Osteoarthritis is the most common arthritis and affects around 242 million people worldwide. It is also one of the top causes of disability in the US.
Osteoarthritis is also a degenerative joint disease since it involves a breakdown of cartilage in the joints where two bones meet. As the cartilage in a joint breaks down, it can result in pain, swelling, stiffness, and decreased function of joints.
Although osteoarthritis can damage any joint, it is most common in the joints of the hands, knees, hips, and spine. To prevent this pain, disability, and dysfunction, a functional medicine approach to osteoarthritis utilizes dietary and lifestyle interventions to help balance inflammation, reduce pain, and keep joints functioning well.
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Osteoarthritis Signs & Symptoms
Osteoarthritis can occur throughout the body but is most common in the following joints:
- The cervical spine of the neck
- Lumbar spine in the lower back
- Hips
- Knees
- The base of the big toe
- The base of the thumb
- The most distal joints of the fingers (those closest to the fingertips)
The most frequent symptoms of osteoarthritis result from inflammation and the destruction of joints. These include:
- Pain during or after movement
- Stiffness which is often most prominent after waking or being inactive
- Loss of function, flexibility, and movement
- Grating sensation, popping, or cracking when using a joint
- Swelling due to soft tissue inflammation around joints
- Difficulty with everyday activities
Over time, osteoarthritis can cause bone spurs to grow around the joints. These extra bits of bone feel like hard lumps around an affected joint.
Osteoarthritis Possible Causes
Osteoarthritis involves disintegration of the cartilage, where two bones meet in joints. Cartilage is the tissue that cushions the ends of bones to allow joints to move freely and easily. It contains a high percentage of water (85%) in a matrix with specialized protein molecules called proteoglycans that makes it slippery to allow it to minimize the friction that occurs with the movement of bone on bone.
With age, cartilage loses the ability to bind water and can become stiffer and more brittle, contributing to the development of osteoarthritis and joint deterioration. Since cartilage does not contain blood vessels, it has a limited ability to regenerate and heal.
While the causes of osteoarthritis are not entirely known, the risk of developing this condition increases with age, although not everyone will develop the disease. It does not occur just due to "wear and tear" alone, as many believe.
Some Risk Factors for Osteoarthritis Include
- Advancing age
- Women are more likely to develop osteoarthritis, though it isn't clear why.
- Obesity or extra body weight
- Repetitive stress on a joint from occupational overuse or sports
- Metabolic diseases like hemochromatosis (where the body has too much iron)
- Genetics
Factors like extra body weight, bone deformities, or injury that add stress to weight-bearing joints can contribute to the development of osteoarthritis. In addition, fat tissue produces cytokines that increase overall inflammation, including within the joints.
The cartilage contains chondrocyte cells, which manufacture an extracellular matrix composed of collagen, glycoproteins, proteoglycans, and hyaluronic acid. These components are metabolically active and affected by mechanical stress and their environment within the joint. Under stressful conditions, these substances in the extracellular matrix contribute to inflammation that degrades cartilage.
Research shows that imbalances and dysfunction of the cartilage cells and the related matrix of structures that make up the joint is an important factor in osteoarthritis.
Changes in the structure of these substances make the joint less resilient when faced with stress and mechanical loading. As the cartilage loses elasticity and cushioning power, the synovial membrane that surrounds the joint and secretes synovial fluid to lubricate the joint can also become inflamed.
Conventional Labs to Diagnose Osteoarthritis
Osteoarthritis is diagnosed through a physical examination to check the affected joint(s) for tenderness, swelling, redness, and flexibility. It can be confirmed further with imaging to look at the joint structure. X-rays cannot show cartilage itself but can reveal a narrowing of the space between the bones in the joint that suggests a loss of the cartilage cushion and can also show bone spurs around a joint. To look more closely at cartilage and other soft tissues, magnetic resonance imaging (MRI) can be used.
There are no specific laboratory tests for osteoarthritis, but many blood tests can look for markers in the blood reflecting elevated inflammation or antibodies associated with other causes of arthritis, like rheumatoid arthritis, to narrow down a diagnosis.
Joint fluid analysis is sometimes used to confirm a diagnosis. This involves using a needle to remove some fluid from an affected joint that is then tested for inflammation and to determine whether joint pain is caused by other conditions like gout or infection rather than osteoarthritis.
Functional Medicine Labs to Test for Root Cause of Osteoarthritis
Inflammation
Since imbalanced inflammation is a main contributor to osteoarthritis, markers such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can help assess inflammation throughout the body that is often associated with altered immune function.
Gut Health
Imbalanced bacteria in the gut (microbiome), unaddressed food sensitivities, toxicity, and a leaky gut barrier that allows food and other substances to enter the bloodstream increase inflammation, which can contribute to the joint damage that occurs with osteoarthritis. A Comprehensive Stool Test measures gut bacteria, inflammatory markers, leaky gut, and pathogens to assess the state of the gut and can help guide treatment aimed at restoring balance.
