Osteoarthritis: Symptoms, Causes, Lab Tests, Treatment

Osteoarthritis (OA) is a degenerative and chronic joint disease. It is the most common form of arthritis worldwide. It affects millions of people and is considered one of the main causes of disability in adults. The disease is characterized by progressive wear and tear of the articular cartilage. This elastic tissue covers the ends of the bones in the joints, allowing for smooth and painless movement.

Osteoarthritis is not limited to cartilage damage. As the disease progresses, the following are observed:

• Thickening of the hypochondrial bone (the bone under the cartilage),
• Growth of osteophytes (bone protrusions),
• Inflammation of the joint synovium (the layer that surrounds the joint), and
• Reduction of synovial fluid, which reduces lubrication.

Although it is often treated as an "inevitable result of aging," it is now clearly a disease with an active inflammatory and metabolic basis, which is affected by lifestyle, diet, physical activity, and overall health.

Early diagnosis and intervention are crucial. If not appropriately treated, osteoarthritis can cause significant disabilities, even leading to surgical replacement of the joint.

Epidemiological Data of Osteoarthritis

Osteoarthritis is one of the most common causes of chronic pain and disability. Its spread is constantly increasing due to the aging of the population and the increase in the prevalence of obesity.
Global Data:

• According to the Global Burden of Disease 2019, more than 528 million people are affected by osteoarthritis.
• This number has doubled in recent decades, not only due to age, but also due to sedentary lifestyle, diet, and environmental factors.
• More than 10% of the population over the age of 60 shows symptoms of osteoarthritis, especially in the knees.

In Greece:

• It is estimated that about 1 in 5 people over the age of 65 has been diagnosed with some form of osteoarthritis.
• The most common form is knee osteoarthritis, which significantly affects mobility.
•  Postmenopausal women have a higher incidence, which is linked to hormonal changes and a decrease in the protective effects of estrogen.

The forecast for the coming decades is bleak: as life expectancy increases and obesity becomes an epidemic, osteoarthritis will be a significant burden on health systems and societies.

Symptoms of Osteoarthritis

The symptoms of osteoarthritis appear progressively and worsen over time. They often start mildly and can be ignored for a long time, leading to a delayed diagnosis.

• Pain during movement: The most characteristic and early indicator. It occurs when the joint is activated and can subside with rest. In more advanced cases, the pain is also present at rest.
• Morning stiffness: Occurs after periods of immobility (e.g., in the morning or after sitting). It usually lasts less than 30 minutes and subsides with mobilization.
• Reduced flexibility and functionality: The joint becomes stiff, and the patient has difficulty performing basic movements, such as bending the knee or holding an object.
• Joint sounds ("crepitus") during movement: Caused by the abnormal contact of the bones due to cartilage wear.
• Swelling and heat: Especially after intense joint use, slight swelling, pain to the touch, and increased temperature locally may be observed.
• Instability or a feeling of "blockage" can result from the detachment of small pieces of cartilage inside the joint.
• Muscle weakness: The muscles that support the joint are weakened because people avoid using them due to pain.

The presence and intensity of these symptoms vary depending on the severity of the condition, general health, and the patient's age.

Causes of Osteoarthritis

A single factor does not cause osteoarthritis, but rather complex biological, mechanical, and environmental interactions. The main causative factors include:

• Aging: Cartilage has a limited ability to self-repair. With age, the ability of chondrocytes to regenerate cartilage decreases.
• Genetic Predisposition: A Family history of osteoarthritis increases the risk. Genes related to cartilage structure may affect joint resilience.
• Mechanical Stress: Repetitive movements, work that requires physical strain, and frequent bending strain the joints.
• Obesity: Each extra pound of weight increases the pressure on the knees by 3 to 5 times. Adipose tissue acts as an inflammatory organ, aggravating the condition.
• Injuries: Injuries to the knee or ankle during adolescence or young adulthood can lead to premature osteoarthritis.
• Hormonal Changes: Especially in postmenopausal women, the sharp estrogen decrease negatively affects the cartilage structure.

