Arthritis is a group of chronic diseases affecting the joints and other connective tissues. These conditions are often characterised by swelling, joint pain and stiffness.
A common misconception about arthritis is that it only affects older people. Arthritis can occur at any age. In fact, in adolescents, a wide range of symptoms can manifest throughout the body including, among others, rashes, dry eyes, sensitivity to light, high fever, swelling, redness and/or tenderness around joints, difficulty moving after long periods of rest, diarrhoea, shortness of breath and more. This is diagnosed as juvenile arthritis or idiopathic arthritis. As children get older, symptoms may disappear or they may be diagnosed with adult arthritis.
Although osteoarthritis is usually diagnosed in people over 55 or post-menopausal, anyone can develop it. And like osteoarthritis, rheumatoid arthritis can develop at any age; however, it usually appears between the ages of 30 and 60. It is these two types, which are usually the most common, that we will focus on today.
The Most Common Types of Arthritis
There are more than 100 arthritic diseases, but the most common are osteoarthritis (a degenerative condition) and rheumatoid arthritis (an autoimmune disease).
Osteoarthritis (OA)
OA occurs when the cartilage that lines the joints wears down to the point where the bones rub against each other. It is a degenerative disease that worsens over time and makes it difficult to perform everyday tasks.
Osteoarthritis is usually diagnosed in people over the age of 55 or in menopause, but anyone can get it at any age. Major joint injuries from accidents, sports injuries and even repeated stress can lead to a diagnosis of osteoarthritis. Health problems such as diabetes, high cholesterol and even autoimmune disorders also increase the likelihood of OA.
It is believed, however, that OA is mis-conceptualised because our bodies are kept in a constant balance of degradation and repair. The problem occurs when degradation happens more frequently than repair.
Among the characteristics that describe osteoarthritis are an alteration in postural biomechanics and body movements. Therefore, it should not be considered as a degenerative disease, rather, it is up to us to find the repair tools to regenerate those affected body parts. This is achieved by neutralising and treating inflammationin the body; adopting proper nutrition; addressing the points of mechanical dysfunction that promote incorrect posture and re-educating the body to regain postural biomechanics; and improving poor circulation through physical activity and exercise.
Rheumatoid Arthritis (RA)
RA is a chronic autoimmune disease that causes the immune system to attack the entire body. It damages the joints of fingers and hands, feet and toes, knees, ankles, wrists; but it can also affect the skin, eyes, mouth, lungs and heart.
It is generally assumed that RA is a genetic consequence and although some people actually have genes that make them prone to immune reactions, whether by histamines, antibodies, B or T lymphocytes, these can promote an autoimmune attack on their cells.
Factors That may Induce the Onset of Arthritis
The exact cause of arthritis is currently unknown; however, there are some factors that may increase the risk of developing arthritis over a lifetime.
Gender
Being born female tends to make you more susceptible to developing RA due to the decrease in oestrogen as you get older. Also, women have two copies of the X chromosome which can increase a chance of genetic mutation. If this happens in the human leukocyte antigen region of an X chromosome, a woman's immune system would be vulnerable.
On the other hand, males are more susceptible to developing gout. Gout occurs when urate crystals accumulate in the joint, causing the inflammation and severe pain that characterises a gout attack. Urate crystals can form when there are high levels of uric acid in the blood. The body produces uric acid when it breaks down purines, substances that occur naturally in the body.
Genetics
It is believed that if any of your immediate biological family members, such as a parent or sibling, has arthritis, you may have an increased risk of developing the same form of arthritis later in life.
The thing about genes is that we, depending on our lifestyle (diet, physical activity, stress management, restful sleep), have the ability to ‘turn on’ or ‘turn off’ certain genes and this is known as EPIGENETICS.
In fact, epigenetics is a field of study that identifies how your behaviour and your environment can cause changes that affect the way your genes work. Unlike genetic changes (mutations), epigenetic changes are reversible and do not change the sequence of DNA bases, but they can change the way an organism reads a DNA sequence.