Vitamin D
Higher serum 25-(OH) vitamin D levels are associated with reduced knee cartilage loss and a lesser risk of osteoarthritis. Vitamin D can be measured in the blood.
Iron
Studies suggest that iron overload, which can occur in genetic conditions like hereditary hemochromatosis, thalassemia, hemophilia, and sickle cell disease, is associated with osteoarthritis. Laboratory testing for iron metabolism and storage includes iron, total iron binding capacity (TIBC), transferrin, and ferritin. A high ratio of iron to transferrin in the blood may suggest a person has hemochromatosis, a genetic condition where the body does not process iron normally. This can be confirmed with genetic testing.
Ruling Out Other Forms of Arthritis
If the type of arthritis is unclear, some testing can help rule out alternative causes of joint pain and inflammation, such as rheumatoid arthritis. Blood markers like rheumatoid factor (RF) and antibodies to cyclic citrullinated peptides (anti-CCP) can help assess rheumatoid arthritis.
5 Things That Help With Osteoarthritis Pain
A functional medicine approach to osteoarthritis aims to manage pain and other symptoms, balance inflammation, and prevent further injury and damage to the joints. Standard drug treatment includes pain management and nonsteroidal anti-inflammatory drugs (NSAIDs) to address inflammation. Functional medicine treatment for osteoarthritis can involve lifestyle changes, nutrition, mind-body approaches, acupuncture, manipulative therapies, and dietary supplements.
1. Lifestyle Modification
Educating patients about osteoarthritis and how lifestyle can be used to manage this condition shows promise for helping individuals become empowered to manage their pain and care for their joints.
Balanced and individualized exercise and maintaining a proper weight can help manage osteoarthritis. Both aerobic and resistance exercises have been shown to help patients with osteoarthritis of the knee. In general, swimming and pool exercises, biking, and aerobic dance may be helpful. Strength training can help prevent the muscle wasting that comes when joints and muscles are not used regularly due to pain and results in more stable joints. Maintaining good flexibility increases the range of motion to keep joints moving well.
Regular enjoyable physical activity is also one way to maintain a balanced weight. Being overweight increases the risk of developing osteoarthritis, pain, and disability. For example, for every pound gained, you add three pounds of pressure on your knees and six pounds of pressure on your hips which can worsen the risk of osteoarthritis and the resulting pain and joint destruction.
2. Diet and Nutrition
An individualized diet that emphasizes anti-inflammatory foods and minimizes inflammatory processed foods and additives can help balance overall inflammation and maintain a proper weight.
Studies suggest that eating a Mediterranean-style diet can reduce the risk of osteoarthritis and result in a higher quality of life for those living with osteoarthritis.
3. Mind-Body Approaches
Mind-body movements like tai chi and yoga have also proven valuable. Studies suggest that practicing tai chi reduces pain and increases the ability to use the joints in osteoarthritis patients. Other research suggests that regularly practicing yoga improves hand pain, strength, joint size, and motion.
Research has also looked at acupuncture to reduce pain and disability in osteoarthritis. Acupuncture has a beneficial effect on relieving pain and is being studied more for its effectiveness in chronic pain syndromes.
4. Manipulative Therapies
Manipulative therapies using touch and movement include chiropractic treatments, massage therapy, and osteopathy. For example, Swedish massage was shown to improve pain, range of motion, and function in patients with osteoarthritis of the knee. At the same time, chiropractic treatment combined with moist heat improved pain from osteoarthritis of the lower back better than heat alone.
5. Supplements
Glucosamine and chondroitin have been studied as supplements to help reduce pain and prevent continuing damage to affected joints.
For example, glucosamine significantly improves pain and function over time in patients with osteoarthritis and results in less deterioration and narrowing of joints.
Similarly, chondroitin sulfate is a naturally occurring part of the cartilage of joints and can be taken as a supplement. It seems to help prevent further joint deterioration in osteoarthritis with minimal side effects.
Antioxidants such as curcumin, Boswellia, L-glutathione, and vitamin C have demonstrated some ability to modulate inflammation in joints by helping to balance free radicals and oxidative stress.
Summary
Osteoarthritis is the most common form of arthritis, impacting millions globally. Pain, inflammation, and joint dysfunction occur when the protective cartilage between bones degenerates over time.
Increased wear on the joints with age, obesity, repetition, injury, metabolic imbalances and genetic factors that influence the breakdown of cartilage can contribute to the development of osteoarthritis. A functional medicine approach utilizes dietary and lifestyle interventions to help balance inflammation, reduce pain, and keep joints functioning well.
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