Osteoarthritis affects almost 30 million North Americans, making it the most common joint disease. It damages cartilage most often in the knees, hips, fingers and spine and is associated with aging, trauma, and obesity, but its primary cause now appears to be an overactive immunity that damages joints (Nature Medicine, November 6, 2011), rather than wear-and-tear injuries (Bone, 2012;51:249–257). Since obesity turns on your immunity, it is associated with increased risk for arthritis as well as heart attacks, diabetes, and cancer. More than 80 percent of obese people suffer some form of joint disease, most likely because having the liver and muscles full of fat is associated with an overactive immunity that can damage every cell in your body including the cartilage in joints. Excess weight is associated with both osteoarthritis and rheumatoid arthritis. Weight loss can reduce joint damage and disability and improve quality of life in overweight people with joint disease (PMR, May 1, 2012;4(5 0):S59–S67).

What's the Evidence?
• Obese people are seven times more likely than normal weight people to suffer osteoarthritis of the knee (Joint Bone Spine, 2011; 78(2):150-5).
•The more overweight you are, the greater your chance of suffering from osteoarthritis of the knee and hip Joint (Bone Spine, 2012; 79(3):291-7).
• Obesity is a potent trigger to develop rheumatoid arthritis, ankylosing spondylitis or psoriatic arthritis (RMD Open, June 29, 2015;1(1): e000012).

How Excess Weight Damages Joints
Obesity turns on your immunity to raise blood levels of cytokines that can damage joints: interleukins, tumor necrosis factor and C-reactive protein (Clin Chem Lab Med, 2010;48:1141–1145) and galactins (The Journal of Immunology, February 15, 2016;196(4):1910-1921). High levels of these cytokines predict the onset and progression of osteoarthritis (Clin Immunol, 2012;144:228–236).

Your immunity is helpful because it attacks and destroys germs that invade your body since it can tell that germs have different surface proteins than you do. However, if your immunity stays active all the time, it can use these same chemicals and cells to attack and destroy your own cells. This is called inflammation and anything that causes your immunity to continuously produce these chemicals and cells can damage the cartilage in your joints as well as all of the other cells in your body. Obesity, particularly excess fat stored in your liver and muscles, can cause high blood sugar, high blood pressure and cell damage everywhere in your body, including joint damage (Ther Adv Musculoskelet Dis, Apr 2013;5(2):77–94).

In just 16 weeks, weight loss lowered high markers of inflammation in people with osteoarthritis (Osteoarthritis Cartilage, 2014;22(11):1817–25) and losing weight markedly reduced pain and limitation of movement in patients with osteoarthrtis (Arthritis Care Res, 2013;65(1):15–22).

My Recommendations
If you are overweight and also suffer joint pain, lifestyle changes can be an even more effective treatment than the drugs that doctors prescribe for osteoarthritis. Drugs can help to relieve pain, but they do not cure osteoarthritis. Non steroidal anti-inflammatory drugs (NSAIDs) available over-the-counter can help to relieve pain, but they do nothing to slow down the destruction of cartilage in joints. Prescription drugs that can slow down joint damage have many side effects, including increased risk for infections and cancers. Caution:  Always check with your doctor before stopping or changing dosage on any prescribed medication.

Treatment of osteoarthritis should include:
• Loss of excess weight. I recommend intermittent fasting
• A regular exercise program that includes continuous movement and avoidance of exercises that increase pain when you do them. See my report on exercise therapy for osteoarthritis
Also see Osteoarthritis Probably Caused by Inflammation

Checked 4/19/18