Weight Loss: The Golden Ticket to Osteoarthritis Prevention

Article by Dr Alvin Ng Choong Meng

Weight Loss: The Golden Ticket to Osteoarthritis Prevention

Dr Alvin Ng Choong Meng

National University of Singapore
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My 8-year-old daughter confronted me just a few weeks ago about the miracle creams and pills that the television advertisements are showing for arthritis. “No need for any more surgery then.” She said. That led me to wonder: if these supplements and creams are the tickets to osteoarthritis prevention; that is really an excellent quick fix. No need for exercising either since running is terrible to our knees and ankles as the stomping trashes the joints. The marathoners must be destroying their knees! But are the professional runners really getting osteoarthritis early and more frequently then the rest of us?

In a study published when I was still doing 2.4km runs in less then 9.05mins, formerly competitive runners did not have higher rates of arthritis in their hips, knees or ankles when compared to non-runners.

  • What about the regular recreational runners? A more recent study in the American Journal of Preventative Medicine investigated differences in the progression of knee osteoarthritis in middle- to older-aged runners compared to healthy non-runners over two decades. No association was found.
  • Medical literature generally does not support the idea that running and exercising contributes to the degeneration of articular cartilage. So what does?
  • Whereas once knee osteoarthritis was considered a 'wear-and-tear' condition, it is now recognized that knee osteoarthritis exists in the highly metabolic and inflammatory environments of fat tissue.

Weight loss and osteoarthritis

  • Chemicals known as cytokines associated with adipose tissue may influence osteoarthritis though direct joint degradation or control of local inflammatory processes.
  • Moreover, obesity loads may be detected by mechanical receptors on cartilage cell surfaces triggering production of such chemicals leading to increased arthritis.
  • Fat (adipose) tissue, once considered a passive storage of energy, is now recognized as a highly metabolic endocrine organ with the capacity to secrete such inflammatory chemicals, which have been detected in the joint fluid and the blood of patients with osteoarthritis.
  • As doctors will tell you, inflammation is an important hallmark of osteoarthritis, and we give you anti-inflammatory medications to help reduce the pain and swelling from osteoarthritis.
  • With the cytokines found in fat tissue being an important part of inflammatory processes, reducing fat tissue where these nasty chemicals are produced can do prevention. Voila, the golden ticket!
  • In addition to the nasty chemicals, being overweight also leads to abnormal loads on the joints.
  • Clinical and animal studies of joint loading have provided evidence that abnormal loads can lead to changes in the composition, structure, and mechanical properties of articular cartilage.
  • Kind of like a watermelon placed on a grape, I guess you get the picture. But weight is not just the whole picture, loss of muscle mass and strength may reduce the shock-absorbing potential of the joint, thereby causing cartilage damage.
  • Pain is the main reason patients see me when they have osteoarthritis. Obesity has known to be linked to abnormal glucose homeostasis (control) and insulin resistance in the body.
  • In studies of acute pain in trauma and surgery, there is decreased insulin sensitivity.
  •  In these same studies of induced acute pain, there were increases in circulating concentrations of hormones associated with altered glucose homeostasis.
  • Because obesity is frequently, though not always, associated with insulin resistance, altered glucose homeostasis has an important role related to chronic pain from the arthritis.

We have been searching for miracle drugs to reverse osteoarthritis for a long time to no avail. Of course, weight management, albeit the Golden Ticket to osteoarthritis, prevention may not be the quick fix everyone is looking for. If it ever comes to a need for a knee replacement or ankle fusion by Orthopedic surgeons like me to repair chronically damaged joints, we will always be available to help you.