Osteoarthritis (OA) is a degenerative musculoskeletal disorder in which cartilage surrounding the ends of bones within certain joints breaks down, which can cause pain, swelling and stiffness in the affected joints. Although OA can affect any mobile joint in the body, it’s most common in the hips, knees, fingers and lower back. Over time, as OA worsens, the underlying bone may respond by forming growths called spurs, and bits of cartilage or bone can then chip off and remain within the joint, simply floating around. This sets off an inflammatory cascade, and enzymes and other chemicals then cause further damage to a point where cartilage is completely worn down, and you may be left with bone rubbing on bone, leading to more pain, swelling and further joint damage.
Some predisposing factors that increase the risk of developing OA include the overuse of certain joints, inflammation or infection of a joint, genetics, repeated or severe musculoskeletal injuries, as well as being overweight or obese.
The most common symptom of OA is sore and stiff joints, which can occur especially in the mornings. Affected areas may also swell, particularly after movement and any activity which triggers symptoms such as climbing stairs, walking, lifting objects and even using a can opener. Osteoarthritis affecting the knees or hips can cause someone to live a sedentary lifestyle, and with this comes risk factors for poor health outcomes, due to the isolation that can occur as a result, potentially leading to conditions such as depression. With a lack of movement may come increased weight gain, and an increased risk for other chronic illnesses such as heart disease and type 2 diabetes.
Certain foods may also trigger OA symptoms due to their ability to drive inflammation in the joints, although this is controversial. These foods include nightshades such as eggplant, potatoes, capsicum, chili and tomato, in addition to sugar and ‘white’ processed foods.
A number of conventional treatment options are available for those with OA, including both pharmacologic and non-drug methods. Managing symptoms such as pain, stiffness and swelling is the main focus of treatment and this may include taking analgesics (pain relievers such as paracetamol), non-steroidal anti-inflammatories (NSAIDS). If there’s strain on the joints due to excess body weight, then healthy weight management and physical activity are important. Aimto maintain a balance between participating in physical activity, and not aggravating symptoms, while keeping pain under control.
Diet, nutrition, and nutritional supplementation
Beyond the traditional methods, a range of complementary and alternative medicines are beneficial in the treatment of OA. Taking chondroitin supplements can improve quality of life, for example, according to a study measuring pain, function and disability. Another trial established that after 6 months, people who took chondroitin scored 10 points lower on a pain scale compared to those who took placebo. X-ray evidence also suggests that chondroitin helps to slow down narrowing of the joint space.
When compared to placebo, chondroitin specifically improved osteoarthritis in the knee by reducing the amount of pain experienced. Additionally, chondroitin was confirmed as safe, with little or no adverse reactions. 1
Glucosamine is another option that can be beneficial in the treatment of OA. There is evidence to suggest that a daily dose of 1,500mg taken orally can significantly reduce the symptoms of OA in the lower limbs.2
The disease progression in osteoarthritis is predominantly driven by inflammation and this is hastened by obesity due to increased release of inflammatory chemicals which contribute to joint degeneration in osteoarthritis. A diet high in inflammatory fats increases leptin levels, which is a hormone produced by the body’s fat cells, in local cartilage tissue, contributing to the progression of osteoarthritis. 3
Omega-3 and omega-6
A high consumption of omega-6 fatty acids induces inflammation, cartilage damage and increases the risk of subchondral bone deterioration. Optimising your fatty acid intake by balancing out omega-6 fats with omega-3 fats can aid in reducing systemic inflammation and keeping inflammatory mediators at bay. The standard Western diet consumes an omega-6 to omega-3 ratio of about 16:1, where ideally it should be around 1:1.
The oils that are high in omega-6 which you should aim to reduce include:
Whereas foods that are high in omega-3 which should be increased include:
Oily fish such as salmon, herring, mackerel, sardines
Though it’s important to consume a wide range of healthy foods, it can be difficult to ensure you get enough of the essential vitamins, nutrients and minerals, such as omega-3 fatty acids, in. If you do struggle to make sure you eat enough, it might be worth considering taking a daily, high-quality omega-3 supplement. These can often contain more omega-3 than you’d be able to get through food consumption, and can be a lot more convenient. If you’re vegetarian or vegan, there’s a range of vegetarian options to fish-sourced omega-3 supplements available, that are derived from directly from microalgae (the source that fish get their omega-3 from).