Root Causes of Osteoarthritis

Functional medicine focuses on finding the root of the problem and not just relieving symptoms. Thus, osteoarthritis is not simply treated as a result of mechanical wear, but as a result of systemic disorders, such as:

• Dysbiosis of the intestinal microbiome: Gut health is closely related to inflammation. An imbalance of bacteria (dysbiosis) can cause intestinal wall permeability (leaky gut), leading to immune system activation and chronic inflammation affecting the joints.
• Oxidative stress and lack of antioxidants: The degeneration of cartilage cells is associated with the overproduction of free radicals. Deficiency in essential antioxidants such as glutathione, vitamin C, and vitamin E enhances the inflammatory process.
• Chronic low-grade inflammation: It is not evident as in acute inflammation, but manifests itself through pain, fatigue, and tissue damage. This inflammation can originate from diet, stress, or the environment.
• Hormonal disorders: Hormones such as estrogen, testosterone, and cortisol regulate cartilage regeneration and the immune response. Hormonal imbalance, especially after menopause, accelerates joint wear.
• Nutritional inflammation: A diet rich in sugar, trans fats, and processed foods increases markers of inflammation, disrupting metabolic and immune balance.
• Toxic charge and heavy metals: Lead, cadmium, and mercury have been linked to an adverse effect on cartilage cells.

Conventional Laboratory Tests for the Control of Osteoarthritis
 

• Joint X-ray: The basic imaging examination for the diagnosis of osteoarthritis. It depicts features such as stenosis of the interarticular space, presence of osteophytes (bone protrusions), hardening of the hypochondrial bone, and joint deformation.
• Magnetic Resonance Imaging (MRI): It is used when detailed imaging of soft tissues is needed or to evaluate early lesions that are not visible on simple X-rays.
• Synovial Fluid Analysis: It rules out other forms of arthritis, such as gout or rheumatoid arthritis. The fluid is usually clear with slightly increased viscosity.
• Blood tests: They are used to rule out autoimmune diseases (e.g., rheumatoid factor, CRP, ESR), although they are not diagnostic for osteoarthritis. Arthritis Profile

Functional Medicine Tests and Special Tests for the Control of Osteoarthritis
 

• Intestinal Microbiome Testing (EnteroScan® Comprehensive) checks the intestinal microbiome, inflammatory markers (calprotectin), microbiome balance, and many other factors. It reveals chronic intestinal inflammation, which is often overlooked.
• Oxidative Stress / Antioxidant Capacity: Measurement of Basic Oxidative Stress (Glutathione, Catalase, Total Antioxidant Capacity and Total Oxidative Stress), Superoxide Dismutase (SOD) to identify deficiencies that intensify cartilage destruction.
• Nutrient Measurement: The levels of vitamins D, K2, B12, Omega 3, magnesium, and iron, essential for bone structure and reducing inflammation, are checked.
• Food Sensitivity Test (TrophoScan® IgG & IgA): This test evaluates the body's reactions to various foods that may cause an inflammatory response.
• Cartilage Matrix Oligomer Protein (COMP): This protein plays a key role in cartilage's structural integrity and function. It is used as a biomarker for cartilage renewal and degradation, making it a valuable tool in diagnosing and monitoring osteoarthritis.
• Osteoarthritis Genetic Testing: The polygenic risk score (PRS) assessment for osteoarthritis is based on examining 27 gene polymorphisms.
• Knee Osteoarthritis Genetic Testing: The polygenic risk marker (PRS) for knee osteoarthritis is assessed by examining 11 gene polymorphisms.
• Hip Osteoarthritis Genetic Testing: The polygenic risk marker (PRS) for hip osteoarthritis is assessed by examining 28 gene polymorphisms.
• The Musculoskeletal Diseases, Genetic Test includes the above genetic tests and additional screening for eight other diseases.

