How can I prevent the worsening of arthritis?

How to Prevent Worsening of Arthritis

Regular exercise is the single most important intervention to prevent arthritis progression, with particularly strong evidence for osteoarthritis and axial spondyloarthritis showing consistent effects on reducing pain and improving function. 1

Core Prevention Strategies

Exercise (Highest Priority)

All people with arthritis should engage in regular exercise, whether performed alone at home or in group classes. 1 The evidence shows:

• For osteoarthritis and axial spondyloarthritis specifically, exercise demonstrates particularly strong and consistent benefits for disease-related outcomes, making it especially critical for these conditions 1
• Exercise therapy including land-based, aquatic, resistance, and mind-body exercises (yoga, Tai Chi, qigong) all show improvements in physical function and pain 1
• The specific type, frequency, intensity, and duration should be tailored to your current capabilities and disease activity, but the key is "moving regularly" 1
• Group exercises show slight benefits over exercising alone, though both are effective 1

Weight Management

If you are overweight or obese, weight loss is strongly recommended as it reduces mechanical stress on weight-bearing joints 1, 2

This is particularly important for hip and knee osteoarthritis where excess weight directly accelerates joint damage 2

Smoking Cessation (Critical for Rheumatoid Arthritis)

If you have rheumatoid arthritis and smoke, stopping is essential - smoking is detrimental to symptoms, function, disease activity, disease progression, and occurrence of comorbidities 1

• Smoking may also limit response to disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis 1
• You should be offered support to quit and progress should be monitored 1

Alcohol Consumption Guidelines

For rheumatoid arthritis, moderate alcohol consumption increases risk of disease flares and comorbidities - discuss your alcohol intake with your healthcare provider, especially when starting new treatments like methotrexate 1

• Low levels of alcohol consumption are generally unlikely to negatively impact most arthritis outcomes, except in certain situations 1
• For gout specifically, moderate alcohol consumption is associated with increased risk of gout flares 1

Physical Therapy and Occupational Therapy

Participation in comprehensive physical therapy and occupational therapy is conditionally recommended throughout the arthritis disease course 1

• These interventions can be tailored to your unique needs at different stages of disease 1
• For hand involvement specifically, performing hand therapy exercises is recommended 1
• Manual therapy combined with supervised exercise may provide additional benefits 3

Pharmacological Prevention (For Inflammatory Arthritis)

For rheumatoid arthritis patients at risk of developing persistent or erosive disease, DMARDs should be started as early as possible - even if you don't yet fulfill established classification criteria 1

• Methotrexate is considered the anchor drug and should be used first in patients at risk of developing persistent disease 1
• The main goal is to achieve remission, requiring regular monitoring of disease activity 1

Additional Supportive Measures

Patient Education

Understanding your condition is essential - education programs aimed at coping with pain, disability, and maintaining work ability should be employed as adjunct interventions 1

Physical Modalities

• Local heat or cold applications can provide temporary pain relief 2, 3
• Assistive devices such as walking aids, braces, and supports can reduce joint load and improve function 2

Dietary Considerations

A Mediterranean diet pattern may be beneficial - low in fat and sodium, rich in fruits, vegetables, whole grains and nuts, with omega-3 fatty acid supplementation 4

• High fish/omega-3 polyunsaturated fatty acid consumption may reduce arthritis risk 5
• Reduce consumption of sugar-sweetened beverages, red and processed meat, and trans fats 4

Monitoring and Follow-Up

Regular monitoring is essential - disease activity should be assessed at one to three month intervals until remission is achieved 1

For rheumatoid arthritis specifically, monitoring should include:

• Tender and swollen joint counts 1
• Patient's and physician's global assessments 1
• ESR and CRP levels 1
• Structural damage via radiographs of hands and feet every 6 to 12 months during the first few years 1

Common Pitfalls to Avoid

• Do not avoid exercise due to fear of joint damage - exercise is safe and highly beneficial, with extremely low risks of harm 6
• Do not rely on glucosamine and chondroitin supplements - they are not recommended based on current evidence 2, 3
• Do not delay seeking rheumatology care - patients presenting with arthritis of more than one joint should be seen by a rheumatologist ideally within six weeks after symptom onset 1