If you take your DNA, human DNA as such corresponds to 1%, but your body also harbours bacteria and microbes which possess their own DNA corresponding to 99% of your DNA and which mainly inhabit your colon and respiratory tract.
The health of your colon is extremely important, as it contains 100 million neurons and is the main producer of neurotransmitters. For this reason, it has been called ‘the second brain’.
In addition, the gut is home to 1 trillion immune cells, meaning that most of your immune system is basically located in the colon. It is therefore logical to consider that factors such as diet, physical activity, stress management, restful sleep, etc., which, according to epigenetics, can ‘turn on’ and ‘turn off’ genes, can balance or unbalance the health of your gut.
Mitochondrial Function
Although the exact cause of autoimmune diseases is unknown, science emphasises the fundamental role of mitochondrial function in the development and progression of these diseases.
It turns out that the same factors that can cause your genes to ‘switch on’ or ‘off’, such as diet, stress, pollution, even household chemicals and drugs, and that can contribute to the rise of autoimmune diseases, also affect your mitochondrial function.
Mitochondria, often referred to as the ‘powerhouses of the cell’, play a crucial role in energy production and cellular metabolism. They are also involved in the regulation of immune responses, to the extent that they have also been described as the ‘powerhouses of immunity’.
According to studies conducted with researchers at the Chinese Academy of Medical Sciences, at the organelle level, mitochondria have been shown to be critical players in the initiation and progression of multiple autoimmune diseases. This is why malfunctioning mitochondria are considered to play a key role in immune system problems. Damaged mitochondria cannot support important signalling molecules, such as the mitochondrial antiviral signalling protein (MAVS). Also, debris from damaged mitochondria, such as mitochondrial DNA, can trigger abnormal inflammation.
In this sense, when damaged mitochondria or their components are released into a cell or the surrounding area, they can trigger inflammation because the immune system recognises them as foreign, as if they were bacteria or other pathogens.
How might mitochondrial dysfunction be linked to rheumatoid arthritis (RA)?
A recently published study has shown that mitochondrial DNA is increased in the plasma of RA patients. This mitochondrial DNA may act as a DAMP [mitochondrial danger-associated molecule] and induce or maintain inflammatory responses in RA.... T-cell mitochondria in RA have defective DNA repair mechanisms, which is associated with low mitochondrial oxygen consumption and ATP production.
Previous Injuries and Repeated Stress
If you have suffered joint injuries (often occurring in contact sports), existing damage may worsen over time, particularly by altering the mechanics of movement, deteriorating your posture in one or more parts of the body.
Obesity
Being overweight places additional strain on the joints of the hands, spine, hips and knees. As such, it can cause the cartilage and connective tissues surrounding the joint to deteriorate more rapidly over time. This could lead to a diagnosis of Osteoarthritis (OA).
Would Your Diet Have a Causal Relationship with Arthritis?
Both as a risk factor and as a treatment strategy, the relationship between diet and osteoarthritis has been a topic of great interest. Low intakes of certain nutrients, such as vitamin D, vitamin C, vitamin E, vitamin K and magnesium, have been found to increase the risk of osteoarthritis progression or worsening of symptoms.
A study published in the journal frontiers found that muesli (a cereal mixture usually consumed for breakfast) intake was negatively associated with osteoarthritis of the knee, osteoarthritis of the spine and total knee replacement. Nut intake had a negative association with knee osteoarthritis and total knee arthroplasty.
On the other hand, the same study mentions that cheese consumption may reduce the risk of knee and spine osteoarthritis.
Another study from the Wiley library showed that the Mediterranean dietary pattern reduced the progression of osteoarthritis symptoms. Whereas the American dietary pattern increased symptomatic progression of osteoarthritis. Increasing total fibre intake reduced symptomatic progression of osteoarthritis and worsening pain, but the effects of fibre from each food group were inconclusive.
