Osteoarthritis Is a Metabolic Disease

Osteoarthritis is the most common joint disease in adults. Many of us end up having it. Most of us think of it as a wear and tear disease. Osteoarthritis is the leading cause of replacement of weight bearing joints like the knee and hip. Wear and tear make sense. But look at the joint at the end of the index finger above. It is severely deformed but there is no weight bearing there. The cartilage in these joints does not wear out. It dies because of metabolic changes.

New science tells us that earlier chronic disease development and more rapid aging are related to genes, especially gene regulation (epigenetics), and related changes in molecular biology and biochemistry. Most of us think of osteoarthritis and aging as a wear and tear problem— we just wear out. You can’t do much about wearing out, but you can directly block the abnormal molecular biology and biochemistry that makes us older and sicker faster.

Just consider the case of the medication losartan which was developed to treat high blood pressure. Losartan is a precision medicine. It does one thing and one thing only. There is a hormone made in abdominal fat that operates like a key for a very specific lock on the surface of cells. (angiotensin II). Losartan is like a broken off key in the lock. When you take losartan, the hormone that comes from fat can’t activate the lock. Taking losartan slows down cartilage destruction in osteoarthritis. That means the hormone from fat is part of the cartilage destruction process. We used to think of losartan only in relation to controlling blood pressure but that has all changed. Now we know that it interferes with the root causes of cardiovascular and other diseases. Blocking that hormone made in abdominal fat reduces oxidant production to protect all cells and organs, including the joints.

There is also suggestive evidence that statins may slow the development or progression of osteoarthritis. Statins do lower cholesterol, but that is probably not how they impact osteoarthritis. They also reduce oxidant production, inflammation, and abnormal cell growth. Statins promote cartilage cell growth and reduce cartilage cell death.

Metformin directly activates a master genetic metabolic survival switch. (AMPK). Research evidence suggests that AMPK activity in cartilage is critical for maintaining health and that downregulation of AMPK activity is associated with the worsening of osteoarthritis. That makes perfect sense. AMPK activation is beneficial in chronic diseases. Human studies suggest that metformin treatment slows down osteoarthritis progression. Over a six-year period, people on metformin had a joint replacement rate of 5.4% vs 11.6% in non-users. Those on metformin lost cartilage at half the rate of non-users over a period of 4 years. These findings strongly suggest that metformin treatment has a disease modifying effect in osteoarthritis.

Your joints don’t just wear out. Osteoarthritis is a metabolic disease. Eating real food, intermittent fasting to switch on AMPK, and medicines that block the oxidant production causing the disease can make a difference here just like they do in other metabolic diseases. It is another example of how aging and chronic illnesses are tied together.