Arthritis

Osteoarthritis

It is estimated that 10 million people in the UK have arthritis. 9 million of these have osteoarthritis. This type of arthritis more commonly affects weight-bearing joints – so hips and knees - however, sufferers who carry excess weight also experience osteoarthritis in non-weight-bearing joints such as fingers, wrists and shoulders. This hints that there is more to this type of arthritis than simply wear and tear.

What is happening in your joints when you have osteoarthritis?

There are four different stages of osteoarthritis (OA), from early signs (Stage one) to advanced degradation often leading to joint replacement (Stage four). Over time, the cartilage becomes thinner and more damaged through injury, wear and tear, and inflammatory processes.

Compensatory movement after initial changes can cause further degradation. Bone becomes exposed and bony spurs called osteophytes may grow. Cartilage has no blood supply and is without feeling. Bone, however, does have feeling and it is the rubbing of bone on bone, or bone on cartilage, that causes pain.

Who is at risk?

We know that there is a greater risk of osteoarthritis in the following groups:

• people over 65 years of age
• women – 60% of diagnoses are given to women
• previous joint injury or occupational joint loading
• abnormal joint shape or malalignment
• family history of joint replacement
• elite/keen athletes
• low birth weight
• genetics – particularly related to vitamin K

There's not much you can do about many of those! However, we also know that people who are overweight, have type 2 diabetes, raised blood pressure, raised cholesterol, inflammatory dietary patterns and poor key vitamin status, are also at greater risk of an osteoarthritis diagnosis.

These are – to a large extent – within your control. When your quality of life is suffering from the daily pain of arthritis, it feels great to have something positive to focus on. Diet and lifestyle changes can significantly impact how you feel day-to-day and affect disease progression, so are worth some time and attention.

What causes osteoarthritis?

Everyone’s journey to a diagnosis of osteoarthritis will be somewhat different. Listed below are some of the known causes of osteoarthritis:

• mechanical instability in the joint and/or abnormal joint shape
• previous joint injury
• frequent activity and overuse
• ageing
• long term use of anti-coagulant medications such as warfarin
• excess weight
• gut dysbiosis – when the ‘garden’ of gut bacteria gets out of balance and less diverse.

Symptoms of osteoarthritis 

Whilst all arthritic conditions cause joint pain, they all have subtle differences in presentation. Some of the common symptoms of osteoarthritis include:

• morning stiffness that clears after 30 minutes of getting up
• reduced flexibility and mobility
• pain and grating sensation in the joint with movement
• warmth and/or bony swelling around the affected joints
• oedema (swelling due to accumulation of fluid)

Diagnosing osteoarthritis

Your GP will conduct a clinical assessment if you are over the age of 45, suffer from activity-related joint pain and either have no morning stiffness or stiffness that clears within 30 minutes of moving. You may have a blood test, checking specifically for two inflammatory blood markers, CRP and ESR. In some cases, particularly if it is suspected that the stage of osteoarthritis is at three or four, then you may be offered an x-ray or MRI. Some GPs and rheumatologists use a questionnaire known as ‘WOMAC’ which assesses impacts on quality of life and tracks changes and disease progression.

This article provides some practical steps you can take to support your diet and lifestyle if you – or a loved one - have a diagnosis of osteoarthritis. Before we dive into that, let’s take a look at a different sort of arthritis.

Inflammatory arthritis

There are many different forms of inflammatory arthritis, including rheumatoid, psoriatic, reactive and ankylosing spondylitis. Of these, rheumatoid arthritis is the most common, affecting approximately 1% of the UK population.

Modern medications have significantly improved the quality of life and outlook of people with a rheumatoid arthritis diagnosis and early diagnosis is important. Diet and lifestyle can also play a role, so keep reading to find out more.

Rheumatoid arthritis

Rheumatoid arthritis is an autoimmune condition which largely affects synovial joints (joints which are encapsulated in a synovial membrane). In contrast to osteoarthritis, it typically affects the small joints of the hands and feet and, usually, will affect both sides equally and symmetrically.

It is a systemic disease and so can affect the whole body, including the heart, lungs and eyes. It is characterised by the presence of auto-antibodies – parts of the immune system that, instead of attacking intruders, start to attack itself. The two most common auto-antibodies are rheumatoid factor and anti-citrullinated protein antibodies, although individuals may receive a diagnosis of rheumatoid arthritis even without the presence of these auto-antibodies.

What is happening in your joints when you have rheumatoid arthritis?

With rheumatoid arthritis, the membrane lining of the synovium becomes inflamed. This inflammation is driven by the presence of various pro-inflammatory cytokines such as TNF-alpha and interleukins in the joint capsule. The inflammation causes heat and swelling and, over time, may lead to erosion of the bone, degradation of the cartilage and a narrowing of the joint space.

Who is at risk?

There are a number of factors which raise the risk of a rheumatoid arthritis diagnosis:

• genetics – a set of genes known as ‘HLA-class ii’ raise the risk
• female – women are 2-4 times more likely to have rheumatoid arthritis than men
• also: watch for more research on post-covid autoimmune joint inflammation

What causes rheumatoid arthritis?

