When the Joints Wear Down: Dealing with Osteoarthritis
"Wear and tear on the joints is unavoidable in some ways as we get older... But there are steps that you can take to protect yourself."
Many people today are suffering from Arthritis, a painful condition involving inflammation of the joints. Today, Dr. Keller Wortham, MD, will take a closer look at Osteoarthritis, the most common form of Arthritis. We'll talk about what it is, what causes it, some various risk factors, and recommendations for alleviating the symptoms.
- 00:35: What Arthritis Is
- 01:29: Osteoarthritis
- 03:20: Risk Factors for Osteoarthritis
- 07:00: Getting Diagnosed
- 08:12: Treating Osteoarthritis
- 16:58: Natural Solutions
- 25:36: Wrap-Up
What Arthritis Is
So, what are the main symptoms of arthritis? If you suffer from it, you already know it involves pain and perhaps, swelling and stiffness in one or more joints. The term arthritis means inflammation of the joints. The "itis," means “inflammation” and "arthro" is the Greek word for joint. However, arthritis itself is a nonspecific term, because a lot of things can cause arthritis, and there are a lot of different kinds of arthritis.
The many forms of arthritis include rheumatoid arthritis, osteoarthritis, and septic arthritis, to name a few. Some of these can be caused by infections, autoimmune disease, or simply wear-and-tear. Today, we’re focusing on the most common form — osteoarthritis.
Osteoarthritis is a wear-and-tear disease that happens when the cartilage in our joints starts to wear down and expose the bone. Cartilage is a very slippery, almost waxy substance made of a molecule called collagen, that exists in our joints to allow for a smooth, gliding, almost frictionless motion. It's in all of our joints, and it's there to help protect the bony surfaces of the joints so that we can bend our knees, elbows, shoulders, and hips without the bones (which have a much rougher surface), rubbing on each other.
Unfortunately, like many things, collagen wasn't built to last forever. As it wears down, it can get rougher, or we lose some of it, which causes more friction, and exposes the bony surface of the joint. When this happens, the joints can become irritated and inflamed, and you start to experience the symptoms associated with osteoarthritis. These include pain, swelling in the joints, and decreased range of motion. Your joints might also become tender to the touch, and in severe cases, can become visibly red and puffy.
Risk Factors for Osteoarthritis
Unfortunately, osteoarthritis is not really a preventable disease. Our bodies were not meant to last forever, and collagen and cartilage aren’t immortal either. So, as we put more and wear-and-tear on our bodies, they naturally begin to wear out. That happens more commonly in certain joints than others, but with osteoarthritis it’s typically, the knees, hips, or shoulders, and the joints between each vertebrae in the back. These are common areas for cartilage to wear down, and for you to start experiencing pain as bones get closer together, and more friction occurs in the movement of your joints. Aside from general wear-and-tear, there are some things that can put you at a higher risk of developing osteoarthritis.
- Age — This one probably goes without saying but the longer you're around, the more wear and tear your body experiences, and the higher your risk of developing osteoarthritis.
- Gender — Women seem to be at a higher risk of osteoarthritis than men. We're not exactly sure why that is. It could have to do with the stability of the bones, or the inherent stability of the cartilage. It could be that men in general have stronger muscles, and muscles can be protective to the impact on joints. Whatever the reason, women unfortunately have a higher risk of osteoarthritis.
- Obesity — Our joints are designed to carry a certain load, and if you're carrying excess weight it can increase the pressure on joints — especially the weight-bearing joints like ankles, knees, and hips, which can wear out faster. The cartilage can be compressed more, and you can develop osteoarthritis sooner.
- Joint Injuries — If you've sustained joint injuries that have damaged the soft tissue like the cartilage and meniscus, or aspects of the labrum in your shoulder or hip, that can lead to an increased loss of cartilage and more irritation to the bony surface.
- Repetitive Stress — If you participate in a high-impact activity, whether that’s a sport or employment activity that pounds the joints — if you work all day, jackhammering, or you're playing football or basketball and you're running a lot and jumping a lot, your cartilage will experience higher wear and tear.
- Genetics — Some people are just more prone to osteoarthritis than others. So if you have a family history of it, chances are you're at a higher risk. This can also include bone deformities. If you have a joint that was just structured wrong from birth, that can lead to a higher degree of osteoarthritis.
- Metabolic Disorders — Diabetes is a very common metabolic disorder that raises insulin levels. It affects your immune system and increases inflammation in the body. Other metabolic disorders like hyperparathyroidism and hypothyroidism can also play a role in the development of osteoarthritis.
If you're experiencing pain and swelling in your joints, soreness, or reduced range of motion, then go see your doctor, and get diagnosed.
