Osteoarthritis: Is dehydration implicated?

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Is it possible that dehydration plays a role in the degradation of the cartilage found in Osteoarthritis?

Unlike rheumatoid arthritis, which is an auto-immune disease, osteoarthritis (OA) is a degenerative disease, where the cartilage (the smooth, cushiony, rubbery, white stuff that surrounds the ends of the bones that form a joint) deteriorates, eventually degrading the bone itself, resulting in stiff, painful joints. The big question in my mind is what causes the cartilage to begin deteriorating in the first place? I have searched, as has my colleague, Sue Bond who helped me research this topic, and we have found nothing much in the scientific journals that provides a satisfactory answer. Getting older and being overweight seems to be commonly associated with osteoarthritis, but many that are older and overweight do not get it. And there are some who are young and thin who do. A previous joint injury may pre-dispose someone to osteoarthritis, but once again, not everyone that has suffered a joint injury goes on to get OA. And unlike most of today’s chronic diseases, osteoarthritis has been around for a very long time. There is fossil evidence that some dinosaurs and other prehistoric animals suffered from OA (Wells, 1973), as did many of the Egyptian mummies (Braunstein, 1988), as well as two thirds of the Romano-British skeletons studied (Thould and Thould 1983).

I think there must be a biochemical imbalance of some kind that must create an unhealthy environment within the joint space resulting in the cartilage wearing away, and even though science has not as of yet put its finger on what exactly that issue is, I have a theory. I agree with Dr. Batmanghelidj that body dehydration may play an important role – I fully admit I cannot back this idea up with scientific studies, but I think it is worth considering because healthy cartilage is full of water, and water plays an integral role in how cartilage works. Cartilage functions something like a very dense sponge, and as we put weight through our joints, the water it contains squishes out, and when we take the weight off our joints, the water diffuses back into the cartilage. The water within the joint space also provides lubrication allowing the bones to glide smoothly on each other. If one is not drinking adequate water, the body would prioritize the viscosity of the blood over joint health, and water would be pulled from the cartilage resulting in it "drying out", probably making it more likely to degrade due to increased friction and weight-bearing stress. This theory would fit the observation that those that are older and overweight are more likely to suffer from osteoarthritis, as it is well known that as we age we tend to dry out, and putting a greater amount of weight through the joints would wear them out faster. And I think it is reasonable to expect that at all times in history some people would have been chronically dehydrated.

Cartilage is actually uncalcified bone. New cartilage cells grow on the bone surface, so cartilage nutrition come via the bone itself, and if wear and tear strip away the surface cells faster than the underneath cells can grow, the cartilage layer will become thinner. If the bone marrow and the cartilage are competing for water, the cartilage will lose out, losing its supply of nutrition. Now the joint needs to get nutrition another way, via the arteries in the joint capsule, which then expand causing swelling and increased synovial fluid in the joint space. But water coming from the joint space does not hydrate or nourish the cartilage in the same manner is water coming via the bone itself, and this extra fluid is often inflammatory and painful.

I don't know if it is reasonable to expect that damaged bone and cartilage will repair itself much if one suddenly pays attention to drinking sufficient water, but it may be worth while to do so in order to prevent further damage because as osteoarthritis progresses it becomes increasingly more painful, and anything that can be done to prevent further degeneration of the joint surfaces can only be viewed as helpful.

Other things one can do to decrease progression of the disease and reduce pain? The big one is to lose weight, which would result in less wear and tear on the joints. Studies have shown that a combination of glucosamine and chondriotin also aid in preventing further degenerative damage and reduce pain, especially in those that are suffering the most. News stories a couple of years ago on a study published in the New England Journal of Medicine suggesting that these supplements did nothing are misleading, as these popular-press articles unfortunately did not fully explain the results. Although the study showed that glucosamine and chondriotin did not help everyone with OA, they helped 79% of those that were the most seriously affected and in the most pain. (If you are allergic to shellfish, you are most likely allergic to glucosamine, so don’t take it.) It makes sense to me that eating soups made from bone broths, which provide hydrophilic gelatin to the body would not hurt either. Increased omega 3 fatty acid consumption (fatty fish and fish oils) reduce body inflammation, which studies have also shown reduces the pain of OA. Tumeric is also very anti-inflammatory, and research supports its use to reduce the pain of arthritis. And many studies also support acupuncture for reducing the pain of OA. Maintaining strength and flexibility about the affected joints is also helpful, and water exercise can be particularly beneficial, as strength and muscle endurance can be gained without putting undo weight-bearing stress through the joints.

If you want to search for other posts by title or by topic, go to www.wellnesstips.ca.

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Batmanghelidj F. MD Your Body’s Many Cries for Water Global Health Solutions, Falls Church, VA, 1997

Zhang W et al. OARSI recommendations for the management of hip and knee osteoarthritis, Part II: OARSI evidence-based, expert consensus guidelines. Osteoarthritis Cartilage. 2008 Feb;16(2):137-62.

