Treating obesity, joint inflammation and pain

Doctors at the University of Florida recently published research in which they attempt to outline ways doctors can help patients with chronic joint pain alleviate their symptoms by losing weight. They focused on exercise and the ability to exercise.

Writing in the Journal of pain research, the Florida doctors suggest that in obese patients, general and specific musculoskeletal pain is common. Emerging evidence suggests that obesity worsens pain by mechanical loading (weight stress on joints), inflammation (creating a destructive inflammatory environment in the joints, see below), and psychological status.

They researchers continue: “Pain in obesity contributes to deterioration of physical ability, health-related quality of life, and functional dependence . . . While acute exercise may transiently exacerbate pain symptoms, regular participation in exercise can lower pain severity or prevalence. Aerobic exercise, resistance exercise, or multimodal exercise programs (combination of the two types) can reduce joint pain in young and older obese adults in the range of 14%–71.4% depending on the study design and intervention used.”1

To benefit from exercise, a patient needs to be able to exercise. Tackling the difficult problem of obesity to many researchers is the start.

Food choices can cause worsening of chronic joint pain

A new study from Ohio State University concluded that good food choices, and a diet rich in foods anti-inflammatory effects helps control body pain in obese individuals.

There are many lists of anti-inflammatory foods, most lists include: tomatoes, green leafy vegetables, nuts (specifically almonds and walnuts), fish and fruits strawberries, blueberries, cherries.

If anti-inflammatory foods are beneficial in fighting chronic pain than pro-inflammatory foods can worsen pain symptoms.

Doctors at the University of Calgary, in examining obese laboratory animals found that not only does obesity cause osteoarthritis because of weight load, but it also causes osteoarthritis in a “non-mechanical” way – in other words by inflammation without wear and tear. The inflammation attacking the joints of the animals was caused by a high fat/high sugar diet.3

This type of research is helping doctors get away from the excessive weight load model of thinking, although weight load does cause obvious problems, and helps them look at the inflammation problems.

This was confirmed by French researchers who suggest that the rising prevalence of hand osteoarthritis is from obesity and since the hand does not bear weight, this suggests that the role of systemic inflammatory mediators in fat cells cause inflammation signaling to be sent out and attack joints.4

A new study paints a grim but accurate picture of the effects of obesity on aging patients. In a group of patients who were mostly females average age 51, obesity was linked to mental distress, poor sleep quality and poor physical fitness. This lead to a condition of WSP – WideSpread musculoskeletal Pain.5

Simply: obesity + mental distress + poor sleep = Pain.  To effectively heal, these issues need to be addressed.

In a recent paper, researchers noted and speculated that obesity may prevent tissue remodeling – in other words your ability to heal. Since stem cells are closely associated with the remodeling and repair of bone and cartilage, these doctors hypothesized that obesity would alter the frequency, proliferation, multipotency and immunophenotype [healing protein expression] of stem cells from a variety of tissues.Does this mean stem cell injection therapy will not work for obese patients? The answer is not fully understood, obesity certainly makes healing more difficult not only in stem cell therapy but in knee replacement as well.

Knee replacement does not fix all these problems

Many patients are under the assumption that the quickest way to attack their obesity problem is to get a joint replacement. The thinking is that is they eliminate their knee pain they will be able to exercise and lose weight. Surgeons are being told to tell patients that is not true for many obese patients.

