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Understanding osteoarthritis: strategies for management

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Table of Contents

Osteoarthritis is often a painful condition in which joint tissues break down over time. It can have a negative impact on daily activities, mobility and quality of life. 

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS),1 it is the most common form of arthritis, is more prevalent in older people and is more likely to affect women, especially those aged 50 and over.  

Other risk factors include being overweight and previous injury to the joint.

Younger people may be affected due to injury, if it runs in the family, or due to genetic deformity. 

The most affected joints include the hands, knees, hips, neck and lower back.

Osteoarthritis can affect each person differently in terms of the pain and how fast it progresses, though it generally develops progressively over the years. 

What happens in osteoarthritis

It’s still unclear what causes or triggers the breakdown of joint tissues, but according to the NIAMS,2 the structural changes include damage to joint cartilage, the connective tissue that covers and protects the joints. 

Once this begins, all parts of the joint can become damaged, including the bone, tendons, ligaments and cartilage.  As this damage progresses, pain, swelling and loss of joint motion can occur.

Other changes can occur and cause more damage, including changes in the shape of joints or bones, small bone growths on joints, or pieces of bone or cartilage breaking off within the joint space. 

Symptoms

Symptoms can include joint pain, swelling and difficulty moving. Joints can also become stiff, especially in the morning or after a period of immobility. 

Diet and lifestyle support

While there is no cure for osteoarthritis, some research is available that can guide how nutrition can help manage symptoms and prevent their progression.

Weight management to reduce the load on joints

Dr Jeffrey Zarin2 from The Cedars Sinai Kerlan-Jobe Institute points to weight loss as one of the two lifestyle factors that slow the progression of arthritis. Weight reduction can reduce the load on the joints. Exercise is the other factor, as it can strengthen muscles around the joint. New research suggests that the earlier weight is managed, the better. A 2024 Monash University study published in Osteoarthritis and Cartilage3 revealed that preventing weight gain from early adulthood could reduce knee replacements in Australian adults by almost 30 per cent. 

Anti-inflammatory diet is key 

As osteoarthritis results in a predominantly inflammatory response to damaged cartilage in the joints, the most common lifestyle approach to slow the progression of osteoarthritis, according to the Zarin2, is to reduce inflammation created by the body in response to the damaged cartilage in the joints. 

The Mediterranean diet is now widely known as one that can help reduce inflammation and aid weight loss. It’s a diet that those living in the Mediterranean countries have long eaten. According to the Arthritis Foundation4, many studies have found that people who follow this diet shed weight unintendedly. In addition, because excess fat promotes inflammation, inflammation reduces, too.

A review published in the Nutrients Journal5 reports that most evidence supported the Mediterranean diet in improving osteoarthritis-related outcomes. 

On the other hand, it reports that poor diets, such as those high in saturated fat and refined carbohydrates, are associated with higher inflammation and linked to accelerated progression of osteoarthritis. 

Anti-inflammatory foods

The Arthritis Foundation4 reports that the Mediterranean diet’s power is in its ability to regulate inflammation through consuming anti-inflammatory foods high in fibre, beta carotene, magnesium, and omega 3s. These foods consist mainly of whole foods, locally grown fruits and vegetables, healthy fats like olive oil and nuts, whole grains and some fish, yogurt, and red wine. Limiting foods that trigger inflammation is also a feature of the diet. 

  • Omega-3 fatty acids: Studies have shown that omega-3 fatty acids have an anti-inflammatory effect. A 2018 literature review in the Rheumatology Journal6 found that increasing consumption of omega-3 fatty acids, including from oily fish, may improve pain and function in OA patients. Fish that have the highest levels of omega-3s include salmon, scallops, sardines, herring, and tuna. Arthritis Australia7 reports, however, that it is unlikely that enough omega-3 fats can be obtained from diet to reduce inflammation without fish oil supplements. 
  • Fibre: The beauty of foods high in fibre is that they are filling, which can aid in maintaining a healthy weight. According to the Arthritis Foundation4, some studies have shown that fibre can lower blood levels of C-reactive protein (CRP), an inflammatory marker. 
  • Wholegrains are a fantastic source of fibre. Look out for those with the complete grain kernel, such as oatmeal, whole-wheat flour, brown rice, quinoa, and bulgur. However, the Arthritis Foundation4 points out that eating gluten, the protein found in wheat and other grains, may lead to an inflammatory reaction for people with gluten insensitivity.
  • Beans are also high in fibre and phytonutrients, which help lower CRP. 
  • Nuts and seeds: According to The Arthritis Foundation4, studies have shown that nut intake is associated with anti-inflammatory outcomes because of its monounsaturated fat content, which also aids in satiety and weight management. Quality sources of nuts include walnuts, pine nuts, pistachios, and almonds.
  • Fruits and vegetables: The 2023 Nutrients review reported5 that fruits and vegetables contain antioxidants that may reduce inflammation and improve symptoms associated with osteoarthritis, though this was not completely conclusive.
  • Spices: The Arthritis Foundation8also suggests sprinkling spices on your meals may provide an anti-inflammatory benefit. These include cayenne, garlic, turmeric, cinnamon and ginger. 

