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Addressing the Global Challenge of Osteoarthritis


Osteoarthritis – the most prevalent chronic joint disease

Joint health may not be a priority on our minds until pain, stiffness, and dysfunction develop. These symptoms can interfere with daily self-care activities, work-related functions, and recreational exercise.

Osteoarthritis is considered the most prevalent chronic joint disease. Typically, it affects the knees, hips, and hands. This can lead to cartilage damage, inflammation of synovial tissue, and pathological changes in the subchondral bone of affected joints.

In a recent systematic analysis, researchers examined the global prevalence of osteoarthritis from 1990 to 2017. Considering data from 195 countries and territories, they concluded that “osteoarthritis is a major public health challenge … and the burden is increasing in most countries.” The U.S. was among the top three countries with the highest age-standardized prevalence estimates of osteoarthritis in 2017.

There is no cure for osteoarthritis, so prevention and management are important. Unfortunately, many conventional therapies for osteoarthritis have significant limitations.

Medical Management Limitations for Osteoarthritis

The conventional medical treatments for osteoarthritis focus on managing symptoms or total joint replacement:

  • Acetaminophen — A recent systematic review concluded that acetaminophen “provides only minimal improvements in pain and function for people with hip or knee osteoarthritis.”
  • NSAIDs — Nonsteroidal anti-inflammatory drugs have analgesic and anti-inflammatory actions, but these carry the risk of side effects, including cardiovascular and gastrointestinal concerns.
  • Corticosteroid Injections — Recently, a randomized, double-blind, clinical trial of 140 patients with symptomatic knee osteoarthritis revealed that intra-articular triamcinolone injections given every 3 months for 2 years “resulted in significantly greater cartilage volume loss and no significant difference in knee pain than did saline injections” (i.e., a placebo).
  • Surgical Treatment — Although hip or knee replacement can be effective for end-stage osteoarthritis, the replacement components can also wear out or fail over time. In some cases, revision surgery may be necessary.

Considering the limitations of traditional, medical management for osteoarthritis, it is prudent to encourage patients to support joint health. At a minimum, this should include weight management.

Managing Weight to Maintain Joint Health

A significant underlying factor in the rising rates of osteoarthritis is the increasing prevalence of obesity. Excess body weight increases mechanical loads on hip and knee joints during physical activity. This can cause cartilage degeneration.

Body mass index (BMI) should not be the sole consideration when assessing the risk of excess body fat. Research indicates that an increase in waist circumference is a risk factor for osteoarthritis. Abdominal obesity is defined as a waist circumference of more than 40 inches for men and 35 inches for women.

Adipocytes produce and release adipokines, including leptin, which are similar in structure to cytokines and can cause inflammation. Notably, chondrocytes have leptin receptors that permit interactions and subject the cartilage cells to inflammation.

Maintaining healthy body weight and waist circumference could go a long way toward managing osteoarthritis risk. For those who are overweight, losing more than 5% of body weight has produced significant improvement in knee osteoarthritis. Exercise can support weight loss efforts and may be individually tailored to improve pain and function.

Nutritional Support for Joint Health

In addition to weight management, our diet and specific nutritional components may help support joint health. Important dietary and supplemental considerations include:

  • Omega-3 Fatty Acids — Osteoarthritic joints accumulate high levels of omega-6 fatty acids, which are precursors of pro-inflammatory eicosanoids. In contrast, omega-3 fatty acids are associated with lower levels of inflammatory mediators. Omega-3 fats can be obtained from cold-water fish like salmon and sardines, but typical dietary intake is low. Supplementing with omega-3 fatty acids in the triglyceride form — the same way they naturally occur in fish — provides a convenient, bioavailable source of these beneficial fats.
  • Collagen Peptides — Ingesting collagen provides a concentrated source of the amino acids (including glycine, proline, and hydroxyproline) that comprise this protein, which may help promote collagen synthesis. A double-blind, placebo-controlled, 13-week clinical trial of 30 men and women (ages 30 to 65 years) with knee osteoarthritis found that a collagen supplement of 5 g twice daily significantly improved joint discomfort compared to a placebo.
  • Bioflavonoids — Scutellaria baicalensis (Chinese skullcap) and Acacia catechu contain bioflavonoids that support a balanced inflammatory response. In a double-blind, randomized controlled trial, 79 men and women (ages 40 to 90 years) with mild-to-moderate osteoarthritis were given a blend of S. baicalensis and A. catechu of 500 mg daily for 1 week. Participants had a significant decrease in perceived pain and a significant increase in knee joint flexibility, which was comparable to those given naproxen (an NSAID).
  • Other Supportive Nutrients — Ascorbic acid (vitamin C) is required for collagen synthesis. Vitamin K plays a role in cartilage mineralization. Glutamineglucosamine sulfatealoe vera, and silicon may also support the synthesis of collagen.

By Marsha McCulloch, MS, RDN, LN