I’m going to reveal a commonly missed factor that causes and worsens arthritis. There is actually much more to osteoarthritis than just a simple wear and tear disease. We now understand that arthritis is far more complex, involving not just the joints, but also our weight, metabolic health, and even our lifestyle choices. I’m going to give you a look at the science behind arthritis, the cutting-edge research that’s changing how we understand this condition, and practical steps that you can take to manage and improve your joint health.
Let’s first start off by understanding what osteoarthritis actually is. Osteoarthritis is one of the most common forms of arthritis affecting millions of people worldwide. But what exactly happens in our joints when osteoarthritis takes hold?
Imagine your joints as a smooth, well oiled machine. The ends of your bones are covered with a protective layer called articular cartilage. This cartilage is like a cushion – it helps your joints move smoothly and absorbs the shock from movements like running or lifting.
But in osteoarthritis, this cartilage starts to wear away. Think of it like the treads on a tire wearing down over time. As the cartilage thins, the bones can begin to rub against each other. This can cause pain, stiffness, and sometimes swelling in the joints. It can make it harder to move the joint and do everyday activities, like climbing stairs or even opening a jar.
Now, here’s where things get interesting. For a long time, it was believed that osteoarthritis was just due to the wear and tear of the joints. But recent research has shown that it’s much more than that. Groundbreaking studies have revealed that our metabolic health and systemic inflammation plays a significant role in osteoarthritis. And guess what? This inflammation is not just confined to the joints; it’s a complex interplay involving our immune system, metabolism, and more.
So I want to start first by defining what I mean by metabolic health. This includes things like blood pressure, blood sugar, weight, triglycerides, and cholesterol. We actually have a medical terminology for all of this and it’s called metabolic syndrome. This is characterized by a combination of several metabolic abnormalities including abdominal obesity, high blood pressure, high blood sugar, high triglycerides, and low HDL cholesterol.
Having metabolic syndrome significantly increases the risk of developing chronic conditions like type 2 diabetes and cardiovascular disease, including heart attacks and strokes. It’s also linked to other chronic diseases like kidney disease and fatty liver disease.
Clinical research has now established an association between metabolic syndrome and osteoarthritis. A recent study found that people with higher metabolic syndrome severity have worse progression of osteoarthritis as defined by worse bone spurring, worse bone marrow lesions, and worse defects in their cartilage. All of this indicates worse progression of arthritis.
So the question is, why? How exactly does our metabolic health affect symptoms related to arthritis and worsening progression? Let’s take obesity as an example.
First, we’ll talk about the obvious – the extra mechanical stress. When someone is obese, the added weight puts additional pressure on the weight-bearing joints like the knees and the hips. In fact, for every pound of body weight you are carrying, the knee joint will experience 3 to 4 times the amount of that weight. So if you are 20 pounds overweight, then your knee joint is actually experiencing an extra 60 to 80 pounds of extra weight. This will fast track and accelerate the wear and tear of the knee.
So this is a logical explanation for why overweight individuals have higher rates of osteoarthritis in their knees and hips. But here’s the kicker! Why are these same individuals also at high risk of getting osteoarthritis in non weight bearing joints like the hands and the wrists? This is where things get really interesting.
Obesity is associated with chronic inflammation throughout the body. This isn’t the same as the inflammation you get from an injury – it’s a low-grade, persistent inflammation. Fat tissue, or adipose tissue, isn’t just sitting there. It’s actually quite active and releases molecules called adipokines, which circulate in your body and can promote inflammation. This inflammation can affect the joints and contribute to the development of osteoarthritis.
But it’s actually much worse than that! Not only is there inflammation, but obesity also affects how the cells in the joint function. Chondrocytes are cells that help make up articular cartilage. Obesity actually interferes with the cellular metabolism of chondrocytes. This means that they might not be able to repair the cartilage effectively or could even contribute to breaking it down.
And it's this combination of inflammation and metabolic dysregulation that creates a kind of vicious cycle. The inflammation contributes to metabolic changes, and these metabolic changes can, in turn, exacerbate inflammation. This is how obesity can lead to progressively worsening arthritis over time.
All of these effects are actually compounded and magnified when we start adding in other variables such as blood sugar, triglycerides, and cholesterol. High sugar consumption promotes the production of pro-inflammatory cytokines, which can worsen arthritis symptoms.
This cohort study looked to examine the longitudinal relationship between blood glucose levels and knee symptoms related to arthritis. They found that higher blood glucose levels were associated with worse knee symptoms over the 1 year follow up time period.
