Around ten million people in the UK will suffer from arthritis1, while countless more suffer undiagnosed joint pain. And this figure will only rise thanks to an ageing population and soaring obesity levels.

Not only is joint pain a massive drain on the economy, with direct and indirect costs running into billions – it is also costly in terms of quality of life, creating a vicious circle of decline, reduced mobility and pain. While prolonged or serious joint problems should be properly assessed and diagnosed by a GP or specialist, there is a great deal that an individual can do to protect and care for their joints before problems impact greatly on their lives.

A poll of 2,000 people2 carried out last year revealed just how little people know about their joints and how to protect them, despite the fact that one in three of those responding said they suffered joint pain themselves. The poll showed that:

- 83 per cent had no idea what joints are made of
- Nearly seven out of ten believed joint pain is not treatable
- 68 per cent did not know that omega 3 fatty acids are good for health and fewer than one in 10 thought their GP would be sympathetic to joint pain.

Some common treatments for osteoarthritis, such as paracetamol and non-steroidal antiinflammatory drugs (NSAIDs) help relieve symptoms, but they do not address the underlying causes of the condition, so it makes sense for everyone to start taking care of their joints to keep them healthy for as long as possible. Two important factors in maintaining healthy joints are:

- Exercise and maintaining a healthy weight
- Diet and supplementation.

Keep on moving

To keep joints healthy, it is important to be as active as possible and to choose types of exercise which are suited to the individual. If someone has not exercised for some time or already has health issues, they should speak to their GP for advice before starting to become more active. Just getting off the bus one stop earlier and walking a few hundred yards further, taking the stairs rather than the lift and walking just a little faster than usual when out with the dog will all start to make a difference, and as people become fitter they can challenge themselves a little more. Exercise specialists will always advise people to start slowly and choose activities which they enjoy, so that including exercise in their life becomes a pleasure and not something to be endured and which they will soon give up.

A mix of different types of exercise is important to gain most benefit, and may include:

- Non-impact exercise – this type of activity puts less stress and strain on the joints and could include swimming and water-based exercise classes, cycling or using a cross-trainer.
- Weight bearing exercise – where the legs support the body weight. It is important to do some weight-bearing exercise (which also helps protect against osteoporosis in later life). Walking is a good starting point and skipping, golf or dancing are other easy ways to include weight-bearing exercise in someone’s routine. Running has more impact on the joints and regular running may cause problems for some people over time.
- Flexibility and toning – yoga or Pilates are good ways to maintain and improve flexibility. They can also improve posture – and good posture helps to ensure that weight is properly distributed, which means less stress on the joints.

Two relatively new types of exercise which have been shown to help joints are rebounding, using a small trampoline, and vibrating ‘power plates’. Regular exercise will also help keep weight at a healthy level and so reduce strain on the joints.

Whether people are exercising or just going about their daily lives, they should always think about their footwear. When exercising, it is important to wear the appropriate type of trainer for the activity and at home or at work, women should vary the height of heels and wear flat shoes as often as possible, saving the skyscraper heels for special occasions.

Diet and supplementation

Exercise alone is not enough. We have all heard the phrase, ‘you are what you eat’, and diet certainly has a role to play in helping to maintain healthy joints. Like exercise, a healthy diet will help manage weight, but it can also supply the nutrients that play a role in joint health. People at risk of joint problems, older people, those who play a lot of sport and those whose jobs involve heavy manual work, may consider taking a supplement containing ingredients that are known to benefit the joints.

Omega-3 fatty acids have received a great deal of publicity thanks to their benefits for heart health, but their antiinflammatory action is also important in maintaining joint health. Marine lipids have been shown to help encourage the body to produce its own anti-inflammatory agent, lipoxin. They do this by inhibiting two inflammatory pathways that involve different enzyme systems known as cyclo-oxygenase (COX) and lipoxygenase (LOX)3. But, unlike oral NSAIDs, marine lipids have not been associated with stomach irritation and gastric bleeding4.

