Osteoarthritis and Inflammation

More than half of North American adults over 65 years of age suffer from osteoarthritis. It used to be that you would go to your doctor and tell them that you have pain in your knees, hips, hands or spine (Arthritis Rheumatol, 2022;74(7):1172-1183). Your doctor would order multiple x-rays and blood tests and most would come back normal, so they would then tell you, “Aha, you have osteoarthritis, ” which meant they didn’t have the foggiest idea why your joints hurt. Recent studies show that inflammation is involved (Curr Opin Rheumatol, 2023 Mar 1;35(2):128-134), and that an anti-inflammatory lifestyle should be an important part of the treatment.

What is inflammation?
Your immune system is supposed to be good for you because it produces cells, cytokines and antibodies that try to kill the germs that invade your body. However, after the germs are gone, your immune system is supposed to slow down. If your immune system remains active, it can use the same chemicals and cells that attack germs to attack any part of your body, and that includes destroying the synovial coverings and cartilage in your joints. Osteoarthritis has been linked with other diseases of inflammation:
• People with osteoarthritis have high blood levels of galectins that turn on a person’s immune system to cause inflammation, just as in rheumatoid arthritis and reactive arthritis (J of Immunology, February 15, 2016;196(4):1910-1921).
• Synovial damage in osteoarthritis is turned on by an overactive immune system (Arthritis Res Ther, 2017 Feb 2;19(1):18).
• Joint macrophages turn on your immune system in osteoarthritis (Clin Exp Rheumatol, 2019 Sep-Oct;37 Suppl 120(5):57-63).

Types of Arthritis
Arthritis generally begins with gradually-increasing pain in the knees, hips, back and/or hands. Doctors classify arthritis into several types, including:
• degenerative arthritis (following trauma. work-induced injury or repetitive motion injury)
• various kinds of reactive arthritis, such as rheumatoid arthritis, in which a person’s immune system is overactive
• infections in joints
• crystal diseases, such as gout, in which crystals form in joints

Osteoarthritis does not fit into any of these categories. People are usually diagnosed as having osteoarthritis if they have swelling of the knuckles and joints on the ends of the fingers next to the fingernails, not in the middle finger joints (Rheumatoid arthritis usually affects the middle joints of the fingers and the joints where the fingers join the hand). The pain of osteoarthritis is usually worse in the morning and lessens as the person keeps moving.

Lifestyle Factors That Increase Risk for Osteoarthritis
• Lack of exercise: The rate of knee osteoarthritis (loss of cartilage) has risen at a frightening rate over the last 50 years, reflecting changes from active agrarian or industrial lifestyles to a post-industrial society in which most people do not do a lot of physical labor and gain too much weight (Proc Nat Acad Sci, August 29, 2017;114(35):9332-9336). Knee cartilage has such a poor blood supply that it has to get its nutrients from constant movement and weight bearing that effectively pumps the nutrients into the cartilage. Not moving your knees enough deprives knee cartilage of the nutrients necessary to sustain itself so that the cartilage becomes smaller and weaker. Knee cartilage can be damaged in sports activities or accidents, but less than 10 percent of knee osteoarthritis appears to be related to trauma.
• Obesity: Almost 70 percent of obese people eventually develop knee osteoarthritis (Arthritis and Rheumatism, Sept 15, 2008;59(9):1207-13) and losing as few as 11 pounds reduces risk of developing knee osteoarthritis among women by 50 percent (Arthritis and Rheumatism, August 1998;41(8):1343-55). Excess weight causes inflammation.
• Diet: A study of almost 5000 people showed that those who eat a plant-based Mediterranean-type (anti-inflammatory) diet have a much lower prevalence of osteoarthritis (Clin Nutr, Oct 8, 2016). Factors associated with increased diabetes risk are increased in people who have osteoarthritis (Br Med Bull, Sept 2015;115(1):111-21). Taking sugared drinks increases risk for osteoarthritis and the more a person drinks, the greater the risk (BMJ Open, July 18, 2013;3(7):e002993).

Little Evidence that Surgery Cures Knee Osteoarthritis
Removing damaged attached cartilage offers little benefit (Br J Sports Med, 2016;50:1473-1480). Exercise is more effective than surgery (arthroscopic partial meniscectomy) in treating people with knee pain and degenerative meniscal tears (BMJ, July 20, 2016). Surgery has not been shown to be more effective than exercise in treating knee osteoarthritis (N Engl J Med, 2013;368:1675-84) and arthroscopic partial meniscectomy is not more effective than sham placebo surgery for a degenerative meniscal tear (N Engl J Med, 2013;369:2515-24). An editorial in the same issue of the journal states: “The surgery is a highly questionable practice without supporting evidence of even moderate quality . . . the latest nail into what should be a sealing coffin” (BMJ, July 20, 2016). More than 20 years ago, the first of several studies showed that arthroscopic partial meniscectomy is no more effective than a placebo (N Engl J Med, 2002;347:81-8). Yet arthroscopic partial meniscectomy to trim a torn knee meniscus is one of the most common surgical procedures, with more than 750,000 knee arthroscopies done in the United States each year. See Arthroscopic Knee Surgery is Usually Useless

My Recommendations
If your joints hurt, check with your doctor. If you have sudden locking of a joint and it gets better but then recurs, you may have “joint mice”, loose pieces of cartilage that slip between the cartilage to cause horrible pain. Your doctor can usually fix this by removing the loose pieces by arthroscopy.

Everything you can do to reduce inflammation will help you to combat the pain of osteoarthritis:
• Lose weight if you are overweight. I recommend Intermitent Fasting.
• Eat an anti-inflammatory diet that includes lots of fruits, vegetables, whole grains, beans, nuts and other seeds, and severely restrict red meat, all foods with added sugar, all sugared drinks including fruit juices, and fried foods.
• Keep blood levels of hydroxy vitamin D above 30 ng/dL.
• Exercise and keep moving, but be guided by pain and stop immediately when the pain increases or does not go away when you slow down.
• Avoid sports that involve impact. Since the force of your foot hitting the ground can break off cartilage, do not run, jump or participate in exercise that involves impact of your feet hitting the ground. You can cycle since your feet never leave the pedals, so pedaling is not an impact sport. Swimming is also a good non-impact sport.
• Use non-steroidal anti-inflammatory drugs as needed to control pain, but realize that they do nothing to cure the problem. Take the lowest dose possible to relieve pain.
• If knee pain becomes so unbearable that it keeps you awake at night, you may want to consider a Total Knee Replacement