Young people - managing your symptoms

Although diets and supplements won't cure your arthritis, eating a healthy, balanced and varied diet is good for your overall health and well-being.

Your body needs energy and nutrients from food to keep you going throughout the day, as well as to help your bones and muscles stay strong and develop

Eating should be pleasurable and can be an important way of spending time with friends and family.

Basing a healthy diet around whole (rather than processed) foods, which are low in fat, sugar and salt, would be good.

Eating plenty of fruit and vegetables is a smart move as well – you've probably heard of the ‘five-a-day’ recommendation. Eating fruits and vegetables can help prevent heart disease and strokes and possibly reduce the chance of some types of cancer.

Read more about diet.

Eat fibre

Foods with fibre are also good for you. As well as having a beneficial effect in preventing heart disease, people with diabetes tend to find increasing the fibre in their diet can help improve their blood sugar control.

Foods high in fibre include:

• fruit and vegetables
• beans
• nuts
• oatmeal and some cereals
• wholemeal bread and whole wheat pasta.

It's recommended that people consume at least 20–35 g of fibre each day. You can check the amount of fibre in many foods by reading the product label.

Drinking plenty of water throughout the day is important as this helps carry nutrients around your body and get rid of waste. Having tea and coffee as part of a balanced diet is fine, but it's important that caffeinated drinks aren't your only source of water.

Look for low-fat options

A healthy diet is low in fat, especially saturated fats. Saturated fats are found in:

• butter and lard
• pies
• cakes and biscuits
• fatty cuts of meat, sausages and bacon
• cheese and cream.

Certain fats are worse than others. Trans fats are especially unhealthy – they raise your cholesterol level and increase your chance of getting heart disease.

Trans fats are found in:

• margarine
• many fast foods
• some processed ready-meals.

Try to avoid eating foods with these types of fats.

Fish contains healthy fats (polyunsaturated fats) that are healthy and can actually reduce your chance of heart disease. Olive oil also contains polyunsaturated fats, so use this when you're cooking.

Get enough vitamins

Doctors will often prescribe a folate (or folic acid) supplement, but you can also help by making sure you have natural folate in your diet. Folate is found in many breakfast cereals, oranges and orange juice, and green leafy vegetables.

Folate is another name for vitamin B9 and along with vitamin B12, it helps your body carry out many important jobs, including keeping the nervous system healthy. If your body doesn't produce enough of these particular vitamins it can lead to problems including muscle weakness and a lack of energy.

Some people with arthritis may be taking methotrexate, a medication that can interfere with how you process the vitamin folate. 

If you have a balanced diet, you generally won't need to take vitamin supplements. But it probably won’t hurt to take a multivitamin or a small dose of individual vitamins. If you do take vitamins, you still need to make sure that you have a healthy and nutritious diet.

Calcium and vitamin D

You need calcium and vitamin D to help prevent osteoporosis. Osteoporosis is a condition that causes bones to become thin and break more easily than usual. If you’re taking steroids, it's even more important to ensure you have plenty of calcium and vitamin D in your diet.

Foods and drinks that have a lot of calcium include:

• dairy products (soya milk is the best source of calcium as a non-dairy alternative to milk)
• green vegetables such as kale, collard greens, and broccoli
• certain nuts.

Many foods have calcium added, such as cereals and soy products.

Oily fish (salmon, mackerel) are the best natural source of vitamin D. Many products also have vitamin D added to them, including cereals, milk, orange juice and many yoghurts.

Sunlight in the UK is a good source of vitamin D, though you must be careful not to get burned, especially if you have fair skin. People with some conditions, such as lupus, are more at risk of getting burned by the sun.

Keep to a healthy weight

Having a low-fat and nutritional diet as part of a healthy lifestyle can help you maintain a healthy weight. This is good for your joints because less stress will be placed on them.

Being overweight has been known to cause extra inflammation and may make your symptoms worse overall.

We all need different amounts of calories in our diet, depending on our age, size and lifestyle. Making sure you don't have too many calories is important. Check food labels to find out how many calories are in food. Many foods in supermarkets are now colour coded – remember to look for more green and amber products and avoid red ones.

