Lorna Rothery spoke to Dr Wendy Holden, Arthritis Action’s medical advisor, about osteoarthritis and ageing, the key supportive and preventative strategies needed, as well as the charity’s 2024/26 strategy
Around ten million people in the UK are living with a form of arthritis or musculoskeletal condition. While there is no specific cause for most types of arthritis, genetics, age, injury, gender, and lifestyle could play a part. The most common type of arthritis is osteoarthritis (OA), whereby joints become painful and stiff and sometimes swollen. Arthritis Action is a UK charity committed to raising awareness about the condition and ultimately empowering people to take control of their arthritis and lead a more active life. Lorna Rothery spoke to the charity’s medical advisor, Dr Wendy Holden, about the link between osteoarthritis and ageing, how the condition can be managed, and the charity’s three-year strategy.
Osteoarthritis usually starts in the late 40s; why is this? Do you expect the prevalence of OA to increase alongside population ageing?
The symptoms of osteoarthritis usually start to appear in the mid to late 40s, but the process may have already begun before that. Certain factors can increase the likelihood of experiencing joint pain. In women, hormones play a significant role, and the onset of menopause is often linked to the diagnosis of osteoarthritis. However, it does not necessarily mean that the two are causally related. The timing of menopause may coincide with the onset of osteoarthritis. Additionally, low hormone levels during menopause can cause menopausal arthralgia, which results in joint pain, especially in the knees and hands. As we get older, we also tend to become less active and gain some extra weight, which can place more pressure on our joints and lead to joint pain. We also tend to accumulate injuries and traumas over our lives, for example, sports or skiing injuries, and these might start to affect us in our 40s or later stages of life.
As our population ages, the costs to the NHS of managing osteoarthritis will also increase. The predicted cost of medication for osteoarthritis is expected to double by 2030. The prevalence of joint replacements is predicted to increase by 40% by 2060.
What preventative lifestyle measures are most important to lessen the risk of OA? How significant is diet, particularly in older age?
It is important to understand that being overweight or obese significantly increases the risk of osteoarthritis not only in weight-bearing joints such as hips, knees, and feet but also in hands due to the pro-inflammatory state associated with being overweight. Ideally, prevention strategies should be implemented at a governmental level to support healthy lifestyles, as losing weight after becoming overweight can be very difficult. When it comes to managing pain, it is important to stay active. However, what often happens is that if we start experiencing pain in one area, such as the knees, we naturally avoid any activities that we think will aggravate that pain. For instance, we might avoid climbing stairs and opt for the lift instead. This is the exact opposite of what we should be doing. Avoiding exercise will weaken the muscles that support the joints, and this will make pain worse. Although exercise may hurt a bit, exercise cannot damage the joints, in spite of what many people fear, and it is important to stay active and strengthen the muscles as this will help pain and maintain independence. Just exercise in knee joint osteoarthritis has been shown to reduce pain by a third. Unfortunately, there is a lack of education about pain and arthritis, and many people still believe the outdated advice of resting painful joints. Obviously if you have an acute injury a joint should be rested, but staying active with osteoarthritis is vital in terms of pain, wellbeing and even mortality.
In terms of healthy eating and arthritis, there is no such thing as good or bad food in terms of worsening or helping arthritis, but a Mediterranean-style diet and avoiding too many processed foods may help to reduce inflammation in our gut and this may have a beneficial effect on the joints and will help to maintain a healthy weight.
Could digital solutions help with managing OA?
Studies have shown that just wearing a step counter or carrying a smartphone can increase your daily step count by a significant amount. Even without actively trying, wearing a tracker can naturally make you more active. Although the idea of needing to walk as much as 10,000 steps a day has been challenged, increasing your activity level by any amount can have significant health benefits.
How are people’s lives affected by osteoarthritis?
It is often overlooked that osteoarthritis can have wider impacts on people’s lives beyond just pain and disability. It can also lead to trouble sleeping, fatigue, and mental health issues such as anxiety and mood changes. These issues can affect a person’s social life and daily activities. Therefore, it is crucial to pay attention to self- management strategies that can improve mood, anxiety levels, and sleep quality, which in turn can reduce pain and improve overall wellbeing.
Tell us about Arthritis Action’s Three-Year Strategy 2024/26 and its key goals.
The new 2024-26 strategy builds on our previous three year strategy, which is focused on supporting as many people with arthritis around the country as possible. Over 20 million people are living with an MSK condition in the UK; that’s around a third of the UK population. Our goals are:
- To empower people living with arthritis to better self-manage their condition: People with a long-term condition, such as arthritis, spend less than 1% of their time with a healthcare professional and are therefore expected to manage their condition themselves for much of their lives. This is why we believe it’s vital that we raise awareness and continue to deliver our integrated self-management approach to empower people with arthritis to take control of their condition and manage its debilitating physical and mental health symptoms.
- To support more people in work of all ages: Around a third of the UK workforce live with a long-term condition, and one in ten have an MSK condition. Arthritis Action is keen to work with employers to better support employees living with arthritis – a leading cause of disability and sickness absence in the workplace. Moreover, more than a third of the UK workforce is over 50. This figure is expected to rise with the increase in the national retirement age over time. Recognising that most people living with arthritis are of this age demographic, Arthritis Action would like to support this cohort so they can lead healthier working lives. Arthritis can profoundly impact young adults’ personal and professional lives, too. Arthritis Action plans to develop services suited to this age group and engage more young adults in its work.
- To have a self-management approach that attracts referrals from healthcare professionals: Arthritis Action would like to expand its networks with healthcare professionals so we can promote the benefits of our self-management approach more widely.
- To raise awareness of the charity, arthritis, and MSK conditions: Generating awareness and publicity of arthritis and our charity is very important to us, whether through our work with the media, other charities, and the NHS or in the policy space. We also work closely with our members and service users to share their stories and amplify the message.
- To actively reach out to and make a difference for diverse communities affected by arthritis across the UK: Arthritis Action works very hard to reach and support more people from low-income communities and underrepresented groups. Arthritis Action commissioned research in 2022, which revealed that people in economically deprived areas are more likely to be impacted by arthritis for longer, be forced to give up work and be less likely to receive support. We continue to make an impact in this area and would like to build on this in 2024-26.
- To achieve long-term financial sustainability: Arthritis Action is taking steps to achieve a balanced budget in the next few years by diversifying our income sources, developing long-term corporate partnerships and exercising sound financial management and expense control.
