Ask the Doctors by Eve Glazier, M.D. and Elizabeth Ko, M.D

Diet, Exercise and Flexibility Training Can Alleviate OA Pain

Dear Doctor: I just learned that the constant pain in my right knee, which I injured playing college basketball, is osteoarthritis. I'm only 33 and want to do everything I can to get better. Is it true that fish oil can help? Is there anything else I can do?

Dear Reader: Osteoarthritis, also referred to as OA, is a chronic degenerative condition that affects the joints. Unlike rheumatoid arthritis, which is an autoimmune disease, osteoarthritis is associated with the breakdown of the cartilage in the joints due, in large part, to wear and tear. Although OA is most common among people in their mid-60s and older, it can affect people of any age. A sports injury like yours is a significant risk factor for developing OA. So are chronic overuse, being overweight or obese, and genes. Both types of arthritis tend to be more common in women than in men.

OA most often affects the weight-bearing joints of the knees and hips. It can also affect the neck, spine, shoulders, elbows, hands and feet. Symptoms include joint stiffness, swelling, a reduced range of motion and pain. People with OA often report hearing clicking or popping sounds when they bend their joints. One side of the body is usually affected more than the other, perhaps because we tend to have a "stronger" side and unconsciously allow it to do more work.

Morning stiffness is a challenge and can require a half-hour or so of slow and deliberate activity to get the affected joints working freely. That stiffness typically returns after long periods of inactivity, like sitting at a desk at work, or remaining in the same position for extended period of times, such as when driving. Diagnosis is done through imaging tests like MRIs or X-rays, which can show the extent of damage that has taken place to the joint capsules.

With the findings from a recent study published in the journal Rheumatology, researchers from Great Britain added to the mounting evidence that nutrition and exercise play a role in managing the disease. An analysis of 68 studies about OA found that patients who took a low-dose supplement of fish oil of 1.5 capsules per day reported a measurable reduction of pain. The thinking is that the essential fatty acids in the fish oil help address the chronic inflammation that is part of the OA disease process.

Also important to managing OA was weight loss, which not only eased pressure on the joints but also led to a reduction in inflammation. In addition to a healthful diet of whole foods to reduce blood lipid levels, vitamin K, which is present in abundance in kale and spinach, was associated with positive outcomes. Vitamin K is required for the synthesis of certain proteins that help maintain the health of bones and connective tissues.

Finally -- and this can seem counterintuitive when dealing with the pain and stiffness of OA -- a gentle but consistent program of aerobic exercise, along with strength and flexibility training, proved to be important. None of this is a cure, but when undertaken together and incorporated into an ongoing lifestyle, living with OA can be a bit easier.

(Send your questions to, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)