It's also useful to look at the sugar in your food too. In general, men shouldn't have more than 70 g of sugar a day, and women shouldn't have more than 50 g.

If you’d like more information about what would be the best diet for you, talk to a GP or your rheumatology consultant as they might be able to put you in touch with a dietician.

Read more about diet and arthritis.

Regular, careful and safe exercise is one of the best things you can do to manage your condition and improve your health.

There’s no evidence to suggest that exercise makes your arthritis worse. In fact, we know that gentle exercise can help with inflammation.

Why do I need to exercise?

Your body is supposed to move and it needs exercise. If you don’t exercise regularly and keep your joints moving, they'll become stiff and painful.

Exercise is great because it:

• improves your self confidence and mood
• increases your energy levels
• improves your sleep patterns
• produces endorphins, which help to reduce pain, stiffness and anxiety
• increases fitness, strength and flexibility
• can reduce the risk of complications caused by your arthritis, such as muscle weakness and stiffness
• helps speed up your recovery from flare-ups.

Exercise can also help you to keep to a healthy weight. Being overweight can make your symptoms worse, put extra strain on your joints and make treatments less effective. A healthy weight can help you manage your condition and improve your self-confidence.

The more you get into an exercise routine, the more natural it'll be, and the more you'll enjoy it. Aim for at least one hour of moderate exercise a day. Try to include exercise in your daily life, for example by cycling to school or to see friends, instead of getting a lift.

What exercise could I try?

You don’t have to be a marathon runner to keep active and be fit and healthy. There are many different ways to exercise and you need to do what you enjoy. Your physiotherapist can help if you need suggestions of exercises to try.

You might be able to mix a few different types of exercise. This will keep exercise interesting and work out different parts of your body

Keeping active will help your whole body, not just the affected joints. The stronger and fitter you are, the more support your joints will have.

Swimming

Swimming is a great exercise for some people with arthritis. It builds strength, which helps support your joints, and suppleness.

Swimming also improves your cardiovascular health and fitness, which means that your heart and lungs are exercised, and the blood is pumped around your body at a good rate.

It won’t put any stress on your joints as the water supports your weight, so it's great if you have inflammation around your joints.

Cycling

Cycling is also a superb form of exercise. Again, it’s great cardiovascular exercise and doesn't put pressure on your joints. It strengthens your leg muscles, which helps support your joints.

If you don’t fancy cycling on roads, you could cycle on a static bike in a gym or at home. If you do head out on a bike, wear a helmet and take care.

If you’ve had a period of time when you haven’t been able to exercise, your body will need to get used to training again. You should gradually increase your training; your physiotherapist will be able to help you plan this.

Pilates and yoga

Some people find that Pilates and yoga classes are enjoyable and good for managing their condition.

Pilates focuses on stretching and strengthening exercises and routines which works the whole body to improve posture, flexibility, strength and balance. It incorporates elements of Western forms of exercise with yoga and martial arts.

Practitioners say that Pilates is a more gentle way of raising your activity levels and is said to be particularly beneficial and suitable if you have poor mobility, aches and pains or an injury. Pilates is a gentle, low-impact form of exercise. 

Yoga also focuses on developing strength, posture, balance and good breathing technique. It can have a more spiritual side.

Yoga concentrates on breathing and on the participant developing particular postures, through a series of movements designed to increase the strength and flexibility of the whole body.

Should I exercise during a flare-up?

It’s important to try to maintain your exercise levels even when you’re having a flare-up. Swimming and cycling can be good during this time as it avoids loading of the joints.

You may also find that isometric exercises are more comfortable during this time. Isometric exercises are when you tighten particular muscles without moving a joint. Your physiotherapist will show you these exercise and explain when they should be practised.

It’s often advised that you avoid high-impact activities while your joints are swollen.

Once the inflammation has been controlled, talk to your rheumatology nurse or consultant about returning to exercising. If there’s been swelling around a joint, it’s common to have some muscle wasting.

You may notice your muscles look smaller and feel weaker. Your physiotherapist will assess your muscle strength and give you some strengthening exercises to practise at home to build this up again.

How can I stay motivated?

It’s good to keep an exercise diary to keep track of how you’re doing. This will allow you to look at patterns of how exercise is hopefully helping you manage your condition.

