Osteoarthritis is a condition which causes swelling, pain and stiffness in the joints. It is typified by inflammation and destruction of the cartilage which lines the bones within the joints. Traditionally it was thought that this was a ‘wear and tear’ arthritis and that the more the joints were used, the more they wore down, much like the part of a machine gradually being eroded away by many years of use. It was also thought that this was a one-way process and that osteoarthritis could not be reversed, condemning sufferers to lifetime of pain and disability.
Previous efforts at treatment have focused on relieving the pain and swelling caused by the condition until the was no other option but to replace the joint. Joint replacements have come on dramatically in the last few decades and some joints, such as hips, can restore a huge amount of functionality and last for a very long time. However, this mode of treatment can be very disempowering. Patients must put up with taking multiple pharmaceuticals which invariably cause side effects, until their surgeon deems their pain severe enough to warrant a risky and painful procedure to replace the joint.
This perception of osteoarthritis is outdated but is unfortunately still practised by many. The body is an organic structure, designed to repair itself, and if provided with the correct raw materials and environment, osteoarthritis can be prevented and reversed.
Rather than being a linear process of articular cartilage thinning until it disappears, joints are in a continual state of flux, with osteoblasts working to repair damage in the bone and condrocytes performing the same job for the cartilage. The reason why osteoarthritis occurs is because there is an imbalance between the destruction of the cartilage and it’s repair.
When a joint suffers repeated impact, the bones and cartilage are weakened and break down. If I sat and banged my head against my desk continually for the next 10 years, I can guarantee that I would destroy the articular cartilage between the vertebrae of my neck and give myself osteoarthritis. If I only bang my head against my desk once a week, the condrocytes will have time to repair the cartilage in my vertebra between impacts. Condrocyte repair is a slow process so if damage is caused to the cartilage too frequently then repair cannot keep up.
When cartilage and bones breakdown faster than they are repaired several things happen. Firstly, the inflammatory process within the joint can cause some unregulated bone growth, resulting in extra bits of bone growing around the articular cartilage. Cysts also develop in the bone close the surface of the joint. The cartilage is also destroyed before it can be rebuilt. Usually the lovely lubricating synovial fluid stops the bones from touching each other, but as the cartilage is destroyed, the bones get closer and closer until eventually they touch. This all leads to joint swelling, pain, deformity and bad times all round.
Well, at least that used to be believed. Interestingly, joints that exhibit all the above characteristics don’t always cause the symptoms we would expect. The typical characteristics of a joint with osteoarthritis is not just due to the destructive process but also the ongoing attempted repair. Sometimes the extra bony growth, cyst formation and joint narrowing can result in a joint which is functional and painful, albeit changed slightly, similar to how scar tissue on the skin looks a little different to regular skin but still works perfectly as well.
The bottom line really, is that it doesn’t matter what the joint looks like on the inside, it’s the symptoms and functionality that counts. The two ways to maintain the functionality and to reduce the symptoms is to strengthen the joints and to manage the level of inflammation.
Exercise done incorrectly can be bad news for joints. Running for example, especially when done on a hard surface with incorrect shoes, often causes knee problems later in life. The continual heavy impact sustained by the joint causes damage and inflammation which isn’t given time to repair, leading to joint destruction. Contrastingly, exercising with ample resistance whilst removing the repetitious impact which running necessitates, leads to stimulation of the condrocytes to strengthen the intra-articular cartilage. Stronger cartilage is able to cope with more stress, thus helping prevent future breakdown. Over-stressing of the joint is likely to cause tendonitis so it’s about getting the balance right. Resistance exercising once or twice a week is the right range for most people.
People suffering from osteoarthritis often benefit from strengthening of the muscles, joints and tendon via resistance training. Condrocytes are also stimulated under stress in a joint affected by osteoarthritis, helping speed up repair. Maintaining flexibility of a joint affected by osteoarthritis is important. Pain causes people to hold a joint in a fixed position, leading to shortened tendons and reduced range of movement. The remodelling which occurs can also reduce the range of movement and over the longterm lead to deformity of the joint. Strong muscles surrounding an arthritic joint help to support it and disperse much of the pressure put on it, therefore reducing pain.
Inflammation in a joint serves the purpose of stimulating repair and restoring the joint to full functionality. But, when the inflammatory process goes into overdrive, it can cause increased joint destruction with pain and swelling. This can happen if the joint is exercised too frequently, but also when the amount of pro-inflammatory compounds consumed in the diet is too high. Avoiding grains, sugar and omega-6 fatty acids is essential in preventing excessive inflammation.
The UK guidelines for management of osteoarthritis suggest that the isn’t enough evidence to justify the use of glucosamine and chondroitin. However after reviewing the evidence it seems to me that glucosamine sulphate (not hydrochloride) has a strong body of evidence that it can be effect in some people, especially for those suffering from osteoarthritis of the knee. Chondroitin, a component of cartilage, works well when taken with glucosamine and seems to potentiate it’s effect. Glucosamine was initially thought to be an essential building block for cartilage production. Interesting this is part of the reason why many dismissed it as a pointless supplement, because why would eating glucosamine make it magically appear in the joints? But it’s now theorised that it works by binding to a chemical called transglutaminase-2 which would otherwise be liable to bind with gluten and form inflammatory compounds.
Several other supplements such as fish oil, ginger, rose hip and boswellia serrata have decent evidence to suggest that they work to reduce the pain of osteoarthritis. Turmeric reduces pain and inflammation and there is also some evidence to suggest that it protects chondrocytes and help prevent osteoarthritis in the first place. Vitamin D deficiency is also associated with increased pain from osteoarthritis.
So, far from being the progressive degradation of joints that osteoarthritis was previously though to be, it’s actually part of natural process of joint breakdown and repair. Stresses on the joints, biochemical balance of inflammatory level and the body’s ability to repair, dependent on factors such as age and general health, all influence the development and possible recovery from osteoarthritis.
In summary, my advice for avoiding and recovering from osteoarthritis is as follows:
• Avoid pro-inflammatory food as much as possible, including grains (especially gluten), refined sugar and foods containing high levels of omega-6 fats.
• Brief, high resistance exercises, several times a week. Anything more than mild pain in the joints should prompt you to stop and consider reducing the level of resistance next time.
• If you want to run, barefoot shoes will minimise the impact of each footfall and help reduce osteoarthritis of the knees and hips.
• Supplement with glucosamine and chondroitin. They are often available together as a single supplement. Make sure it’s glucosamine sulphate rather than hydrochloride. Glucosamine sulphate 500mg three times a day and chondroitin sulphate 400mg three times a day is the recommended dose. Another alternative is to drink bone broth and eat the cartilaginous parts when eating chicken wings for example.
• Incorporate turmeric into cooking. If this is difficult then is can be supplemented as curcumin phytosome 200mg twice a day.
• Ensure adequate levels of vitamin D
• Help balance inflammation by getting plenty of sleep and keeping stress levels low.
• If you suffering from joint pain but don’t wish to use pharmaceuticals, then consider fish oil, boswellia serrata, rose hip or ginger.
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