In reviewing the most up-to-date studies on the effect of diet on osteoarthritis, a diet low in sugars and allergens; high in fibre and processed dairy may help alleviate the symptoms of this condition.
The so-called ‘anti-inflammatory diet’ protocol recommends, in addition to the foods already mentioned, opting for wholegrain foods, animal protein, vegetables and some saturated fats.
For rheumatoid arthritis (RA), based on the genome-wide association methodology that has generated a host of strong associations for a number of traits and diseases, it is believed that an epigenetic approach could effectively counteract the environmental triggers for rheumatoid arthritis, and this is done by addressing aspects of diet, digestion, restorative rest, exercise and stress management.
It is crucial for any type of autoimmune disease, and especially for arthritis, to provide your gut with both soluble and insoluble plant fibres to create a healthy cycle of bacterial growth and breakdown in the colon. Remember that the gut flora is primarily composed of an environment of oxygen-intolerant bacteria, while the oxygen-tolerant bacteria that are also present must be kept to a minimum. It is therefore essential to support mitochondrial function and maintain a balanced gut environment.
EXERCISES to Prevent, Relieve and Improve the Symptoms of Arthritis but Which also help to Balance the Other Epigenetic Factors Involved in the Management of Arthritis, Whatever its Type.
According to the American College of Rheumatology, “exercise and arthritis can and should coexist. People with arthritis who exercise regularly have less pain, more energy, better sleep quality, and better function in daily tasks.” (article)
The same institution emphasises that people with many forms of arthritis can exercise safely, regularly and appropriately. In long-term studies, it was found that even people with inflammatory arthritis, such as rheumatoid arthritis (RA), can benefit from moderate-intensity, weight-bearing activity.
For osteoarthritis (OA) in the knee or elsewhere in the body, programmes that combine strengthening, stretching and aerobic exercise reduce symptoms, improve joint mobility and function, increase coordination and balance, and control body weight.
Exercises Recommended by the American College of Rheumatology
Flexibility exercises. Active range-of-motion and stretching exercises help maintain and improve flexibility in the affected joints and surrounding muscles. This helps to improve posture and function and decrease the risk of injury.
Five to 10 repetitions of active range-of-motion exercises should be performed every day. Doing the range-of-motion exercises in the morning helps to get the joints moving. It is recommended that stretching exercises be performed 4 to 5 days a week and that each stretch be held for 10 to 15 seconds.
Strength training. As the muscle gets stronger, it provides greater support to the joint and helps to decrease the load and stress placed on the sore joint. Strong muscles, in addition to improving joint function, help reduce bone loss associated with inactivity, some forms of inflammatory arthritis and the use of certain medications (corticosteroids).
It is recommended that a set of 8 to 10 exercises for the major muscle groups of the body be performed 4 to 5 times a week. Most people should perform 8 to 10 repetitions of each exercise. For older people, 10-15 repetitions with less resistance may be more appropriate. The resistance or weight should be of sufficient intensity to work the muscles without increasing soreness.
Cardiovascular endurance exercises. Aerobic exercise improves heart, lung and muscle function. For people with arthritis, this type of exercise is beneficial for weight control, mood, sleep and overall health.
Safe ways to do this type of exercise include walking, aerobic dance, water aerobics, cycling, or exercise equipment such as stationary bikes and treadmills or elliptical machines.
Body awareness or proprioception exercises. These exercises incorporate activities to improve posture, balance, joint position sensation, coordination and relaxation. And while some of these improvements are obtained with the types of exercises already mentioned, in many cases, problems in these areas require different exercises. Tai Chi and yoga are examples of disciplines that incorporate elements of body awareness.
A diagnosis of arthritis, no matter what your age, should not prevent you from living your life to the fullest. Take advantage of this information, as well as the support and help you can get from your doctor, physiotherapists and trainers at the gym. As your quality of life improves, so will your confidence to resume the activities you enjoy.