According to the World Health Organization, about 528 million people worldwide were living with osteoarthritis in 2019, an increase of 113% since 1990. With aging populations and increasing rates of obesity and injury, the prevalence of osteoarthritis is expected to continue to grow. (20) 

Therapeutic goals of treating osteoarthritis, the most common joint disorder in the United States, include stopping tissue damage, supporting cartilage regeneration, decreasing inflammation, and managing symptoms. A functional medicine protocol implements a multidisciplinary approach to meet these goals successfully.

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What is Osteoarthritis?

Osteoarthritis (OA) is a degenerative joint disorder characterized by the gradual breakdown of cartilage, the smooth and flexible tissue that covers the ends of bones in a joint. Cartilage acts as a cushion, facilitating smooth movement and preventing bones from rubbing against each other. In OA, the cartilage deteriorates over time, leading to pain, stiffness, and reduced joint mobility.

As the disease progresses, other structures within the joint, such as ligaments, tendons, and the synovial fluid that lubricates the joint, may also be affected (22). This can result in inflammation, further contributing to discomfort and limiting joint function (3). OA commonly affects weight-bearing joints like the knees, hips, spine, hands, and fingers. It is often associated with aging, genetic predisposition, joint injuries, and excessive mechanical stress on the joints due to obesity or certain occupations. (27) 

Osteoarthritis Signs & Symptoms

Osteoarthritis can manifest with a range of signs and symptoms that gradually worsen over time. The severity and specific symptoms can vary from person to person. As the disease progresses, the combination of pain, stiffness, and limited range of motion can impact daily activities, such as walking, climbing stairs, or gripping objects. Some common signs and symptoms of OA include:

• Joint Pain: The most prominent symptom of OA is joint pain. Pain can be described as a dull ache or a sharp sensation, usually localized to the affected joint. Pain that is better with rest and worsens with movement or activity often helps to distinguish OA from other types of inflammatory arthritis. 
• Stiffness: People with OA may experience joint stiffness that makes it difficult to move the affected joint smoothly, especially after periods of inactivity, such as waking up in the morning or sitting for an extended period. 
• Limited Range of Motion: OA can reduce the ability to move a joint through its full range of motion. This limitation may affect daily activities such as bending, reaching, or walking.
• Swelling: In some cases, joints affected by OA may become swollen and tender due to inflammation.
• Crepitus: OA can cause a grating or crackling sensation when the affected joint moves. This sound or sensation is caused by the roughening of the joint surfaces.
• Muscle Weakness: Weakness in the muscles surrounding the affected joint may develop due to reduced joint use and pain during movement.
• Joint Deformities: Over time, OA can lead to joint deformities, such as knobby swellings around the joint edges or changes in joint alignment.

What Are the Possible Causes of Osteoarthritis?

The pathophysiology of osteoarthritis involves a combination of mechanical, biochemical, and genetic factors that contribute to the gradual breakdown of cartilage and the subsequent changes within the affected joint. In OA, there is a progressive loss of cartilage integrity. Cartilage normally provides a smooth and flexible surface that allows bones to glide over each other during joint movement. In OA, the cartilage becomes thinner and more fragile due to an imbalance between cartilage degradation and repair processes. The bone underneath the cartilage, called subchondral bone, undergoes structural changes, becoming denser in some areas and thinner in others, leading to altered load distribution within the joint. As the cartilage deteriorates, the body may respond by forming osteophytes (bone spurs), bony outgrowths that can develop at the edges of the joint. Osteophytes can contribute to joint pain and restrict movement. The joint capsule and surrounding ligaments may become thickened and less flexible in response to OA, further limiting joint mobility. (22, 27) 

Chronic low-grade inflammation often accompanies OA. The synovium, a membrane that lines the joint, can become inflamed (synovitis) and release inflammatory molecules that contribute to joint pain and damage. It is important to recognize that this inflammation is a secondary component of the degenerative process, not an initiating factor like other types of arthritis. (3) 

