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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.

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