Achy Bones: Osteoarthritis

I thought we’d share some on arthritis today because it is a significant problem and probably the number one cause of disability in America.  About 50% of adults over the age of 65 have arthritis that impairs normal daily activities.  We’re talking over 20 million people with osteoarthritis and another 10 million with other kinds of arthritis.  It’s an incredibly disabling event that is happening to a large percentage of adult America.  I thought it would be interesting for us to gain a little knowledge and understanding of that area.

In truth, the term arthritis is kind of a catch-all for multiple problems.  In fact there are probably over 100 conditions that could cause arthritis.  It’s a highly diverse topic.  By and large probably 40 – 50% of all arthritis would fall under the category of osteoarthritis.  There are others: gouty arthritis, lupus arthritis, fibromyalgia, juvenile rheumatoid arthritis.  There are all different kinds of arthritis.  I thought we might cover osteo today and maybe next week work on some of the other arthritises.  They are really different things completely.  What they have in common is that they just all manifest in the joints.  It looks like the same critter but there are a lot of different possibilities there.

So what is arthritis?  It’s a condition of the joints that is usually characterized by pain and stiffness with limited range of motion and swelling.  As I just mentioned there are a hundred different things that cause that.  It can involve, also, the immune system and even other organs in the body including the bowel and spleen and liver and other parts of the body and has significant implications for other parts of the body.  But when we think of the term arthritis we usually think of joints and joint pain.

Certainly the most common joints affected are our fingers.  Usually the knuckle joint first and then the next up.  These joints in our hands are the most commonly affected.  However, the ones that get us the worst are usually hips and knees.  Those are the big ones that wind up in surgery.  When you think of the economics of having a huge problem that you have to deal with you usually think of hips or knees, but by far and away the most common daily problem that we encounter is arthritis and osteoarthritis of the hands.

As far as male/female it’s usually about 50% of women, about 40% of men.  That may be due to calcium loss during pregnancy and things like that.  It could also be related to less exercise.  There are a lot of things we don’t know about it.  We have some statistical numbers, but that doesn’t necessarily relate to fact or reality of what is actually going on there.  You can take some guesses.  If women have it more than men, maybe it’s because of babies.  Maybe it’s because they aren’t as physically active.  Who knows?  We really don’t know the answers to those questions.

What’s going on in that joint when osteoarthritis occurs?  Normally is there is cartilage on the surfaces so that the bones don’t rub bone to bone.  Then you have a little sack around the joint called the bursa that holds fluid on there.  It’s kind of a lubricant on the two joints which are surfaced with cartilage.  That cartilage begins to break down.  Realize that cartilage doesn’t have any blood.  It has no nerves and it has no lymphatics.  It’s kind of a unique tissue in the body.  It grows slower than molasses.  It’s like brain cells.  They grow very slowly and reproduce very slowly.  It’s a different sort of situation that the muscles or other tissues of the body, even kidneys or liver or bowel because it grows so very slowly.  Cartilage is composed of about 95% water.

So those joints begin to get inflamed, whatever may be the cause of it, and there are lots of different causes.  Osteoarthritis begins to happen a lot of times even in your teenage years.  By the time you’re 50, half of us have some osteoarthritis.  By the time you’re 70 it’s almost universal.  

It’s interesting as you look at different other vertebrates in the animal kingdom. Most people might think you get arthritis because you’re walking and standing.  But whales and porpoises have arthritis.  They’re surrounded by water, that’s a pretty good cushion.  It’s interesting that the only two animals that don’t get arthritis are bats and tree sloths which hang upside down to sleep.  So let’s hear it for the inversion tables here.  I propose that we have a study.  Anyone who wants to enter my study to sleep upside down on an inversion table every night, we’ll publish a paper in about 10 years and tell whether that had an effect on you.  I’m just joking about that. But it would be interesting to see if people that use inversion tables daily have a little less arthritis.

Anyway, you’ve got this cartilage which has no nerves, no blood vessels, no lymphatics.  You’d think that trauma would have a lot to do with causing arthritis.  If trauma were a cause then long-distance runners would all have osteoarthritis.  They don’t.  They don’t get it at any different rate than the rest of us.  

There are only a couple of things that are known to prevent osteoarthritis.  One is weight control.  If you are over weight you should modify that and change that.  Exercise, you might think, would pound the cartilage, causing damage.  Actually this is beneficial because there are no blood vessels going to it.  The way it gets its nutrition is by compression and relaxation.  It kind of pumps the fluid of the joint in and out of the cartilage surfaces as you exercise.  That’s why you would think, okay, my joint is hurting, I should stop using it.  Instead, the exercise is beneficial to it because it pumps nutrients and oxygen into the cartilage surface.

Treatments – the common varieties such as acetaminophen, aspirin, and other non-steroidal anti-inflammatories are hugely and broadly used with some significant benefit.  There are also downsides to a lot of those.  The acetaminophen can harm the kidneys; the non-steroidal drugs may cause bleeding from the bowels.  

Natural things that are of benefit I would put fish oil right at the top of things I would do to keep my joints healthy and functional.  If you’ve got some osteoarthritis, certainly chondroiton sulfate and glucosamine are highly beneficial.  Curcumin is a known anti-inflammatory.  There are others such as nettle leaf.  And I certainly won’t forget MSM.  Those are good things that have benefit for osteoarthritis.  

We’ll talk about some of the other forms of arthritis next week and what we can do about those.