Conventional Treatments for Osteoarthritis

The treatment of osteoarthritis based on classical medicine has as its primary goal the management of pain, the enhancement of functionality, and the prevention of deterioration of the joint. In detail, the basic therapeutic approaches include:

• Painkillers: Like paracetamol, they are initially prescribed for mild pain. They are generally well tolerated, but their effectiveness decreases in more advanced stages.
• Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): E.g. ibuprofen, naproxen. They are more potent in relieving pain and inflammation, but their long-term use can cause gastrointestinal problems or cardiovascular complications.
• Corticosteroid injections: They are injected directly into the joint and provide short-term relief from acute pain. They are mainly used in exacerbation phases but are not indicated for frequent use as they can aggravate cartilage damage.
• Hyaluronic Acid Injections increase the elasticity and lubrication of the synovial fluid. They are mainly used in knee osteoarthritis with variable results.
• Physiotherapy includes a personalized exercise program that focuses on strengthening the muscles around the joint, improving stability, and maintaining mobility. It is accompanied by therapeutic massage, electrotherapy, and hydrotherapy.
• Orthopedic aids: Splints, crutches, and special footwear or soles relieve joint pain and prevent deformities.
• Surgical Replacement (Arthroplasty): Joint replacement can restore functionality in severe destruction and pain that do not respond to conservative measures.

Natural Remedies for Osteoarthritis

The modern approach proposes incorporating natural strategies into every treatment plan, enhancing the body's self-healing and reducing the need for medications. The most important natural remedies include:

• Anti-inflammatory diet: The Mediterranean diet (olive oil, vegetables, fatty fish, nuts, whole grains) has been shown to significantly reduce markers of inflammation and help manage pain in the long term.
• Type II collagen and glucosamine supplements: They support cartilage structure and may help improve mobility and reduce stiffness, especially in mild forms of osteoarthritis.
• Omega-3 fatty acids: They have a natural anti-inflammatory effect, suppressing the production of prostaglandins and cytokines. They are obtained through consuming fatty fish (salmon, mackerel) or as a fish oil supplement.
• Weight loss: Reducing even 5% of body weight dramatically reduces the mechanical load on the knees and improves the quality of life.
• Low-intensity exercise: Yoga, pilates, tai chi, and swimming are indicated, as they promote strength and balance without burdening the joints.
• Stress management: Chronic emotional tension enhances inflammation through an increase in cortisol. Techniques such as meditation, mindfulness, and deep breathing positively affect pain.

Dietary Supplements for Osteoarthritis

Herbal remedies offer a natural and mild treatment of inflammation and pain, often with fewer side effects than conventional medications.

• Curcuma (Curcuma longa): Contains curcumin, a powerful antioxidant and anti-inflammatory ingredient. Studies show comparable efficacy to NSAIDs in mild to moderate cases of osteoarthritis, without the gastrointestinal side effects.
• Boswellia serrata (Indian frankincense): Inhibits the action of enzymes involved in the inflammatory response (such as 5-LOX). It has been successfully used to reduce pain and stiffness.
• Ginger (Zingiber officinale): Used in capsule form, tincture, or as a beverage. It improves circulation and reduces pain thanks to the active ingredients, gingerols and shogaols.
• White willow (Salix alba): Natural source of salicylates, a precursor to aspirin. It has an analgesic and anti-inflammatory effect, without the side effects of synthetic NSAIDs.
• Harpagophytum procumbens: Contains the active ingredient harpagoside, which has documented effects in treating pain and functional disability in patients with osteoarthritis.

Caution: Herbal preparations should always be used under a doctor's or pharmacist's guidance, especially when combined with medicines.

Indicative Dosage of Supplements for Osteoarthritis

Attention! Administration should always be done under the guidance of a doctor or specialized health professional.

References

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3. Panahi, Y., et al. (2016). Curcuminoid treatment for knee osteoarthritis: a randomized double-blind placebo-controlled trial. Phytotherapy Research, 30(9), 1545–1551.
4. Daily, J. W., Yang, M., & Park, S. (2016). Efficacy of Turmeric Extracts and Curcumin for Alleviating the Symptoms of Joint Arthritis. Journal of Medicinal Food, 19(8), 717–729.
5. Wallace, I. J., et al. (2017). Knee osteoarthritis has doubled in prevalence since the mid-20th century. PNAS, 114(35), 9332–9336.