Excessive weight and joint pain – the inflammation connection
In this article we will discuss inflammation and its connection to excessive weight and joint pain
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A 2017 study from Ohio State University in the medical journal Pain, tries to explain how and why obesity causes chronic pain through inflammation. In this research the goal was to evaluate if and how a diet of foods with anti-inflammatory properties affected pain and other problems of inflammation in joints.
Here is what they found:
- Results provide support for (good) dietary intake providing benefit in patients with excessive weight or obesity and their levels of pain.
- Overall, higher body fat was associated with self-reports of greater pain, and dietary practices consistent with better health and anti-inflammatory effects were associated with lower self-reported pain.
- Poorer food choices among individuals with higher body fat may contribute to symptoms of pain.
- Overall, dietary intake of foods with greater anti-inflammatory effects appears to be relevant in the relationship of body fat to pain.
- The researchers found it especially interesting that the primary component of dietary intake driving the beneficial effects were consumption of seafood and plant protein.
- Given the higher content of omega-3 fatty acids in seafood and the documented anti-inflammatory effects of omega-3 fatty acids, this provides further support for the hypothesis that intake of foods with demonstrated anti-inflammatory effects.
- Plant proteins with demonstrated anti-inflammatory effects (eg, nuts and seeds, soy products) accounted for beneficial effects in respondents following a strictly vegetarian diet
The conclusion of the study presented simple data indicating that dietary intake of foods with anti-inflammatory effects helps control body pain in obese individuals.1
This research was not the first to confirm such a connection.
Obesity is more than weight load – it causes inflammation
Doctors at the University of Calgary writing in the journal Osteoarthritis and Cartilage examined obese laboratory animals and 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.2
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 in Current opinion in rheumatology, 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.3
Obesity + mental distress + poor sleep = WideSpread musculoskeletal Pain (WSP)
Norwegian researchers writing in the European Pain Journal paint 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.4
- Simply: obesity + mental distress + poor sleep = Pain. To effectively heal, these issues need to be addressed.
Doctors at the Norwegian University of Science and Technology wrote in the Journal of sleep research that chronic musculoskeletal pain increases the risk of insomnia, particularly among those who report several pain sites. The researchers suggest that a healthy active lifestyle (weight loss and exercise) could reduce the risk of insomnia in people with chronic musculoskeletal pain.5
Doctors at the University of Padova in Italy writing in the Journal of cellular physiology, in citing the above research that suggests obese people have an increased risk to develop not only knee but also hand osteoarthritis, the concept that adipose (fat) tissue might be related to osteoarthritis not only through overloading suggests that obesity induces a low grade systemic inflammatory state characterized by the production and secretion of several adipocytokines (inflammatory mediators) that may have a role in osteoarthritis development.
Moreover, infrapatellar fat pad (the cushion like tissue behind the knee cap) has been demonstrated to be a local source of adipocytokines (a local production of inflammation) and potentially contribute to changing the knee joint towards an osteoarthritic diseased environment.6
Obesity may prevent tissue remodeling, healing and damage rebuild
In a recent paper, Duke University researchers noted and speculated that obesity may prevent tissue remodeling – again, that is 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.7
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.
When an obese patient comes into our office seeking non-surgical alternatives to joint replacement we MAY suggest:
- Stronger treatment protocols beyond simple dextrose prolotherapy. This may include growth factors, platelet rich plasma, stem cells, or a combination of treatments.
- If so we inform the patient they will likely need more treatments than an ‘average weight’ person.
- Nutritional and weight loss guidelines will be suggested.
Weight management not joint replacement
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.
Doctors at the University of Texas MD Anderson Cancer Center 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.8
- 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.9
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.10
The simply summary to all the research listed above is this:
Doctors at Oxford University publishing in the journal Arthritis and rheumatology found that overweight patients are at a more than 40% greater risk and obese patients are at more than a and 100% increased risk of knee replacement surgery compared to patients with normal weight.
Weight reduction strategies could potentially reduce the need for knee replacement surgery by 31% among patients with knee osteoarthritis.11
1 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.
2. 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.
3. Berenbaum F, Eymard F, Houard X. Osteoarthritis, inflammation and obesity. Curr Opin Rheumatol. 2013 Jan;25(1):114-8.
4 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.
5. Skarpsno ES, Nilsen TI, Sand T, Hagen K, Mork PJ. Do physical activity and body mass index modify the association between chronic musculoskeletal pain and insomnia? Longitudinal data from the HUNT study, Norway. Journal of Sleep Research. 2017 Jul 26.
6. Belluzzi E, El Hadi H, Granzotto M, Rossato M, Ramonda R, Macchi V, De Caro R, Vettor R, Favero M. Systemic and local adipose tissue in knee osteoarthritis. Journal of cellular physiology. 2016 Dec 1. [Pubmed]
7. 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.
8. Waimann CA, Fernandez-Mazarambroz RJ, Cantor SB, Lopez-Olivo MA, Barbo AG, Landon GC, Siff SJ, Lin H, Suarez-Almazor ME. Effect of Body Mass Index and Psychosocial Traits on Total Knee Replacement Costs in Patients with Osteoarthritis. The Journal of rheumatology. 2016 Aug 1;43(8):1600-6.
9. 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.
10. 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.
11. 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.