Your doctor will make the diagnosis by looking at the symptoms you're presenting as well as other factors: your age, gender, and other factors we discussed, to determine that it’s probably osteoarthritis. The doctor may also do blood tests to rule out an autoimmune disorder or a metabolic problem, then confirm the diagnosis with imaging. They can use X-rays and MRIs to look at the joint itself, and see if it looks like the bones are getting irritated and the joint space is compacted — as you lose cartilage and collagen, the pillows between the bones get thinner, and an X-Ray will show those two bones getting closer together.
Unfortunately, there’s not really a cure for osteoarthritis. To some degree or another, we will all experience the wearing down of joint cartilage as we get older. But there are things that you can do to start managing your osteoarthritis and reducing symptoms.
Osteoarthritis hurts, and it starts to limit your activities, so the first thing to do is to try to manage pain. One of the primary things the doctor might prescribe for this is an over-the-counter anti-inflammatory like Advil — also called NSAIDs (non-steroidal anti-inflammatory) — or TYLENOL. So these might be used to reduce inflammation and pain. Now, there are some pros and cons to regular NSAID use — and there are health concerns and risks that come with them, so you probably don’t want to take these too often.
If you have concerns about taking ibuprofen regularly for your joints, talk to your doctor about it. They can look at your body, and your other risk factors, and help you decide if that's the right choice for you. You can also consider topical anti-inflammatories. They make topical NSAIDs, like a Voltaren cream, which are usually available by prescription. You can rub them on the joint, allowing the anti-inflammatory properties to get into the joint without so many of the systemic side effects you can get from taking NSAID pills.
Physical therapy is great for strengthening and lubricating your joints. Range of motion is very important, and often if you don't use it, you lose it. So, people might stop using their joint because it's painful, but that can actually make the problem worse. Disuse can cause the muscles to get weaker, and muscles are the main shock absorbers for impact. As they get weaker, the impact on the bones gets worse, which can lead to worse symptoms of joint pain. Also, movement of the joint helps stimulate blood supply there, which is good for getting nutrients to the collagen that's in your cartilage, and also helping lubricate the joint with the natural synovial fluid that's inside of it.
Occupational therapy usually just deals with finding ways to make your daily activities a little bit easier. This could include something like a large-grip toothbrush if you're having a lot of wrist pain, or looking at new ways to position your keyboard that will reduce stress on your wrists. It could mean installing a bench in the shower, so you’re able to sit down while showering. An occupational therapist can work with you to help improve your daily activities and put less stress on your joints.
If those first steps aren't helping and your joint pain is severe enough, then you can move to some other techniques, such as joint injections. If you have a really aggravated, inflamed joint, especially a knee, hip, or shoulder, you could ask for a steroid injection from your doctor. We talked about Advil being a non-steroidal anti-inflammatory, but there are also steroid anti-inflammatories.
- You might have heard of a cortisone injection and, basically, that's where you would get that steroid injected into your knee, or your hip, or your shoulder, and it really calms down the inflammation in that joint. However, there's a price to pay. The inflammation goes down very quickly, but steroids are not great for the health of our tissues.If you use a steroid multiple times, it can actually weaken the structures within there — it can weaken the tendons and muscles, as well as the collagen that we're trying to keep robust to protect your joints. From a long-term perspective, this can put you at risk for more injuries, and for further weakening of the protective coating of your bones. So talk to your doctor about whether you need a steroid injection. If you do it repeatedly, it could end up being worse for you. But if you’re in a situation where you have a bad knee and you're about to take a trip to Europe, or you're an athlete and need to have that joint in good working shape again, a steroid injection may be an option.
- There are also other injectables that aren't as bad for your joints. There are joint lubricating injections, or products like a synthetic hyaluronic acid. Hyaluronic acid is one of the components of our joint's synovial fluid. When you inject that into joint, it can kind of buffer that joint, and maybe beef up the protective fluid in there temporarily. Usually, that wears off, but it can give people some temporary relief.
- There's also a new range of biologic injections — stem cell products — that are still widely debated, and their benefits are still in question. So, here are doctors who are injecting amniotic products, and cord blood products. There are a lot of growth factors within amniotic fluid and umbilical cord blood, which are very rich in growth factors. Also, they have a certain kind of stem cell that can later mature into a chondrocyte, which is cartilage-producing cell, or an osteocyte, which is a bone-producing cell. So, a lot of physicians are using those injections, which won't necessarily damage the joint like a steroid injection will, but could help reduce inflammation, promote growth, and maybe create new cell lines that can help grow cartilage. Again, there's a lot of debate out there about these products, and their benefits will need to be studied over time, but it’s an option you can talk about with your physician about.
If your joint is so far gone that there's no cartilage left and you're at the bone-on-bone scenario and it's really debilitating, then you can talk to your doctor about referral for a joint replacement. For joint replacement, they basically take out part of the bone that is all inflamed and has lost its cartilage, and replace it with synthetic materials — titanium, or certain kinds of hard plastics — that can recover that frictionless glide of your joint. There are many joints that can be replaced, and there are different levels — the whole joint can be replaced, or you might only need a partial replacement.