Several factors contribute to the development of OA, including aging, joint injury or overuse, genetics, obesity, and poor joint biomechanics (26). Emerging research on the gut microbiome suggests a potential link between the composition of gut bacteria and OA development or progression. Studies have explored how disruptions in the gut microbiota, known as dysbiosis, may affect the immune system, leading to systemic and joint inflammation related to OA. The gut microbiota also influences metabolic processes, potentially impacting obesity and metabolic syndrome, contributing to OA risk. Gut bacteria produce metabolites, such as anti-inflammatory molecules and short-chain fatty acids, that could influence joint health and inflammation pathways. Future research may uncover how specific microbial species or metabolites contribute to OA and whether interventions targeting the gut microbiota hold therapeutic potential for OA management. However, more investigation is needed to fully understand these mechanisms and their implications. (25) 

Functional Medicine Labs to Test for Root Causes of Osteoarthritis

The diagnosis of osteoarthritis is made based on clinical features and radiographic imaging. While no specific laboratory tests can definitively diagnose OA, they can rule out other causes of joint pain and help diagnose underlying medical conditions that increase the risk for OA development and progression. A functional medicine doctor may also recommend additional testing, discussed below, to help quantify systemic inflammation and identify contributing factors to joint degeneration. 

Inflammation

Inflammation markers, including CRP and ESR, can quantify systemic inflammation secondary to the degenerative process related to OA and monitor the efficacy of implemented treatment strategies.

Altered immune function and inflammation may also occur in other types of joint pain and arthritis, such as rheumatoid arthritis (RA). Measuring autoantibodies rheumatoid factor and anti-CCP, which are associated with RA, can help differentiate between the two types of arthritis.

Comprehensive Stool Test

The gut-joint axis refers to the bidirectional communication and interaction between the gut microbiome and the joints, potentially influencing inflammatory and immune responses within the joints. Research suggests that disruptions to the gut microbiome can contribute to rheumatic disorders causing joint inflammation and pain. As scientists continue to study the link between dysbiosis and joint health, utilizing comprehensive stool tests that assess the composition of the gut microbiome will likely become a more valuable tool in managing osteoarthritis. (4) 

Nutritional Assessment

Various dietary factors and nutritional imbalances have been associated with OA risk and development, including deficiencies and imbalances in vitamins D and K and omega-3 fatty acids. A comprehensive nutritional assessment can measure blood levels of essential vitamins, minerals, and antioxidants for joint health and controlling inflammation.  

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Conventional Treatment for Osteoarthritis

Standard osteoarthritis treatment often involves using nonsteroidal anti-inflammatory drugs (NSAIDs) to alleviate pain and address inflammation. Other pain management medications encompass acetaminophen (Tylenol) and duloxetine (Cymbalta), an antidepressant also approved for chronic pain relief. More invasive interventions like intra-articular corticosteroid or hyaluronic acid injections might be explored in cases where conservative measures fall short of providing adequate relief. (2, 24)

Supplementary to pharmacological approaches, consistent physical activity and engagement in physical and/or occupational therapy may be recommended to sustain functionality while minimizing discomfort (24).

Patients with continued pain and disability of the hip, knee, or shoulder despite maximal medical therapy are candidates for surgical joint replacement (24).

Functional Medicine Treatment Protocol for Osteoarthritis

A functional medicine approach to osteoarthritis aims to manage pain and other symptoms, balance inflammation, and prevent further injury and damage to the joints using lifestyle changes, nutrition, mind-body therapies, acupuncture, and dietary supplements (26).

Therapeutic Diet and Nutrition Considerations for Osteoarthritis

Dietary interventions can play a role in managing osteoarthritis by reducing inflammation, supporting joint health, and promoting a healthy weight. Diets that limit overly-processed foods and emphasize anti-inflammatory foods, such as fruits, vegetables, whole grains, nuts, seeds, and fatty fish, reduce inflammation, support joint health, and combat oxidative stress contributing to joint damage. Studies suggest the Mediterranean diet can reduce inflammation in people with OA, slow disease progression, and protect against weight gain and disability. 