There are no known triggers for rheumatoid arthritis as yet. However, we do know that the following are associated with the incidence of disease:

• Obesity and metabolic syndrome – a combination of overweight, type 2 diabetes, raised blood pressure and raised cholesterol, predispose towards rheumatoid arthritis. this seems to be particularly the case in young men.
• Western populations are more at risk – a combination of diet, stress, medications and environmental pollutants.
• Gut dysbiosis and intestinal hyper-permeability.
• Smoking.

Symptoms of rheumatoid arthritis

In addition to throbbing and aching pain in the affected joints, individuals with rheumatoid arthritis will experience some or all of the following:

• joint swelling and stiffness which is worse after a period of inactivity and usually lasts for longer than 30 minutes
• reduced flexibility and mobility
• general fatigue due to immune system activation
• dry eyes

Diagnosing rheumatoid arthritis

Diagnosis is often made between the age of 20 - 40 years. A GP or Rheumatologist will conduct a clinical assessment for inflammation of the synovial membrane. Blood tests of rheumatoid factor will be made and following a diagnosis, the anti-cyclic citrullinated peptide will be tested, as the latter can have a bearing on disease severity. Blood inflammatory markers – ESR and CRP - are also tested.

The NHS stress the importance of early diagnosis to reduce the impacts of joint destruction. X-rays are routinely conducted to see if bone erosions are present. Functional ability assessments are carried out to assess impacts on quality of life and ability to cope with the practicalities of daily life.

Diet, lifestyle and arthritis

If you have a diagnosis of arthritis, you may be wondering whether there is a role for diet and lifestyle. The answer to that question is an empathic yes! Nutritional therapy should never replace conventional treatment and medications, but, by making diet and lifestyle an integral part of your care, it can improve quality of life, as well as the impact on the disease's processes and progression.

A focus on reducing inflammation

A key element of any plan for arthritis is a focus on inflammation. Diets and lifestyles can either fuel that inflammation – think sugars, hydrogenated fats, alcohol, stimulants, heavily processed foods, and stress – or calm it down.

Elements to focus on from an anti-inflammatory point of view include fresh, whole foods, brightly coloured fruits and vegetables, liberal use of herbs and spices, quality proteins including oily fish, and good fats such as olive oil, nuts, seeds and avocados. Colourful vegetarian and Mediterranean dietary patterns both have good research in relation to arthritis symptoms. Your dietary choices, in particular, can impact ESR and CRP levels, which are used as key blood markers of inflammation.

Balance your blood sugar levels

Food choices can significantly impact your blood sugar levels. Highly processed, refined foods, together with fizzy drinks, caffeinated drinks and alcohol, can send you off on a blood sugar roller coaster. The impacts of this on arthritis relate to inflammation and pain.

Choosing whole, fibre-rich foods can have a positive impact here, keeping your blood sugar levels stable throughout the day, thereby reducing inflammation. The how and when of eating can also have a positive – and a negative - impact on blood sugar control. Everyone is unique and it helps to work with a Registered Nutritional Therapist to work out the style of eating that will work best for you.

Dysbiosis (gut microbiome)

Dysbiosis describes an imbalance in gut bacteria profiles, as well as a general lack of diversity. Whilst it may seem unlikely, medical literature now talks about a ‘gut-joint axis’, meaning that associations exist between gut microbiome changes and the incidence of arthritis.

Specific changes in the microbiome are associated with both osteoarthritis and rheumatoid arthritis and there is plenty of research in progress to examine this further. Human research here is limited, however, it presents a novel target for nutritional therapy. What is known is that low-grade inflammation is driven by gut dysbiosis, so it is likely that this is the principal mechanism behind the ‘gut-joint axis’.

The best way to ‘feed’ your microbiome is to eat plenty of colourful, fresh fruits and vegetables. The more variety the better! When next out shopping, reach for a vegetable that you’ve never cooked before. The internet will be full of inspiration on how to prepare it and make it delicious. Choosing what are known to be pre-biotic foods – these are foods that feed the microbes in your gut – can also be helpful. Artichokes, garlic, onion, leek, asparagus, banana, apples, oats – all these foods and more will help increase the diversity of your gut microbiome.

Weight-loss (if required)

Weight-loss has been shown to improve quality of life and physical function, as well as reduce pain associated with osteoarthritis. There is a gradient here as well – losing greater than 10% of weight sees better improvements to symptoms than less than 5% body weight loss. Weight loss is particularly important in knee arthritis, so make this a focus if you struggle with arthritis in the knee and carry excess weight. Seek help from a Nutritional Therapist who specialises in weight loss if you struggle to find a strategy for sustainable optimal weight.

Find out more about how working with a nutritional professional can help with weight-loss. 

How working with a Nutritional Therapist can help

Nutritional therapy is a wonderful modality for joint pain and arthritis. Whilst there are some diet recommendations that reach across the board, everyone is different. Personal living circumstances, budgets, motivation and support all vary from one person to the next. A Nutritional Therapist will spend time with you to understand where you are starting from and put in place manageable steps that lead you to a more comfortable place.

Arthritis is considered a progressive disease but it doesn’t always have to be. Combining diet and lifestyle changes with modern medicine can be a winning combination.

This content was written by Nutritional Therapist Clare Grundel, MSc Nutritional Therapy, mBANT, CNHC (December, 2022)

All content displayed on Nutritionist Resource is provided for general information purposes only, and should not be treated as a substitute for advice given by your GP or any other healthcare professional.