Good advice is to find something you enjoy and that works well for you.

One of the most successful ways to keep exercising on a regular basis is to take up a sport or a hobby where you have additional social benefits.

Read more about exercise.

Getting a good night’s sleep is important for your physical and emotional well-being.

If you have arthritis, symptoms such as pain may disrupt your sleep.

Poor or disturbed sleep night after night may make you feel more achy, tired and in a low mood. It can cause increased muscle tension and can be linked with muscle pain.

Healthcare professionals will usually suggest you think about ‘sleep hygiene’ – things that you can do to improve your sleep pattern.

Read more about sleep.

How can I improve my sleep pattern?

Get into a relaxing and familiar routine – try to get up and go to bed at roughly the same time every day. Ideally, go to bed when you’re sleepy.

Be active throughout the day so you're tired when you go to bed. Exercise regularly, but not within three hours of going to bed.

Eat sensibly so you don’t feel hungry during the night, but avoid eating and drinking large amounts just before bedtime.

Improve your bedroom

A tidy bedroom and clean, fresh-smelling sheets will make you feel more relaxed. Making your bed can be hard at times, but a made bed with no wrinkles will help add to the relaxed environment.

Your bed shouldn't be too hard or too soft. Use a suitable number of pillows – your neck and back should be in a straight line when you're lying on your side.

The darker the room, the better chance you have of getting to sleep, so it would help if you have thick, dark curtains.

Scented cushions or candles can also make your room smell nice.

Keep warm

Use a hot-water bottle or microwave wheat bags to warm your sheets. A warm bath before you go to bed can help ease stiff or painful joints.

Relax

Do any chores early in the evening if you can, so you have time to relax before going to bed. Pack your bag and get anything you'll need ready for the next day. A to-do list for the next day can be helpful.

Share any worries with someone you can trust and write them down. Don’t bottle them up. You might like to try some relaxation techniques, such as meditation.

If you do have nights when you can't get much sleep, don't be critical of yourself.

What can affect my sleep?

Some activities can overstimulate your brain and make getting to sleep difficult, including:

• playing games
• working and checking emails
• using social media.

Watching TV, particularly scary or exciting programmes, can also be overstimulating. Try to avoid having a TV in your bedroom or turning it on if you can't sleep.

Try to not listen to loud music before going to bed. Maybe find some soft/relaxing/chilled music instead?

It's best not to eat just before you go to bed. Try to avoid caffeinated drinks (tea, coffee, cola, energy drinks) from late afternoon. If you're really struggling to get to sleep you might want to cut these drinks out earlier in the day.

You should also avoid smoking before bedtime or during the night. Of course, it’s strongly advisable not to smoke at all.

Try not to sleep during the day because this can make it difficult to sleep at night.

It's important to get the right balance between work, socialising and resting; and having arthritis can make this challenging.

It's also important to find time to exercise regularly. Staying fit and healthy and keeping your joints moving is a big part of managing your condition. Exercise will help you feel more energetic and sleep better.

The key is to listen to your body – know your limitations and rest when you need to. Overdoing it can cause discomfort or pain the following day.

What is fatigue?

Fatigue is a feeling of extreme physical or mental tiredness, or both. Common features of fatigue include:

• your body and limbs feeling heavy and difficult to move
• flu-like feelings of exhaustion
• feeling that your energy has drained away.

If you have arthritis or a related condition, you may experience fatigue, especially during a flare-up. It shouldn't last and there are ways of managing fatigue.

Most of the time you'll have more or less the same amount of energy as your friends.

If you're feeling these symptoms, talk with a rheumatology nurse or consultant. 

It's important not to confuse lack of stamina, due to deconditioning (not being physically fit), with fatigue. If you're unfit you'll feel tired after exercise. With a gradual training programme your fitness, stamina and fatigue will improve.

Read more about fatigue.

What can help with fatigue?

Pacing means managing your time and working within your limits. It involves being organised and sensible with your jobs. It can help manage fatigue.

Pacing can help you to work out your most important work and chores. Thinking and planning ahead is key.

To begin with, forget about non-essential activities and concentrate on the most important ones. Once you've worked these out, organise your day so that you alternate heavy and lighter activities in order to ensure that you have enough energy left for activities you enjoy.