Bierma-Zeinstra SM, Koes BW. Risk factors and prognostic factors of hip and knee osteoarthritis. Nat Clin Pract Rheumatol. 2007 Feb;3(2):78-85.

Felson DT. An update on the pathogenesis and epidemiology of osteoarthritis. Radiol Clin North Am. 2004 Jan;42(1):1-9, v.

 Miller et al. Intensive weight loss program improves physical function in older obese adults with knee osteoarthritis. Obesity (Silver Spring). 2006 Jul;14(7):1219-30.

Messier SP. Obesity and osteoarthritis: disease genesis and nonpharmacologic weight management. Rheum Dis Clin North Am. 2008 Aug;34(3):713-29.

Clegg DO et al. Glucosamine, chondroitin sulfate, and the two in combination for painful knee osteoarthritis N Engl J Med. 2006 Feb 23;354(8):795-808.

Jang BC et al. Glucosamine hydrochloride specifically inhibits COX-2 by preventing COX-2 N-glycosylation and by increasing COX-2 protein turnover in a proteasome-dependent manner. J Biol Chem. 2007 Sep 21;282(38):27622-32. Epub 2007 Jul 16.

[No authors listed] Glucosamine for knee osteoarthritis – what’s new? Drug Ther Bull. 2008 Nov;46(11):81-4.

Bruyere O, Reginster JY Glucosamine and chondroitin sulfate as therapeutic agents for knee and hip osteoarthritis. Drugs Aging. 2007;24(7):573-80.

Timothy E. McAlindon et al. Glucosamine and Chondroitin for Treatment of Osteoarthritis: A Systematic Quality Assessment and Meta-analysis JAMA. 2000;283:1469-1475.

Herrero-Beaumont G et al. Glucosamine sulfate in the treatment of knee osteoarthritis symptoms: a randomized, double-blind, placebo-controlled study using acetaminophen as a side comparator. Arthritis Rheum. 2007 Feb;56(2):555-67.

Mazieres B et al. Chondroitin sulfate in osteoarthritis of the knee: a prospective, double blind, placebo controlled multicenter clinical study. J Rheumatol. 2001 Jan;28(1):173-81.

Vignon E et al. Osteoarthritis of the knee and hip and activity: a systematic international review and synthesis (OASIS). Joint Bone Spine. 2006 Jul;73(4):442-55. Epub 2006 May 6.

Goldberg RJ, Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain. 2007 May;129(1-2):210-23. Epub 2007 Mar 1.

Emma Dickinson Acupuncture as a complementary therapy to the pharmacological treatment of osteoarthritis of the knee: randomised controlled trial BMJ Volume 329 pp 1216-9

Claudia M. Witt et al. Acupuncture in patients with osteoarthritis of the knee or hip: A randomized, controlled trial with an additional nonrandomized arm Arthritis and Rheumatism Vol 54 Iss 11, pp 3485 – 3493, 2006

Janet L. Funk et al. Efficacy and mechanism of action of turmeric supplements in the treatment of experimental arthritis Arthritis and Rheumatism Vol 54 Iss 11, pp 3452 – 3464, 2006

Copyright 2008 Vreni Gurd

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4 Comments »

  1. Penny Zeeff said,

    February 15, 2009 @ 2:16 pm

    Thank you so much for the tip on vaccinations. I have been thinking about the vaccine for Shingles and wasn’t sure if I should go ahead with it. But after reading your Wellness Tip I am pretty sure I will get one.
    I really enjoy Wellness Tips and learn so much from them.
    Penny Zeeff

  2. Errol Turkowski said,

    June 30, 2013 @ 11:23 am

    While osteoarthritis can damage any joint in your body, the disorder most commonly affects joints in your hands, neck, lower back, knees and hips. Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can slow the progression of the disease, relieve pain and improve joint function.

    Look over our very own internet site too http://healthmedicine.co

  3. David Culm said,

    December 4, 2014 @ 7:39 am

    I am an OA sufferer. I have just spent a week in hopsital (Ilesotomy reconnection) and been hydrated intravenously and had litres of water by mouth. Miraculously my OA pain has disappeared from the knee it affects. QED?

  4. Graham Wise said,

    May 4, 2015 @ 1:35 pm

    I am 66 years old. 175 cms 72 Kgs
    I play singles tennis 1.5 hours per day every day in the tropics.
    I had chronic night time hip pain but no pain while playing. I started drinking 2 litres of water while playing in the hot humid summer.
    My hip pain just about disappeared. At the time I just imagined that I had got fitter or the pain was a ligament problem that had finally eased.
    As the hot weather eased I stopped drinking 2 litres while playing.
    My hip pain returned.
    I was thinking of playing less tennis when I remembered the dehydration problem.
    Yesterday I drank water during the day and 2 litres while playing and no hip pain in bed last night. It was like an on/off switch.
    Hope this helps.
    Cheers Graham

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