Level 2 – Moderate arthritis

Medications  and creams can help with the arthritis pain and inflammation.  Some medications can conveniently be bought  “over the counter” . In order to make sure this is the right thing to do – access your local Pharmacist for advice about safe medication and creams which may help you to manage your pain/ inflammation. They will take into consideration any other medications that you may be taking and other medical conditions that you may have.

All qualified Pharmacists in Great Britain must be registered with the General Pharmaceutical Council (GPhC). For more information, see the GPhC website for details about regulations and registration.

The following are Medications which are commonly recommended by the GP or Pharmacist:

• Pain killers eg: paracetamol/ codeine
• Anti-inflammatory medications to help reduce inflammation and pain: Non -steroidal Anti-inflammatory drugs (NSAIDS) come in 2 types . the traditional medications such as Ibuprofen, Naproxen, diclofenac and the COX-2 inhibitors such as Celecoxib and Eterocoxib
• You can also get NSAID’s in creams – these are described as “topical”. They are less likely to cause upset stomachs

The GP may be able to help you by:

• Providing you with some exercises to do to protect your knee/hip
• Prescribing medications –
  • Pain killers eg: paracetamol/ codeine
  • Anti-inflammatory medications to help reduce inflammation and pain: Non -steroidal Anti-inflammatory drugs (NSAIDS) come in 2 types. the traditional medications such as Ibuprofen, Naproxen, diclofenac and the COX-2 inhibitors such as Celecoxib and Eterocoxib
  • You can also get NSAID’s in creams – these are described as “topical”. They are less likely to cause upset stomachs

• Recommending a corticosteroid joint injection if your joint is very swollen.
• Referring for Physiotherapy
• Requesting an X-ray

They may also discuss with you what stage you joint is in the Osteoarthritis journey and make other recommendation e.g. weight loss.

Obesity is the single most preventable contributor to Osteoarthritis for weight bearing joints. For every pound of extra body weight you may be carrying the increased loading on the knees/hips going up stairs equals 4 pounds – so for every 10 pounds overweight you are your knees will have to take 40 pounds extra load.

If you are overweight it is best to address it with a combination of healthy eating and exercise. Help with this plan can be accessed from groups such as Weight watchers, Slimming World or the local council “Fit 4 Life” program.

Fit for Life program

If you are over 18yrs and have a Body Mass Index (BMI) of 25 or above Harrogate Borough Council offers a free 12 week service called “Fit 4 Life” (funded by NYCC Public health team) which combines Nutrition and lifestyle advice with exercise sessions. These programs are offered at venues across the Harrogate district during the day and some evenings. You can find an up to date timetable here.

The “Fit 4 Life” programme is made up of group sessions consisting of individual weigh-ins, physical activity and weight management advice, covering different topics each week including:

Before taking part in the group session you will be required to attend an induction with the instructor. This will include a basic health check, a health questionnaire and general chat about your lifestyle.

For more information about the Fit 4 Life programme call 01423 500600 (ext. 58382)

At Level 2 stage you may find that exercising is more uncomfortable however it is still very important and physical activity is the best non-drug treatment for improving pain and function in OA. While you may worry that exercising with osteoarthritis could harm your joints and cause more pain, the research has shown that people can and should exercise when they have osteoarthritis. In fact, exercise is considered the most effective non-drug treatment for reducing pain and improving movement in patients with osteoarthritis.

What Exercises Work Best for Osteoarthritis?

• Range of motion exercises can help maintain and improve the flexibility in the joints.
• Aerobic/endurance exercise strengthens the heart and make the lungs more efficient. This conditioning also reduces fatigue, controls weight and builds stamina.. Aerobic exercises include walking, cycling, swimming or using the elliptical machine.
• Strengthening exercises help maintain and improve muscle strength. Strong muscles can support and protect joints that are affected by arthritis. You can find a list of suitable home-based exercises recommended by Arthritis Research UK using the links below:

• Knee pain exercises
• Information and exercise resources

How do I become active?

You will benefit from most exercises although we would recommend that you do not do high impact activity i.e. running long distances on a road surface. Locally Harrogate Borough Council run exercise programs and you can find the information by emailing [email protected] or visiting the sports development section of Harrogate Borough Council Website.