Prioritising tasks can help you get the most urgent ones done and, if necessary postpone less important tasks. Having achieved something makes you feel better about yourself.

Take regular rests, pace yourself and allow lots of time to do activities.

Fatigue may have stopped you doing things you really want to, so it's worth thinking what you could achieve that would make you feel good (for example socialising with friends or getting back into a hobby).

Setting small, weekly goals can help you build up to what you really want to do as you start managing your fatigue.

You're much more likely to meet small, specific goals than vague ones or ones that aim too high. Your occupational therapist or rheumatology nurse specialist may be able to help you set and review goals.

If you're working and find the days are too long, you might find it helps to discuss your condition with your employer and ask about flexitime. You may need a letter from your consultant, but many employers will be happy to accommodate you.

Some general advice:

• When you can, sit rather than stand.
• Don't put extra stress on yourself. Deal with your worries and talk to someone close to you.
• Relax, breathe deeply and avoid holding your breath during difficult tasks.
• Avoid postures which increase levels of fatigue, for example bending and reaching. Make sure your shoulders and neck stay relaxed.

Pain is something you'll unfortunately know more about than most of your friends.

It's very personal and individual. The way your brain interprets pain and how you react to it depends on many factors, including:

• how you're feeling, for example if you're worried or scared
• previous experiences of pain
• other people's reactions
• how well you sleep.

Many people often find it difficult to explain exactly how they're feeling when they're in pain. There are things you can do to help you better explain how you're feeling. If you’d like to know more about this, talk to your rheumatology department.

Pain doesn’t have to dictate how you live. Even if you experience a significant amount of pain, you can lead a fulfilling life. There are steps you can take to reduce the impact of pain and to make yourself feel better.

How can I fight pain?

Keeping up with your medication routine is very important but if you're still experiencing pain, you can ask your doctor for extra or alternative forms of pain relief. 

It's really important to try to gain a sense of control and to not let pain rule your life. The tips below might be helpful.

Read the tips below, or find out more about managing your pain.

Keep doing things you enjoy

Even if you’re in pain, it’s important to try to keep doing the things you enjoy and need to do as much as possible. This might seem tough at times, but it will help.

Doing the things you enjoy, such as seeing friends, can help prevent you feeling sad and can distract you, which can prevent you focusing on pain as much.

Be as independent as you possibly can at all times. Ask your occupational therapist about handy gadgets.

Stay warm

Keeping warm can be a useful way to ease pain. Try having warm baths or doing some gentle stretches in warm water – ask your rheumatology team about this.

Warm your bed with a hot-water bottle, microwaveable wheat pack or electric blanket, and try putting your clothes on a radiator before you get dressed.

Exercise

Doing some exercises recommended by your physiotherapist will help. Try a hot pack over your joints before exercising; if this doesn’t work try a cold pack.

Exercise is important to keep you moving. If you become inactive and then unfit, stresses and strains of everyday life can become harder to deal with and you might find it harder to get to sleep.

Talk about it

Don’t bottle up your worries – talk to family or friends, or your rheumatology nurse/consultant. Sharing ideas about coping with pain with other people in the same situation can also help. 

Having a good posture is important. Try not to be in a position where you are bent over and try not to remain in one position for too long – keep mobile.

Below are some other steps you can take to help yourself feel better:

• Ask the physiotherapists about splints to help relieve joint pain.
• Ask your parents or friends to give you a gentle massage.
• Try to get a good night's sleep.

Concentrate on your breathing

Pain may affect your breathing. It can make you take short and frequent breaths and this can make you feel a little dizzy.

It’s important to concentrate on how you're breathing. Try to take slow, deep breaths and get into a gentle rhythm.

You might find it helpful to put one hand on your chest and one hand on your stomach while you practice. As you breathe in, your stomach should rise a little and as you breathe out it should fall.

Try relaxation

Once you've controlled your breathing, listen to your favourite music and let your mind relax.

One relaxation tip is to visualise your favourite place. This could be a warm beach, or a beautiful lake by a mountain. It might be somewhere you know that makes you feel happy and safe, such as your grandparents’ living room or your favourite cafe.

Try to picture yourself there and think of the sights, sounds and smells.