are especially important. These muscles, which run along the front of each thigh, help absorb shock, reducing stress on the knee joint. Squats, lunges, and step exercises are basic moves that will help bolster these muscles, which in turn will make walking, climbing stairs and other activities easier and less painful. However since the exercises need to be done correctly, consult a trainer before adding them to your regimen.

* Ramp up your heart rate: Studies have shown that walking and other aerobic exercises are as effective as strengthening exercises in reducing arthritis pain. They will also improve your mood and energy, help you sleep better, and keep you from becoming a Blanche DuBois - always relying on the kindness of strangers.

Walking is the most convenient form of exercise, and it doesn't require any equipment beyond a comfortable pair of shoes with well-cushioned soles. If you have any new pain after starting your walking program, consult a doctor, a physical therapist, or a podiatrist. When indicated, shoe inserts or prescription orthotics can improve your body mechanics to reduce stress on joints. Bicycling, aerobic dancing, and swimming are other good choices for aerobic activity. Aquatic exercise is ideal for people with arthritis because the water supports the body.

* Pace yourself: Exercise is important, but it's only half of the activity equation. The other half is rest. Keep an activity record for at least a week - noting what you did, for how long and how you felt afterward. Look for patterns in activity and pain. Then put yourself on a strict schedule of activity and rest, starting with a period of activity that is shorter than what you usually attempt. Forget about "No pain, no gain." The goal is not to work to the limits of your pain but to stop before pain starts. While cutting back on activity 1 may seem like a step backward, if you stick to this plan, you'll find that eventually you can do much more.


Being kind to your joints is one way of taking control. But when you can't kill the pain with kindness alone, it's probably time to add more-intensive pain-relief therapies to your regimen. Fortunately, as you'll see below, there are a lot of options, and not all of them come in a bottle.

* Heat and cold: Heating pads and ice packs are cheap, readily available options for arthritis pain. A good rule of thumb is to use heat before exercise to relax the muscles and to use ice afterward to reduce pain and swelling. Heat treatments should feel soothing, not uncomfortably hot. Ice should never be applied directly to the skin. A bag of crushed ice or frozen peas covered with a moistened towel is a simple compress. Never use heat or cold for more than 20 minutes at a time.

* Capsaicin: Another hot - really hot - pain remedy is topical capsaicin. The chemical that gives chilli peppers their heat; capsaicin alleviates pain by depleting a chemical in the nerves that transmits pain signals to the brain. Capsaicin cream doesn't work instantly - it takes applications for a couple of weeks - but many people find it effective.

* Paracetamol: According to the American College of Rheumatology, the first drug to try for mild to moderate arthritis pain is a Paracetamol. Studies have shown that for many people it does the job just fine - and with considerably less risk than most other pain relievers. When you start on a pain drug, don't stop other strategies for dealing with pain. If you don't have liver disease or other contraindications to paracetamol, experts recommend giving it a few weeks' trial. The standard dose for OA is 1,000 milligrams (mg), four times a day, but check with your doctor.

* NSAIDs: If your pain is more severe or doesn't respond to a trial paracetamol, it may be time to consider a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen or naproxen. When choosing an NSAID, there are a few points to bear in mind. First, there's no evidence any single NSAID is the most effective in relieving arthritis pain. Some people find relief with over-the-counter ibuprofen, while others do better with a prescription NSAID.

Second, NSAIDs, even over-the-counter varieties, can cause ulcers or potentially life-threatening gastrointestinal bleeding. To minimize risk, NSAIDs should be taken with food, at the lowest effective dose and for the shortest time possible. If you're over age 75 or have other risk factors for gastrointestinal bleeding, ask your doctor if you should take a drug to protect your stomach while you're on an NSAID.

The COX-2 inhibitor celecoxib (Celebrex) is less harsh on the stomach than other NSAIDs. Keep in mind that if you're taking low-dose aspirin to protect your heart, the stomach-protecting benefits of celecoxib will be canceled out. And as we noted in the article Pill-oried, if you have heart disease, celecoxib isn't recommended.

* Glucosamine and chondroitin sulfate: Many people turn to nutritional supplements for relief. The most popular supplements for arthritis pain are glucosamine and chondroitin. A recent study funded by the U.S. National Institutes of Health (NIH) indicates that this combination may be worth a try for some patients. The six-month trial, which compared subjects taking either glucosamine, chondroitin, or a combination of the two with those taking celecoxib or a placebo, found that only the COX-2 inhibitor celecoxib was better than the placebo in relieving knee OA pain in the overall patient population. For those with moderate to severe arthritis pain, however, only the combination of glucosamine and chondroitin sulfate offered some relief.

If you're allergic to shellfish, consult your doctor before taking glucosamine. Chondroitin may not be safe if you have a clotting disorder or take prescription anticlotting drugs. If you want to try the combination, pick a product that provides the same doses used in the NIH trial: 1,500 mg of glucosamine and 1,200 mg of chondroitin.

* Weight loss: Excess weight puts excess stress on the joints. If you're overweight, for every pound you lose, you'll subtract four pounds from the load your knees have to support. Some studies suggest that just a 15-pound weight loss can also subtract 50 per cent of your pain.


Not everyone with arthritis eventually needs surgery. But it the lull-court press of drugs and nondrug measures fails to alleviate your pain, surgery may be worth considering. Synthetic joints have come a long way since the first hip replacement was performed half a century ago. For one thing, they're more durable, being made of metal or plastic. A knee can last a decade or two, and a hip can last up to 30 years. Most operations are being done with smaller incisions than in the past, and the recovery is a lot more rapid. If all goes well, after a joint replacement, not only will you experience almost immediate pain relief, but also a dramatic improvement in your quality of life.

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