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Osteoarthritis Linked to Inflammation

Eighty percent of North Americans have X-ray evidence of osteoarthritis by age 65, and sixty percent have significant joint pain. Recent research suggests that osteoarthritis may be caused by inflammation, the same overactive immunity that causes heart attacks and auto-immune diseases. Your immunity is good for you because it kills germs that try to invade your body. However, after the germs are gone, your immunity is supposed to slow down. If your immunity 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 cartilage in your joints. Here are some of the recent studies linking osteoarthritis with other diseases of inflammation:

• People with osteoarthritis have high blood levels of galectins that turn on a person's immunity to cause inflammation, just as in rheumatoid arthritis and reactive arthritis (The Journal of Immunology, February 15, 2016;196(4):1910-1921).
• People who eat an anti-inflammatory Mediterranean-type diet (high in plants, low in red meat and other pro-inflammatory foods) are at reduced likelihood for getting osteoarthritis (Clin Nutr, Oct 8, 2016. S0261-5614(16)31279-1).
• Factors associated with increased diabetes risk are increased in people who have osteoarthritis (Br Med Bull. Sept 2015;115(1):111-21).
• Overweight women are at increased risk for osteoarthritis (Osteoarthritis Cartilage, Oct 27, 2015. S1063-4584(15)01364-3). See How Excess Weight Can Cause Arthritis.
• 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).
• Osteoarthritis is associated with high cholesterol (Osteoarthritis and Cartilage, Feb 9, 2017).

Types of Arthritis
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 immunity is overactive
• infections in joints
• crystal diseases, such as gout, in which crystals form in joints
• osteoarthritis, by far the most common type, where cartilage is worn away and there is no history of trauma or other known explanation. When there is no known cause, treatments are just guesswork. Osteoarthritis is usually treated with non-steroidal drugs (NSAIDs) that help to block pain but do nothing to slow down the destruction of cartilage.

Symptoms of Osteoarthritis
People are usually diagnosed as having osteoarthritis if they:
• have gradually increasing pain in their knees, hips, hands or spine
• are age 40 or older
• have negative results in the standard blood tests for an overactive immunity
• have swelling of the knuckles and joints on the ends of the fingers next to the fingernails, not in the middle finger joints, and at the base of the thumb (Rheumatoid arthritis usually affects the middle joints of the fingers and the joints where the fingers attach to the hand)
• have pain that is usually worse in the morning when a person first gets up. In osteoarthritis, the pain usually lessens as the person keeps moving.

Exercise Treats Osteoarthritis
• A reviews of 55 studies showed that weight bearing exercise reduces pain and improves joint function in osteoarthritis (British Journal of Sports Medicine, September 24, 2015). Exercise helps to reduce inflammation.
• Aerobic and strength training for 20 weeks markedly decreased knee pain and increased mobility (Arthritis Care & Research, 08/30/2016). No serious side effects occurred from the knee strength and conditioning program.
• A review of six studies of a total of 656 men and women with knee osteoarthritis found that exercise improves symptoms of knee pain in osteoarthritis and that it did not make much difference whether the knee exercise program was of low or high intensity (Cochrane Database Syst Rev, 2015 Oct 29;(10):CD010203).
See Treat Osteoarthrits with Exercise
Exercise for Osteoarthrits

Little Evidence That Any Type of Surgery Helps to Treat Knee Osteoarthritis
Removing damaged attached cartilage offers little or no 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 (British Medical Journal, 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).

Why So Much Surgery?
In the United States, medicine is a business and the bottom line of a business is profit. Fifteen years ago, the first of many 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.

My Recommendations
If your joints hurt, check with your doctor to see if you have a known cause. 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. If your doctor cannot find a cause for your pain, you will probably be told that you have osteoarthritis. Everything you can do to reduce inflammation will help you to combat the pain of osteoarthritis:

• Lose weight if you are overweight. I recommend Intermittent 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.
• Exercise and keep moving. Osteoarthritis always worsens with inactivity. However, you must be guided by pain and stop when the pain worsens.
• 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 knee replacement. However, replacing your joint requires driving a spike into the middle of the bones of your knee and that pushes aside the shock-absorbing marrow and weakens the bone to increase your chances of breaking the bones if you fall. If that happens, the knee cannot be replaced again until the broken bones heal. 

February 26th, 2017
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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