Various studies show that marine omega-3 fatty acids reduce pain and morning stiffness5 in arthritic conditions and lower the requirement for non-steroidal anti-inflammatory drugs6,9. Omega-3s are present in oily fish and at least one portion of oily fish, such as salmon, trout, herring, mackerel or sardines, is recommended each week. However, indications are that most people eat far less than this – in fact, research shows that the average UK intake of oily fish is just 56g per week for adults and 14g per week for children, far below the 140g per week which is recommended10. This means that many people may benefit from a supplement containing omega-3s to help make sure that they are receiving the appropriate amount.

Omega-3 polyunsaturated fatty acids (PUFAs) are also found in green-lipped mussels and a potent form is found in the type of mussels grown and harvested in the waters between the North and South Islands of New Zealand. These are rich in eicosatetraenoic acid (ETA), a potent omega-3 PUFA that is thought to be unique to green-lipped mussels. Cod liver oil is also rich in omega-3 PUFAs, including EPA and DHA, and is commonly used to supplement diets that are deficient in fish oils.

Glucosamine is a monosaccharide, and is one of the most commonly used dietary supplements to support the structure and function of joints. It is often combined with chondroitin sulphate and marketed to target people at risk of developing osteoarthritis. Hyaluronic acid (HA) is a polysaccharide found naturally in the body in a wide range of tissues, including cartilage, and is a major component of synovial fluid, the naturally occurring lubricant found in the joints. HA has a variety of functions in the joint, restoring lubrication, providing cushioning, allowing movement and helping to maintain the health of the joint.

Wear and tear on joints may come with age, or through manual work or playing a lot of sport and this often means a loss of joint function, increased stiffness and discomfort as the quality and quantity of synovial fluid in the joint decreases. Cartilage, which protects the ends of the bones, starts to break down and this, in turn, leads to changes in HA, exacerbating the breakdown of cartilage and increasing inflammation in the joint. As a result, the synovial fluid becomes less able to protect, cushion and lubricate the joint. A vicious cycle is started, with inflammation leading the further damage, which in turn causes more inflammation and discomfort. If the quality and quantity of HA in the joints can be improved, the cycle can be interrupted.

References:

1. www.arthritiscare.org.uk
2. One Poll, 2011 for The Mentholatum Company Ltd
3. Macrides TA et al. The anti-inflammatory effects of omega- 3 tetraenoic fatty acids isolated from a lipid extract (Lyprinol) from the New Zealand green-lipped mussel. [Abstract] 88th American Oil Chemists Society Annual Meeting 1997 Seattle, WA May 1997;
4. McFarlane, S. J. (1984). Pharmaceutical preparations with gastro-protective action. U.S. Patent 4,455,298 1984
5. Kremer, JM (1996). Effects of modulation of inflammatory and immune parameters in patients with rheumatic inflammatory disease receiving dietary supplements of n-3 and n-6 fatty acids. Lipids; 31: S243-7 6. Lau CS, Morely KD, Belch JJ (1993). Effects of fish oil supplementation on non-steroidal anti-inflammatory drug requirements in patients with mild rheumatoid arthritis – a double-blind placebo controlled study. British Journal of Rheumatology; 32: 982-9
7. Geusens P, et al (1994). Long-term effect of omega-3 fatty acid supplementation in active rheumatoid arthritis. Arthritis and Rheumatism; 37: 824-9
8. Fortin PR, et al (1995). Validation of a meta-analysis: the effects of fish oil on rheumatoid arthritis. J Clin Epidemiol; 48: 1379-90
9. Galarraga B et al (2008). Cod liver oil (n-3 fatty acids) as a nonsteroidal anti-inflammatory drug sparing agent in rheumatoid arthritis. Rheumatology (Oxford); 47(5): 665-9
10. Bates B, Lennox A, Swan G (2010). National Diet and Nutrition Survey. Headline results from Year 1 of the Rolling Programme (2008/2009). A survey carried out on behalf of the Food Standards Agency and the Department of Health.

The Mentholatum Company Ltd