General Advice

The use of heat is normally used to increase blood flow / circulation, reduce pain, ease stiffness, warm up muscles before exercise, relax muscles when tense and decrease muscle spasm.  

Methods for applying heat:

• Hot packs / wheat bags
• Hot water bottle
• Hot bath/shower
• Whirlpool

• Follow manufacturer guidelines for heating wheat bags / heat packs safely
• Make sure the hot water bottle / wheat pack is wrapped in towelling and has sufficient layers to avoid burns (never use boiling water)  
• Check the skin regularly for signs of skin irritation / burns 
• Do not go to sleep whilst using heat treatment.  
• Leave on for 10 - 15 minutes and then remove.  
• Heat treatment may be repeated up to three times a day  
• If using hot water in a bowl (for your hand or foot) – the temperature should be between 40 - 45° C 

There are two ways to get medication Over the Counter (OTC) or by prescription. 

You do not need a prescription to buy OTC medication. These are available to buy at chemists and supermarkets. They are most effective for mild to moderate pain, before the pain becomes too bad.  They are for short term use. 

Prescription medication is issued by your doctor and is obtained from a Pharmacy.

Pain relief

Paracetamol is the most common medication used for pain relief. It is often seen as one of the safer pain relief tablets to try first. It comes as a tablet, a liquid or a tablet that dissolves in water. If paracetamol is not helping within a few days, it may be worth speaking to your GP to see whether you would benefit from taking something different. More information can be found on the NHS website.

Non steroidal anti inflammatory drugs (NSAID)

Ibuprofen is the most common NSAID used to treat pain and reduce inflammation. It comes as a tablet, a cream, a gel and patches. The gels and creams may be better for joints such as hands, feet, knees.  NSAID tablets are usually stronger than the gels and creams. Certain NSAID are only available on prescription. These are only recommended in short courses and if you have had no benefit within 5-10 days of taking them, they’re unlikely to be helpful so it would be best to stop taking them. More information can be found on the NHS website.

Prescription pain medication

Prescription medication is only available from your doctor, such as: Co-codamol, Tramadol, Naproxen etc.

Please speak to a pharmacist or GP for advice before taking pain medication if you: 

• Are pregnant, trying for a baby or breastfeeding
• Are over the age of 65 
• Have problems with your breathing (including asthma), heart, liver, kidneys, blood pressure, circulation or bowels 
• Are taking other medications 
• Have had a stomach ulcer 
• Have had an allergic reaction to any medications in the past.

There are no diets or dietary supplements that will cure your condition, but some people do find improvements to their symptoms on changing what they eat.

On balance, altering your diet probably won’t have as great an impact on your condition as your medical treatments, and we wouldn’t recommend stopping any of your medications without discussing it first with your GP. However, it’s still worth considering your diet for the following reasons:

• If you’re overweight, losing some weight will reduce the strain on your joints
• A good diet can help to protect you against some potential side effects of drugs. For example, eating plenty of calcium rich foods can help protect against osteoporosis which can result from long term steroid use.
• A healthy diet can also help to protect against heart disease (which can sometimes be a complication of certain type of arthritis)

The two most important things to think about are:

• Whether you are a healthy weight
• Whether your diet provided enough of the important vitamins and minerals

Any of the following measures taken together are likely to be beneficial:

• Eat a balanced and varied diet to maximise your intake of vitamins, antioxidants and other nutrients
• Change the type of fats and oils you eat and include oily fish and olive or rapeseed oil
• Eat a more Mediterranean style diet with plenty of fruit and vegetables
• Take regular exercise

Keeping to a healthy weight

The most important link between you and your diet is certainly your weight; we know that being overweight puts an extra burden on the joints of the back, knees, hips, feet and ankles. Because of the way joints work, the pressure on your knee joints is 5-6 times your body weight when you walk so even a small weight loss can be a big difference.

Am I overweight?

One way to find out whether you are a healthy weight is to calculate your body mass index (BMI). You can use the BMI calculator on the NHS website, or use the calculation below;

Multiply your height in meters by itself e.g. 1.7(m) x 1.7=2.89
Divide your weight in Kilograms (KG) by the number you got in stage 1. e.g. 90(kg) divided by 2.89 = 31.14
The result is your BMI = 31
For most people a healthy BMI is in the range of 20-25

So how can I lose weight and eat a healthy diet?

The only way to lose weight, and keep it off, is to make permanent changes to the way you eat and/or the amount of exercise you do. You need to balance your food intake against the energy you burn.
Your body needs food;

• To supply energy for your daily activities
• To provide a variety of vitamins and minerals to stay healthy.

Some people however may need help and support to achieve their weight loss.