This effect is also seen in those with type 2 diabetes, which is a metabolic disorder characterized by high blood sugar levels. This systematic review and meta-analysis found that type 2 diabetes is associated with the development and worsening of osteoarthritis, even when controlling for confounding factors such as body mass index as well as weight.
The same is true for hyperlipidemia which is characterized by high triglycerides and high cholesterol. This cross sectional study found that people with higher levels of fats in the blood were associated with higher rates of knee pain and clinical knee osteoarthritis.
All of these findings support the hypothesis that systemic inflammation made worse by obesity and metabolic syndrome can contribute to the development and progression of osteoarthritis and is an important aspect of the multifactorial nature of arthritis.
So if all of this is true, now let’s ask the question, what happens to the body after you lose a significant amount of weight? Do symptoms related to arthritis improve after weight loss? And the answer is a resounding yes!
This study looked at what happened to people’s knee arthritis after undergoing bariatric surgery also known as weight loss surgery. They found that there were significant reductions to the inflammatory markers C reactive protein as well as interleukin 6. In addition, weight loss resulted in INCREASED biomarker levels related to cartilage synthesis which is a positive sign of cartilage health. It also resulted in significant DECREASES in biomarkers that result in cartilage degradation, again a positive sign of cartilage health.
Even a 5% or 10% weight loss results in significant benefits to arthritis symptoms. This study found that a 5% weight loss produced small positive effects on pain, self reported disability, and quality of life in adults with obesity and with knee osteoarthritis. A 10% weight loss had moderate to large effect sizes on the same outcome measures.
So I hope it’s clear now that there is a complex relationship between obesity, metabolic health, and osteoarthritis. By addressing these other aspects of your health, you can actually treat your arthritis much more effectively.
So now I want to change gears a little bit and offer you some solutions. How can you manage osteoarthritis in the context of obesity and your metabolic health?
First and foremost, lifestyle changes can make a big difference. Losing weight reduces the mechanical stress on the joints and can also decrease systemic inflammation. Your diet plays a big role in this.
To promote a healthier lifestyle and manage arthritis symptoms effectively, you’ll want to minimize the consumption of processed and fried foods. These types of foods have been associated with triggering inflammation. Additionally, try to reduce the intake of sugary foods and high glycemic index foods, as they can contribute to the production of pro-inflammatory cytokines and potentially exacerbate arthritis. Moreover, studies have shown a correlation between increased inflammation levels and the consumption of processed meats, and this can further aggravate arthritis symptoms.
Instead, try to focus on eating an anti-inflammatory diet. This means filling your plate with foods that have been shown to reduce inflammation and promote joint health. Fruits and vegetables are packed with antioxidants, vitamins, and minerals that can help combat inflammation. Aim for a variety of fruits and veggies, including berries, citrus fruits, leafy greens, and cruciferous vegetables such as broccoli, cauliflower, and cabbage.
Whole grains are another excellent addition to an arthritis-friendly diet. These include brown rice, quinoa, and oats. They provide fiber and important nutrients that support overall health while also reducing inflammation.
When it comes to protein, opt for lean sources like chicken, fish, nuts, seeds, and legumes. These alternatives provide essential nutrients without the added unhealthy fats and inflammatory properties found in processed meats.
Healthy fats, such as those found in avocados, olive oil, and fatty fish like salmon, are also beneficial for managing arthritis. These fats contain omega-3 fatty acids, which have anti-inflammatory properties and can help alleviate joint pain.
And don’t forget about exercise. Multiple studies such as this one suggest that exercise has similar therapeutic benefits to pain and functional improvement as common medications such as acetaminophen, ibuprofen, and naproxen.
Exercise comes in two flavors. This first is aerobic exercise such as daily walking. Walking has benefits to all cause mortality, cardiovascular disease, mental health, cognitive function, immune function, weight loss, and more. Specifically for arthritis, walking helps prevent arthritis from getting worse and is associated with better outcomes. Other excellent forms of low impact aerobic exercise include cycling, swimming, elliptical training, and rowing. Aim for at least 30 minutes every day of aerobic exercise.
The second flavor of exercise is strength training. Targeting muscles in the entire lower extremity as well as focusing on treating the muscles around the knee have been shown to significantly reduce pain and improve function related to symptomatic knee osteoarthritis. The contrary is also true. Weaker leg muscles have been linked to worsening arthritis symptoms in addition to worse radiographic progression of arthritis. Aim to do strength training about 3 times a week.
Remember, osteoarthritis is not solely a result of wear and tear but a complex interplay of metabolic factors and inflammation. Through lifestyle modifications, informed healthcare decisions, and a proactive approach to self-care, you can strive for improved joint health and a better quality of life.