An Holistic Approach to Osteoarthritis

The word arthritis is derived from two Greek words that together mean “inflammation of the joint.” Osteoarthritis (OA) is the most common form of arthritis occurring in knees, hips, spine and hand joints. It is one of the leading causes of pain and disability in the Western world. For example, symptomatic knee OA occurs in 15% of adults who are older than 55 years old, with a radiographic incidence of more than 80% in those over 75 years old.

 

What happens in osteoarthritis?

 Osteoarthritis is traditionally thought of as a “wear and tear” disease which occurs as we age. However, recent research suggests there is more to it than that. The pathogenesis of OA involves a degradation of cartilage and remodelling of bone due to an active inflammatory cell response in the surrounding tissues.

The release of enzymes from these cells break down collagen and proteoglycans, accelerating cartilage loss and subsequently weakening the collagen network. The exposure of the subchondral bone (the bone just beneath the cartilage in the synovial joint)results in hardening of the body tissue, followed by reactive remodelling changes that lead to the formation of osteophytes and bone cysts. The joint space is progressively lost over time.

 Osteoarthritis is usually associated with localised joint pain and stiffness due to a reduction in cartilage integrity, leading to bone rubbing on bone. Some people may have mild osteoarthritis and show no symptoms, whereas others may experience severe pain and have significant loss of joint lubrication, function and mobility.

 

How do I know if I have osteoarthritis?

The majority of the population above 40 years will show some signs of joint degeneration on an x-ray, however many will not feel any symptoms until the cartilage and bone deterioration is significantly worsened. Symptoms to look out for include:

  • Pain on motion, limited range of motion and joint locking
  • Joint stiffness and pain worsens with activity (most commonly affects highly active or load bearing joints i.e. knees, hips and spinal joints)
  • Joint swelling and stiffness, worsened with prolonged inactivity
  • Crepitus i.e. cracking or popping sounds
  • Variable or intermittent nature over time (“good days and bad days”)
  • Bony deformities in the joints e.g. nodules forming in finger joints

 

What are the key drivers?

Ageing

Osteoarthritis is often considered an age-related condition for a couple of reasons. As part of the ageing process, the ability to reduce the impact of joint loading during normal activities is reduced by loss of muscle mass, loss of gait reflexes and poor response times. Our ability to repair and heal cartilage and bone is also reduced making us more susceptible to free radical-induced damage.

Mechanical Stress

Mechanical joint injury, joint malalignment and dysplasia are the most prominent drivers in OA. If there’s too much loading on the joints, this can result in the destruction of cartilage. This could be due to obesity, repetitive occupational loads, or increased load due to structural joint malalignment. Loss of muscle support, destabilisation of the joints due to ligament damage and cartilage weakened by previous arthritis can also lead to mechanical stress.

Obesity

Obesity is a driver of OA through due to mechanical stress as well as poor joint muscle support as a result of physical inactivity. Obesity is also associated with increased systemic inflammation driven in part by inflammatory cytokines that may further compound chronic inflammation within OA.

Inflammation

Chronic inflammation can cause oxidative stress that can contribute to progressive tissue damage and cartilage degeneration.

 

Conventional Treatment

Simple analgesics and topical NSAIDs are the mainstay of conventional medical management alongside conservative measures such as physiotherapy, local heat or ice packs and joint supports.

Intra-articular steroid injections are also sometimes used however whilst these improve the symptoms for a few hours, there is often subsequent ‘steroid flare’ during which the symptoms worsen for a few days.

 

Holistic Treatment

Due to potential side effects of these pharmaceutical anti-inflammatory medications as well as the inability of these medications to improve the overall health of the joint and target the underlying causes, many OA sufferers are turning to complementary medicine for treatment.

Naturopathic treatment of OA aims to provide patients with symptomatic support to enhance the regeneration of the cartilage and reduce chronic joint inflammation and pain whilst also addressing underlying drivers. Naturopathic treatment is also useful and safe in using alongside orthodox medical treatment.

 

What Should you Eat?

When it comes to treating and preventing OA the best thing you can do is to eat foods that are anti-inflammatory and avoid foods that are pro-inflammatory.

Foods that promote inflammation include caffeine, alcohol, animal protein and dairy, gluten, wheat, trans-fatty acids and refined sugar. For some people, nightshade vegetables such as tomatoes, potatoes, eggplant and foods from the pepper family can also be inflammatory. Diets that include too much saturated fat such as meats and dairy products increase CRP, the biomarker of inflammation and foods with a high GI (the measure of how fast a food breaks down into glucose) can increase blood glucose and inflammation.

Focus instead on antioxidant-rich fruits and vegetables, lean protein and whole grains such as quinoa and buckwheat. Incorporate healthy fats into your diet such as avocados, flaxseeds, walnuts and chia seeds and cook with olive oil and avoid oils that are high in pro-inflammatory omega 6.

 

Supplements to Consider

High quality omega 3 essential fatty acids such as EPA and DHA taken in therapeutic doses assist in reducing inflammation in the body and the severity of pain of OA. 1-2 grams of EPA per day in divided doses is recommended. It’s important to get a high quality product as cheaper fish oils don’t contain the therapeutic range needed for the anti-inflammatory benefits.

Glucosamine and chondroitin sulphate supplements also may significantly improve symptoms such as pain and immobility as well as provide nutrients for the cartilage and potentially slow down the progression of OA. Although these nutrients are unlikely to produce side effects, they are best taken under the guidance of a qualified health practitioner.

Some people may require additional support to manage pain. There are various herbal remedies that can provide significant anti-inflammatory and analgesic action in the body such as turmeric, ginger, Boswellia, Corydalis and Californian Poppy. Nutrients such as magnesium, taurine, glutamine and palmitoylethanolamide (PEA) can also help. PEA provides endocannabinoid-like actions to support pain relief, including nerve pan, whilst also providing neuroprotection and anti-inflammatory assistance.

Other modalities that are worth investigating as adjuvant treatments of osteoarthritis include osteopathic medicine, acupuncture, massage, hydrotherapy, yoga and Tai Chi.

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