Research has shown that both muscle strengthening and aerobic exercise (physical activity that makes the heart beat faster) can reduce pain and improve the ability to do everyday tasks. This doesn’t seem to matter whether this takes place as home-based exercises or in an organisation (NHS, Gyms, and Hydrotherapy). They are all as effective as one other.

Therefore, things that help people to keep physically active are;

• Doing activities that can be easily incorporated into everyday life
• Doing activities that are part of a person’s usual lifestyle
• Having fun and getting social support
• Access local facilities and opportunities

Experts emphasise that it is important to keep up exercise routines in order to continue to benefit. Research has shown that group and home based exercise are equally effective. It is therefore important to make a positive change to your lifestyle in order to be more active (The MOVE consensus (2005)).

Many community centres now offer group activities such as keep fit or Tai Chi or chair-based exercise groups. The people who organise and run these activities know that some people worry about going along to these sessions for the first time practically if you are on your own but they are aware of this but there is usually a few regulars around to help look after you.

There are also exercises on this website that can help you get started at home.

There are lots of benefits to stopping smoking and these really do start straight away. You will save money and you will also:

• Have more energy
• Have a reduced risk of getting cancer and other major diseases
• Smell cleaner and fresher
• Have better skin
• Have brighter teeth and fresher breath
• Have an improved sense of taste and smell
• Have lower stress levels
• Improve soft tissue healing

Please speak to your GP or pharmacist about help stopping smoking.

Vitamin D helps control a lot of processes in the body and is very important for musculoskeletal health as these nutrients are needed to keep bones, teeth and muscles healthy and strong.

A severe lack of vitamin D can lead to bone problems such as rickets in children, and osteomalacia in adults. Osteomalacia occurs when bone quality deteriorates. The symptoms can come on slowly and give you pain without an injury. This can lead to broken bones, muscle pain and weakness, resulting in difficulty with stairs, getting up off the floor or standing after sitting in a low chair or a different walking pattern.

Vitamin D deficiency can also cause secondary problems with your thyroid gland, loss of bone thickness, muscle weakness and can increase your risk of falling as you age.

Good Vitamin D levels may also help in:

• Improving muscle strength
• Improving immune system
• Reducing risk of falls
• Helping to prevent depression and anxiety
• Reducing feeling tired

  
Everyone in the UK is at risk but some are at higher risk than others, these include people:

• Aged 65 years and over
• Who have low or no exposure to the sun, for example those who cover their skin for cultural, religious, or health reasons; who are housebound; or who are confined indoors for long periods
• Taking certain drugs
• Are pregnant or breastfeeding
• Who have darker skin pigmentation, for example people of African, African-Caribbean, or South Asian heritage
• Who struggle to absorb foods or who have had weight loss surgery, resulting in a reduced ability to absorb fat-soluble vitamin D
• With severe liver disease or end-stage chronic kidney disease (CKD)
• Over weight with a body mass index (BMI) of 30 or above

How to get Vitamin D into your system

Sunlight: During the spring/summer months, most people can get enough vitamin D through sunlight. If you have fair skin, around 20-30 minutes of sunlight on the face and forearms around the middle of the day (from 11am-3pm) 2-3 times a week is enough to make enough vitamin D in the summer months in the UK. The sunlight has to fall directly on to bare skin. If you have darker skin, you can still make some vitamin D through exposure to sunshine. However, you may not be able to make enough from sunshine and diet alone, so you should consider taking a vitamin D supplement all year round.

Too much exposure to the sun's rays can be damaging. Avoid burning as this can lead to an increased risk of skin cancer.

Supplements: There are a range of products available at supermarkets, pharmacies and other retailers; the recommended dose of vitamin D is 10 micrograms (or 400 International Units (IU)) per day. Taking more than this dose is not necessary, but if you are unable to find a vitamin D supplement providing 10 micrograms (400 IU), products providing up to 25 micrograms (1000 IU) are suitable for everyone.

Diet: Only 10% of Vitamin D is found in our diet, in either foods containing it naturally or that have been fortified.

Food sources include:

• oily fish – such as salmon, sardines,
• herring and mackerel
• red meat
• liver
• egg yolks
• fortified foods – such as some
• fat spreads and breakfast cereals

Cows' milk is generally not a good source of vitamin D because it is not fortified in the UK, as it is in some other countries.

NICE recommends that health professionals should NOT routinely test people’s vitamin D status unless they are classed as being particularly high risk or show clinical signs of deficiency.

In summary: Public Health England and NICE advise that everyone should consider taking a daily vitamin D supplement during the autumn and winter.  Those at higher risk should take daily supplements, all year round.

The recommended dose of vitamin D is 10 micrograms (or 400 International Units (IU)) per day.