Journal of Rheumatology:

  • Analyses showed that increasing BMI (Body Mass Index – Obesity) and anxiety levels and decreasing levels of positive social interactions were associated with increased patient costs (the need for continued care) following total knee replacement. The greater the obesity the greater the patient need for care (cost) following the knee replacement.7

Doctors in the United Kingdom had this to say in the July 2016 edition of  Maturitis

  • There is a proven association between obesity and knee osteoarthritis, and obesity is suggested to be the main modifiable risk factor.
  • Obese patients are more likely to require total knee replacement
  • It is unclear whether total knee replacement facilitates weight reduction
  • Surgery in obese patients is more technically challenging. This is reflected in the evidence, which suggests higher rates of short- to medium-term complications following total knee replacement , including wound infection and medical complications, resulting in longer hospital stay, and potentially higher rates of malalignment, dislocation, and early revision.8

In another study, doctors were much more critical of putting implants into obese patients:

High patient weight is a risk factor for mechanical implant failure and some manufacturers list obesity as a contraindication for implant use. Doctors in the United Kingdom were amazed to find out that:

  • A total of 10,745 patients in a two year period 2012-2013 received knee or hip implants against manufacturer recommendations.
  • 16% of all obese patients) received implants against manufacturer recommendations.9

The simply summary to all the research listed above is this:

Weight reduction strategies could potentially reduce the need for knee replacement surgery by 31% among patients with knee osteoarthritis.10

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1 Zdziarski LA, Wasser JG, Vincent HK. Chronic pain management in the obese patient: a focused review of key challenges and potential exercise solutions. Journal of Pain Research. 2015;8:63-77. doi:10.2147/JPR.S55360. [Pubmed] [Google Scholar]

2 Emery CF, Olson KL, Bodine A, Lee V, Habash DL. Dietary intake mediates the relationship of body fat to pain. Pain. 2017 Feb;158(2):273-277. [Pubmed] [Google Scholar]

3. Collins KH, Reimer RA, Seerattan RA, Leonard TR, Herzog W. Using diet-induced obesity to understand a metabolic subtype of osteoarthritis in rats. Osteoarthritis Cartilage. 2015 Feb 3. pii: S1063-4584(15)00028-X. doi: 10.1016/j.joca.2015.01.015. [Pubmed] [Google Scholar]

4. Berenbaum F, Eymard F, Houard X. Osteoarthritis, inflammation and obesity. Curr Opin Rheumatol. 2013 Jan;25(1):114-8.[Pubmed] [Google Scholar]

5 Magnusson K, Hagen KB, Natvig B. Individual and joint effects of risk factors for onset widespread pain and obesity – a population-based prospective cohort study. Eur J Pain. 2016 Aug;20(7):1102-10. doi: 10.1002/ejp.834.[Pubmed] [Google Scholar]

6. Wu CL, Diekman BO, Jain D, Guilak F. Diet-induced obesity alters the differentiation potential of stem cells isolated from bone marrow, adipose tissue and infrapatellar fad pad: the effects of free fatty acids. International Journal of Obesity advance online publication, 20 November 2012; doi:10.1038/ijo.2012.171. [Pubmed] [Google Scholar]

Waimann CA, Fernandez-Mazarambroz RJ, Cantor SB, et al. Effect of Body Mass Index and Psychosocial Traits on Total Knee Replacement Costs in Patients with Osteoarthritis. J Rheumatol. 2016 Aug;43(8):1600-6. doi: 10.3899/jrheum.151301. [Journal Citation]

8. Kulkarni K, Karssiens T, Kumar V, Pandit H. Obesity and osteoarthritis. Maturitas. 2016 Jul;89:22-8. doi: 10.1016/j.maturitas.2016.04.006. Epub 2016 Apr 11. Review. [Pubmed]  [Google Scholar]

9. Craik JD, Bircher MD, Rickman M. Hip and knee arthroplasty implants contraindicated in obesity. Ann R Coll Surg Engl. 2016 May;98(5):295-9. [Pubmed] [Google Scholar]

10. Leyland KM, Judge A, Javaid MK, Diez-Perez A, Carr A, Cooper C, Arden NK, Prieto-Alhambra D. Obesity and the Relative Risk of Knee Replacement Surgery in Patients With Knee Osteoarthritis: A Prospective Cohort Study. Arthritis Rheumatol. 2016 Apr;68(4):817-25. [Pubmed] [Google Scholar]

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