Physiotherapy can help to reduce pain and functional disability for people who suffer from osteoarthritis.  The Physiotherapist can help with you by assessing your affected joint and other areas which could be contributing to your problem i.e. knee/spine/hip/foot – then agreeing a management plan with you which could include:

• Providing advice about how to manage the problem
• Walking aids/gait re-education
• Manual therapy/mobilisation of the joints and soft tissues
• Exercises
• Corticosteroid joint injections
• TENS machines/Acupuncture

Access to physiotherapy

You can access the NHS Physiotherapy services in the following ways:

NHS Services:

• The GP can refer you to direct access Physiotherapy provided from Harrogate District Hospital, Ripon Community Hospital and some local surgeries. If you have a more complex presentation, then the MSK service offers more interventions i.e. investigation/ joint injection etc
• Education class: these are run on a monthly basis and provide education about the condition and how to best manage it
• Hydrotherapy: use of the Hydrotherapy pool is available with the “Aquasize” Program at Harrogate District Hospital. It is recommended that you have been a patient there before accessing these facilities so that you know what you should be doing in the water. Call 01423 553472
• Self- referral: This service is only available for patients registered with Leeds Road practice Harrogate/Church Lane Practice Boroughbridge and Dr Ingrams practice Ripon. This telephone access to advice/ treatment is available – Call 01423 554554 weekdays apart from Wednesday 9.30am -12pm

Privately:  There are many private providers in the Harrogate and Ripon district. You can find them in the Yellow pages or the Physio2U website. Harrogate District Hospital also has private services which you can access by telephoning 01423 553472.

All physiotherapists should be registered with the Health Professions Council and you can check this on their website. This registration ensures that the physiotherapist is qualified and an acceptable standard of care is provided.

Exercising in water can give relief to pain in osteoarthritic joints. The buoyancy of water reduces the weight bearing load on the joint and provides assistance to range of movement exercises.

The benefits of exercise are similar to those for land based exercise  ie:

• Increased circulation to the part improving tissue health
• Reducing swelling
• Increasing muscle function and strength
• Increasing/ maintaining range of joint movement

The exercise can also help you remain “healthy” – exercising your heart and lungs at the same time and keeping your weight down.

Where to access a pool locally:

You can exercise in water at local swimming pools. Find out opening times and further details on the Harrogate Borough Council website.

Hydrotherapy pool at Harrogate District Hospital. This program is called “Aquasize” and for a small fee (£5) you can use the hospital pool  which is easier to access if you are disabled. You can telephone for further information or to book your slot on 01423 553472 (Monday–Friday 9am-5pm).

Lister house in Ripon also has pool access for the disabled – 01765694740. Southgate, Ripon, North Yorkshire, HG4 1PG

The British Acupuncture Association state that acupuncture treatment may help to relieve pain and improve function in patients with osteoarthritis by stimulating the body to release chemicals which help reduce pain and inflammation. This is done by inserting several small fine sterile needles at points around the body.

There are some people who find that acupuncture is beneficial in the management of the pain and disability created by osteoarthritis.

Should you wish to explore this as an option the following information may help you make a decision:

• NHS Choices – Acupuncture
• The British Acupuncture Council – website can locate your nearest Acupuncturist using your post code
• The Cochrane Collaboration – they have found there is some evidence acupuncture may have a beneficial effect on osteoarthirtis
• The National Institute of Clinical Excellence (NICE) – stated that the evidence supporting the benefits of using acupuncture in the management of osteoarthritis is inconclusive

A TENS machine is a small battery operated device that sends pulses of mild electrical current to your nerve endings via pads (electrodes) placed on the skin. It produces a tingling sensation and is thought to alter pain messages sent to your brain.  It is thought to relieve pain/relax muscles by stimulating the production of endorphins, which are the bodies natural pain killers.

The National Institute for Clinical Excellence (NICE) have stated that TENS machines should be considered for the relief of pain in Osteoarthritis.

Where do I get a TENS machine?

TENS machines are available from pharmacies, other major stores and on line.

Some advice regarding the use of TENS is available from the manufacturers, online here or from your physiotherapist or GP.

If your joint is inflamed it may be that a corticosteroid injection could help with the pain and inflammation. These injections can be done by your GP/ Physiotherapist or in the Radiology department when guidance/imaging is used.

Corticosteroid is injected to reduce the inflammation and a local anaesthetic to help with the pain. It can take up to 3 weeks to have full effect and the benefit can last over a year.

If you are offered an injection make sure that you plan to have a “quiet time” over the following 2 days to give it maximum chance to be effective.

If you would like more information please click here.