Foods to avoid

Ideally, you will avoid eating too many foods that can trigger inflammation, and these include:

  • Saturated fats: This includes those found in animal products such as red meat 
  • Refined carbohydrates such as white bread, white rice, pasta
  • Sugars
  • Dairy
  • Alcohol
  • According to The British Dietetic Association9, omega 6 polyunsaturated fats such as those found in sunflower, safflower, corn and grapeseed oils can be inflammatory, so it’s best to replace these with monounsaturated oils such as olive or rapeseed oils.

Herbal and nutrition supplements

  • Glucosamine and chondroitin: 10 reports that studies show glucosamine—and chondroitin-containing supplements have anti-inflammatory characteristics and may support the symptoms of mild osteoarthritis.  
  • Omega-3 fatty acids: The results of a 2023 of randomised control trials published in the Journal of Orthopaedic Surgery and Research 11 also supported omega-3 fatty acid supplementation to relieve pain and improve joint function. 
  • Curcumin: Curcumin is an optimised form of turmeric that may be suitable for some people who are unable to obtain a therapeutic dose in their diet. 

Conclusion

Supporting osteoarthritis with diet and lifestyle is a great starting point, and if getting the daily required nutrients is challenging, you may like to consider supplementation; however, speak to your GP or healthcare professional before starting anything new to find out what is best for you.

References

  1. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Osteoarthritis [Internet]. Updated 2023 Sep [cited 2024 Dec 22]. Available from: https://www.niams.nih.gov/health-topics/osteoarthritis#:~:text=Osteoarthritis%20is%20a%20degenerative%20joint,a%20short%20period%20of%20time
  2. Zarin J. Slowing the Progression of Osteoarthritis – What Works, What Doesn’t and What’s Next? Cedars-Sinai Kerlan-Jobe Institute [Internet]. Updated 2023 Jun 2 [cited 2024 Dec 22]. Available from: https://kerlanjobe.org/slowing-the-progression-of-osteoarthritis-what-works-what-doesnt-and-whats-next/#:~:text=The%20two%20lifestyle%20factors%20that,muscles%20around%20the%20affected%20joint
  3. Hussain SM, Ackerman IN, Wang Y, English DR, Wluka AE, Giles GG, Cicuttini FM. Trajectories of body mass index from early adulthood to late midlife and incidence of total knee arthroplasty for osteoarthritis: findings from a prospective cohort study. Osteoarthritis Cartilage. 2023;31(3)
  4. Arthritis Foundation. Mediterranean Diet for Osteoarthritis [Internet]. [cited 2024 Dec 22]. Available from: https://www.arthritis.org/health-wellness/healthy-living/nutrition/healthy-eating/mediterranean-diet-for-osteoarthritis
  5. Buck AN, Vincent HK, Newman CB, Batsis JA, Abbate LM, Huffman KF, et al. Evidence-Based Dietary Practices to Improve Osteoarthritis Symptoms: An Umbrella Review. Nutrients. 2023 Jul 6;15(13):3050. doi: 10.3390/nu15133050. PMID: 37447376; PMCID: PMC10347206.
  6. Thomas S, Browne H, Mobasheri A, Rayman MP. What is the evidence for a role for diet and nutrition in osteoarthritis? Rheumatology (Oxford). 2018 May 1;57(suppl_4):iv61-iv74. doi: 10.1093/rheumatology/key011. PMID: 29684218; PMCID: PMC5905611.
  7. Arthritis Australia. Fish oils [Internet]. Updated 2024 Apr [cited 2024 Dec 22]. Available from: https://arthritisaustralia.com.au/managing-arthritis/living-with-arthritis/complementary-treatments-and-therapies/fish-oils/
  8. Arthritis Foundation. Best spices for arthritis [Internet]. [cited 2024 Dec 22]. Available from: https://www.arthritis.org/health-wellness/healthy-living/nutrition/healthy-eating/best-spices-for-arthritis
  9. British Dietetic Association. Osteoarthritis and diet [Internet]. Updated 2024 Oct [cited 2024 Dec 22]. Available from: https://www.bda.uk.com/resource/osteoarthritis-diet.html
  10. Arthritis Foundation. Glucosamine and Chondroitin for Osteoarthritis Pain [Internet]. [cited 2024 Dec 22]. Available from: https://www.arthritis.org/health-wellness/treatment/complementary-therapies/supplements-and-vitamins/glucosamine-chondroitin-osteoarthritis-pain
  11. Deng W, Yi Z, Yin E, et al. Effect of omega-3 polyunsaturated fatty acids supplementation for patients with osteoarthritis: a meta-analysis. J Orthop Surg Res. 2023;18:381. doi: 10.1186/s13018-023-03855-w.