Studies have shown that the Mediterranean diet can have a protective effect in osteoarthritis. This is because of its anti-inflammatory properties, in addition to its anti-obesity and high content of antioxidant-rich fruit and vegetables. The Mediterranean diet is typically rich in plant compounds which curb systemic inflammation and cartilage destruction, resulting in the prevention of osteoarthritis-related musculoskeletal inflammation. This is partly due to the Mediterranean diet having a lower omega-6 to omega-3 fatty acid ratio. 4
The Mediterranean diet is also rich in antioxidants like Vitamin C, some studies have reported that the intake of dietary antioxidants prevents the progression of osteoarthritis.
A typical day of eating the Mediterranean diet might include foods such as:
Full fat yoghurt
Fresh mixed berries
Walnuts, chia seeds
Chickpea & beetroot hummus
Vegetable sticks (carrot, cucumber, celery, green beans)
Large salad: rocket, tomatoes, cucumber, carrot, red onion, boiled eggs, crushed nuts and seeds (almonds, walnuts, macadamias, pumpkin seeds, sunflower seeds), olive oil and lemon juice dressing, goats cheese.
Steamed sweet potato
Sautéed greens: broccoli, green beans, Asian greens, garlic and olive oil
Boiled red quinoa
It’s commonly known that maintaining a healthy weight and staying physically active is part of the treatment for osteoarthritis. This is especially important as obesity is a driver of inflammation. 5
Numerous studies show that exercise and physical activity are beneficial for osteoarthritis. Even when osteoarthritis affects the hand, exercise improves hand function overall by reducing pain and joint stiffness. Exercise in these studies was aimed at improving muscle strength and joint stability. 6 ,7, 8
Exercise also reduces pain, improves physical function and improves quality of life. With regards to knee pain, exercise helps to reduce pain even two to six months after formal exercise therapy was ceased. These effects were comparable to the effects of non-steroidal anti-inflammatory drugs. 9
Studies and reviews conducted on yoga for chronic pain have also shown positive results. Some studies that focused specifically on the effects of yoga on knee osteoarthritis demonstrated beneficial outcomes on symptoms including pain, flexibility, functional disability, anxiety and quality of life after 8 weeks of Hatha yoga. Yoga is a safe and acceptable exercise form for those suffering from osteoarthritis. 10
Various herbal medicines and herbal formulations are also used for their anti-inflammatory effects on the musculoskeletal system.11
Devil’s claw, for example, is a herb that can help to decrease osteoarthritis-related pain. Some studies suggest that there is strong clinical evidence for the herb’s effectiveness on pain reduction, though more studies may be needed. 12
Some studies also indicate that, over a 90-day treatment period, 100mg extracts of Frankincense (Boswellia serrata) can improve symptoms of osteoarthritis. When compared to a placebo, people taking Boswellia serrata rated their pain levels significantly less. What’s more, frankincense was also reported to improve physical function. 13
Curcumin is a constituent found in Turmeric (Curcuma longa) root. It’s a powerful antioxidant and can be used to treat inflammation and pain in chronic conditions such as osteoarthrosis. Studies show that curcumin can significantly decrease pain and improve the ability to perform normal daily tasks. Fewer people in the supplement group had to use rescue medication. Additionally, there was improvement in pain-free walking distance in participants taking the herbal medicine. 14,15
CBD extract may also have anti-inflammatory effects. In a recent study, the extract was shown that topical application of CBD has therapeutic potential for arthritis-related pain and inflammation. 16
The bottom line
If you’re experiencing the symptoms of osteoarthritis, then a holistic approach can help to reduce them. In order to directly tackle pain and inflammation, consider using lifestyle approaches such as exercise, herbal and nutritional medicine, alongside a change in diet. It’s also important to see your GP if the pain persists.
If you’re interested in learning more about how to keep your joints healthy, head over to our advice centre for more information.