This is the part to get really excited about — there are natural ways to both alleviate symptoms of osteoarthritis, and reduce the risk of developing it. If you're younger and not experiencing joint pain, act now — the things you do in early age or the things you continue to do as you get into your midlife will help protect you for your later years.
Exercise is so important for mobilizing your joints, bringing nutrients to them, and strengthening those muscles that act as the shock absorbers around those joints. Get physically active. Obviously, try to do it safely and try to do an activity that's not really a repetitive high impact, which can actually do a disservice to the joints. But doing physical exercise, especially anaerobic training, and strengthening muscles can be very helpful at preventing arthritis.
Avoid Excess Tobacco and Alcohol
Tobacco, and too much alcohol, can cause damage to joints. If you smoke, now’s the time to quit! If you struggle with alcohol addiction, try to kick that habit as well, or if you are not addicted, but do incorporate alcohol into your diet, try to keep it to a minimum.
Maintain a Healthy Weight
As we discussed, excess weight really increases the load on your joints. Every pound you lose translates to multiple pounds of reduced impact on your joints. Weight loss can be really difficult, but it's not impossible. If you're suffering from obesity, talk to your doctor about strategies that can help get you on the right path.
Heat and Cold Therapy
Heat is very good at relaxing muscles, and cold is very good at reducing inflammation, so applying both of these to the joints (one at a time) can really help.
One topical solution you can try is called Capsaicin. Capsaicin is a spicy molecule found in chili powder. There are topical capsaicin products, which you can rub on the skin over a joint. You have to do it repetitively a couple times a day, for several weeks, and then you may start to feel a reduction in pain. Capsaicin is really good at reducing the stimulation of pain through your nerve fibers, and can also be anti-inflammatory.
There are other products that work in a similar fashion, such as products that contain menthol and camphor — Deep Blue is one example. A lot of people also experience pain relief from using a topical CBD product. So, those are a couple options.
Icy Hot is another topical product, which contains Lidocaine. It’s not as natural as some of the other things we’ve listed, but at least you're not going to have the side effects you might get from taking pain pills.
There are also other options outside the realm of topical creams and pills, such as braces for the joints. You can use something like a knee brace to reduce the impact on knee joints, or you can find braces for your wrists to help take the load off the wrist joints. These braces can help support the joint, so it doesn't have to take so much of that traumatic impact that wears down the cartilage and collagen.
Some people are using something called a transcutaneous electrical stem device (TENS) unit. This may be especially helpful if you have arthritis between the vertebrae, which can cause severe back pain. The TENS device sends electrical stimulation through the muscles to help them relax, and it can help change pain signaling pathways, so that you don't experience as much of the pain.
Natural Supplements to Reduce Inflammation
You can also take some natural things to help reduce inflammation, such as Smarter Curcumin — a very powerful natural inflammation fighter. Curcumin is the bioactive ingredient found in turmeric. In the Smarter Curcumin supplement, it’s concentrated and combined with other support ingredients to maximize the inflammation fighting power.
Another Smarter Nutrition product that’s great for joints is Smarter Joint Food. It contains several great anti-inflammatory and joint support supplements to provide nourishment to the joints, including MSM and vitamin C. Vitamin C is really important for helping preserve and promote the growth of collagen, which as we discussed is the main molecule in cartilage. These are natural products that you can use to reduce inflammation and help support your joints without getting into the synthetic medications and their associated side effects.
Other Natural Options
- There are people who swear by acupuncture to help with osteoarthritis.
- Omega-3 oils also help relieve inflammation.
- There is soybean and avocado product that is used frequently in Europe that helps reduce inflammation and pain symptoms in the joints.
- Anti-inflammatory lifestyle — reduce inflammation across the board by eating a healthy diet with no artificial sweeteners, avoiding pesticides and hormones that can promote inflammation in the body, and avoiding environmental toxins from household cleaning and beauty products.
- Intermittent fasting has been shown to reduce inflammation in the body, and also stimulate the expression of certain genes that can be very reparative and restorative to your joints. There have been very good results with intermittent fasting, demonstrating that it is generally safe, and helps reduce inflammation. It can be risky for certain populations, though, so make sure to take a closer look at intermittent fasting here. It can be another great tool to reduce inflammation throughout your body, which will mean less inflammation in your joints.
Wear and tear on the joints is unavoidable in some ways as we get older. We're dealing with equipment that wasn't designed to be immortal. But there are steps that you can take to protect yourself in advance by staying active, by not drinking and smoking, eating a healthy diet, and protecting your joints with good exercise. If you start to experience arthritis pain, go to your doctor. Make sure they make the correct diagnosis, and then look at all these different things we've talked about, from over-the-counter medications to robust natural solutions like Curcumin and other joint products that don't have side effects.
We hope that you keep your joints healthy and happy, and we’ll see you next time.