Supplements Protocol for Osteoarthritis

Evidence-based natural supplements can be incorporated into a holistic and integrative treatment plan to help treat pain and prevent continued degeneration of the joints affected by osteoarthritis.

Glucosamine Sulfate

Glucosamine is a naturally occurring compound found in the body, particularly in the fluid surrounding the joints and cartilage. Glucosamine is involved in synthesizing molecules that form the building blocks of cartilage, helping maintain its structure, function, and integrity. The scientific evidence regarding the use of glucosamine for OA is mixed, suggesting that its effectiveness can vary between people. However, studies agree that it is a very safe supplement and may help alleviate the symptoms of OA, such as pain and inflammation, and promote joint health. Studies have suggested that glucosamine's efficacy can be enhanced by combining it with supplemental chondroitin and omega-3 fatty acids. (5) 

Dose: 375 mg 3-4 times daily

Duration: 6-12 months

Collagen

Collagen is the most abundant protein in the human body and is a crucial component of various connective tissues, including skin, bones, tendons, ligaments, and cartilage. Supplementing collagen for osteoarthritis is based on the idea that increasing collagen intake might support cartilage health and alleviate some symptoms. Studies have supported this notion, showing that collagen supplementation improves pain, stiffness, ability to perform daily activities, and quality of life in patients with OA (8, 11).  

Dose: 10 g of collagen hydrolysate daily

Duration: 6 months

Curcumin

Curcumin is a naturally occurring compound found in turmeric, a spice commonly used in traditional Indian cuisine. Curcumin has gained attention for its potential anti-inflammatory and antioxidant properties, counteracting the degenerative processes associated with OA development. Evidence demonstrates that curcumin reduces pain and dependence on nonsteroidal anti-inflammatory drugs for symptom management. Some research also suggests that curcumin might help protect cartilage from degradation by inhibiting enzymes that contribute to the breakdown of cartilage and support the synthesis of molecules that maintain cartilage structure.

Dose: 180 mg daily

Duration: 8 weeks

Omega-3 Fatty Acids

Omega-3 fatty acids are a type of polyunsaturated fat that is considered essential for human health. These fats are crucial for various bodily functions and are primarily obtained through the diet, as the body cannot produce them on its own. Omega-3 fatty acids are commonly found in certain types of fish, such as salmon, mackerel, and sardines, as well as in plant-based sources like flaxseeds, chia seeds, and walnuts. (9) 

By addressing inflammation and supporting cartilage health, omega-3 fatty acids may improve joint function and mobility in individuals with OA. Chronic inflammation is a key contributor to the progression of OA, leading to joint pain and damage. Omega-3 fatty acids, particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), modulate inflammation by reducing the production of inflammatory molecules and promoting the synthesis of anti-inflammatory compounds. Omega-3 fatty acids may also protect cartilage by supporting its structure and integrity; preliminary studies suggest that omega-3s can help inhibit enzymes responsible for cartilage degradation and promote the production of molecules that maintain cartilage health. Finally, omega-3 fatty acids may contribute to pain relief in OA by modulating pain signaling pathways. (6) 

Dose: 1,500-2,000 mg daily

Duration: at least one month

When To Retest Labs

Following up with patients in 6-12 week intervals to review clinical symptoms and repeat laboratory testing can help determine whether a prescribed treatment plan is sufficient and needs to be modified for continued care.

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Summary

Osteoarthritis is a common type of arthritis defined by loss of cartilage, joint degeneration, and bone spur formation. Functional medicine labs and treatment options can identify and address contributing factors to joint wear-and-tear and inflammation to successfully manage debilitating OA symptoms and support joint health.