My 8 year old daughter confronted me just a few weeks ago about the miracle creams and pills that the television advertisements are showing for arthritis. “There is no need for any more surgery then.” That led me to wonder: if these supplements and creams are the tickets to osteoarthritis prevention, that is really an excellent quick fix. No need to exercising either since running is terrible to our knees and ankles as the stomping trashes the joints. The marathoners must be destroying their knees! But are the professional runners really getting osteoarthritis early and more frequently then the rest of us?

In a study published when I was still doing 2.4km runs in less then 9.05mins, formerly competitive runners did not have higher rates of arthritis in their hips, knees or ankles when compared to nonrunners. (1)What about the regular recreational runners? A more recent study in the American Journal of Preventative Medicine investigated differences in the progression of knee OA in middle- to older-aged runners compared to healthy non-runners over two decades. No association was found. (2) Medical literature generally does not support the idea that running and exercising contributes to the degeneration of articular cartilage (3).

So what does? Whereas once knee osteoarthritis was considered a ‘wear-and-tear’ condition, it is now recognized that knee osteoarthritis exists in the highly metabolic and inflammatory environments of fat tissue. Chemicals known as cytokines associated with adipose tissue may influence osteoarthritis though direct joint degradation or control of local inflammatory processes. Moreover, obesity loads may be detected by mechanical receptors on cartilage cell surfaces triggering production of such chemicals leading to increased arthritis.

Fat (Adipose) tissue, once considered a passive storage of energy, is now recognized as a highly metabolic endocrine organ with the capacity to secrete such inflammatory chemicals which have been detected in the joint fluid and the blood of patients with osteoarthritis. (4,5) As doctors will tell you, inflammation is an important hallmark of osteoarthritis, and we give you anti-inflammatory medications to help reduce the pain and swelling from osteoarthritis. With the cytokines found in fat tissue being an important part of inflammatory processes, prevention can be done by reducing fat tissue where these nasty chemicals are produced. Voila, the golden ticket!

In addition to the nasty chemicals, being overweight also leads to abnormal loads on the joints. Clinical and animal studies of joint loading have provided evidence that abnormal loads can lead to changes in the composition, structure, and mechanical properties of articular cartilage. 6,7,8 Kind of like a watermelon placed on a grape, I guess you get the picture. But weight is not just the whole picture, loss of muscle mass and strength may reduce the shock-absorbing potential of the joint, thereby causing cartilage damage. 9

Pain is the main reason patients see me when they have osteoarthritis. Obesity has been known to be linked to abnormal glucose homeostasis (control) and insulin resistance in the body. In studies of acute pain in trauma and surgery, there is decreased insulin sensitivity.10 In these same studies of induced acute pain, there were increases in circulating concentrations of hormones associated with altered glucose homeostasis. Because obesity is frequently, though not always, associated with insulin resistance, altered glucose homeostasis has an important role related to chronic pain from the arthritis.

We have been searching for miracle drugs to reverse osteoarthritis for a long time to no avail. Of course, weight management, albeit the Golden Ticket to osteoarthritis prevention, may not be the quick fix everyone is looking for but I guess we can also defer to surgery like a knee replacement or an ankle fusion by Orthopaedic Surgeons like myself. We will always be available to help you with that when it comes to that.

Reference:

1. Konradsen L, Hansen EM, Sondergaard L. Long distance running and osteoarthrosis. Am J Sports Med. Jul-Aug 1990;18(4):379-381.
2. Chakravarty EF, Hubert HB, Lingala VB, Zatarain E, Fries JF. Long distance running and knee osteoarthritis. A prospective study. Am J Prev Med. Aug 2008;35(2):133-138.
3. Willick SE, Hansen PA. Running and osteoarthritis. Clin Sports Med. Jul 2010;29(3):417-428.
4. Dumond H, Presle N, Terlain B, et al. Evidence for a key role of leptin in osteoarthritis. Arthritis Rheum 2003; 48:3118–3129.
5. Chen TH, Chen L, Hsieh MS, et al. Evidence for a protective role for adiponectin in osteoarthritis. Biochimica et Biophysica Acta 2006; 1762:711–718.
6. Mundermann A, Dyrby CO, Andriacchi TP. Secondary gait changes in patients with medial compartment knee osteoarthritis: increased load at the ankle, knee, and hip during walking. Arthritis Rheum 2005; 52:2835–2844.
7. Maly MR, Costigan PA, Olney SJ. Contribution of psychosocial and mechanical variables to physical performance measures in knee osteoarthritis. Phys Ther 2005; 85:1318–1328.
8. Rejeski WJ, Craven T, Ettinger WH Jr, et al. Self-efficacy and pain in disability with osteoarthritis of the knee. J Gerontol B Psychol Sci Soc Sci 1996; 51:24–29.
9. Bennell KL, Hunt MA, Wrigley TV, et al. Role of muscle in the genesis and management of knee osteoarthritis. Rheum Dis Clin N Am 2008; 34:731–754.
10. Greisen J, Juhl CB, Grofte T, et al. Acute pain induces insulin resistance in humans. Anesthesiology 2001; 95:578–584.