September is Arthritis Awareness Month – a timely reminder for the millions of seniors facing daily joint pain. One in three adults over 65 deals with arthritis (especially common in women). Arthritis isn’t just one condition – it’s actually an umbrella term for over 100 different joint diseases. Osteoarthritis accounts for the vast majority of cases you’ll encounter, affecting your hands, spine, hips, knees, and feet. While inflammatory arthritis like rheumatoid arthritis is less common (affecting 3-4% of those over 70), osteoarthritis is what we’ll focus on today – the more you understand it, the better you manage it.

Forget what you’ve heard about running and exercise “wearing out” your joints. Here’s the surprising truth: moderate exercise such as running actually protects your joints. The real problem comes from inadequate recovery, overloading joints through heavy lifting or kneeling at work, repetitive injuries and excess weight. This leads to break down of the cartilage, bone remodelling and inflammation of the joint liner. Obesity and prior trauma are the real culprits for osteoarthritis. 

Primary Risk Factors:

• Excess weight (every pound lost removes 4 pounds of pressure from your knees)
• Previous injuries or trauma to the joint
• Chronic overloading from heavy lifting or repetitive work
• Age
• Gender – female
• Genetics

Breaking Free from the Pain Cycle

Here’s what happens when arthritis takes hold: pain leads to less movement, which leads to muscle loss, which creates more pain and immobility. It’s a vicious cycle, but one you can break.

1. Exercise and Strength Training.
The evidence is overwhelming – strengthening muscles around your joints significantly reduces pain. Low-impact activities like swimming, cycling, walking, and tai chi are particularly effective.
2. Smart Weight Management.
Even a 10-20% weight loss can dramatically improve pain, function, and quality of life. Remember: every pound matters.
3. Education is Power.
Studies show that simply understanding your condition improves your quality of life. Knowledge gives you control.
4. Heat and Cold Therapy.
Response varies by individual – experiment to find what works for you. Many find alternating between the two most effective.
5. Acupuncture.
Moderate evidence supports acupuncture’s effectiveness for osteoarthritic pain relief.

Start Conservative, Stay Safe

1.Topical NSAIDs. First
Begin with creams and gels applied directly to painful joints. They’re often effective with pain control with fewer side effects.

2.Oral NSAIDs.
If topical treatments aren’t sufficient, oral NSAIDs can help certain areas with better penetration, but use with caustion. Long-term use carries serious risks: GI bleeding, kidney problems, and cardiovascular complications. Always involve your primary care provider in decisions about long-term NSAID use.

3.Steroid injections.  Can be very effective for some people and provide months of relief. This should be administered via trained provider. 

4. Opioids. Reality Check: despite assumptions that opiods are stronger than NSAIDs, research shows NSAIDs provide improved pain relief to opioids with fewer side effects. That being said, for some people there may be a role to play for opioids. However opioids on a regular basis in the elderly is at high risk for confusion and falls.

5. Topical Ketamine. This is an underappreciated option when other agents are not effective. This can be combined with topical NSAIDs as well as other adjuvants. There is very minimal absorption into the rest of the body minimizing the risk of psychoactive effects.  

6.Duloxetine. In chronic patients with severe pain and not managed with other agents, this could be something to consider. However discussion with your primary care provider is important. 

Patients always ask what supplements work for arthritic pain. The amount of evidence supporting supplements is limited, but the strongest support is for Boswellia serrata. There is also evidence to support the benefit of other supplements listed below. However it appears their effect is limited to short term use. Over the long term, there does not seem to be a measurable benefit.

• curacumin
• collagen hydrolysate
• pycnogenol
• L-carnitine
• avocado – soybean extract
• glucosamine
• chondroitin
• type II colagen

Surgery can be a highly effective option when non-surgical options have failed and leading to functional impairment. There have a number of advances in surgeries that result in amazing outcomes. However in Alberta the surgical wait times remain lengthy. If in doubt, it is better to get a referral to an orthopedic surgeon sooner for an assessment. Surgery also has its risks. People who smoke, are overweight and have diabetes have heightened risks for complications. Optimizing control for these conditions is important.

If you are finding it difficult to get your loved one into a clinic to see their doctor. Consider Beyond Neighbours’ house call services to help improve their quality of life.