Joint Disorders

Joint problems are perhaps the most prevalent cause of decreased quality of life especially in the elderly. Obesity and joint issues follow a vicious cycle. An increase in weight increases the risk of joint disorders and joint disorders increases the risk of obesity. An obese individual has more than fifty percent chances to develop arthritis than a normal individual.

Arthritis is an umbrella term used to describe the damage caused to the joints by different conditions. The common joint disorders seen in obese individuals are osteoarthritis and rheumatoid arthritis. Obese men have a higher risk of developing such disorders.

About obesity related arthritis

Joints enables an individual to walk, wave with hand, write, turn the head, etc. When a damage occurs in the joints, routine activities may be difficult and challenging. Increased weight exerts excess load on the joints especially on the weight bearing joints in the body such as ankles, knees, hips and spine.

The possible mechanisms behind obesity related arthritis are as follows:

1. Excess weight load on joint: In obese individuals, excess weight predisposes the joint to wear and tear damage to the joint cartilage. This marks the beginning of osteoarthritis.
2. Muscle weakness: Increased weight alter the weight bearing forces on the joint. Thus, the muscles that stabilise the joint need to work harder to achieve joint stability. Over time, these muscles are unable to tolerate the workloads and become weak. If the stabilising muscles become weak, the risk of joint damage is more.
3. Obesity mediated inflammation: The adipose tissue secretes adipokines (family of hormones and cytokines), a potent inflammatory mediator. In obese individuals, the excess adipose tissue causes an increase in the levels of adipokines. This increase may bring about inflammatory changes in the joints, damage the tendons and sensitize the nerve endings which further cause joint damage. Adipokines have also been found to trigger rheumatoid arthritis.
4. Kidney dysfunction: In obese people, the kidneys are inefficient, this is mostly due to excess insulin. Obesity causes insulin resistance, that is, the body cells do not respond to insulin and do not utilise blood glucose for energy generation. The result is that the pancreas secretes more insulin but its effect is not there; excess insulin inhibits uric acid excretion in kidneys which ultimately causes gouty arthritis.

Obesity can also delay the natural healing process of the damage to the joints and cause worsening of the symptoms of arthritis such as:

• Joint erosion and pain
• loss of flexibility
• bone spurs (bony projections along the edges of bone, especially in the joints and on the spine)

Obese people with arthritis are also at increased risk of carpal tunnel syndrome, osteoporosis, lung disease, heart disease, kidney problems and insulin resistance.

Back pain in obese individuals

The midsection or the core of the body is the body’s centre of gravity. When a person becomes obese there is a shift in the centre of gravity which causes the pelvis to be pulled forward. The changed posture due to the excess weight will cause strain on the back leading back pain.

Additionally, other factors such as inflammation and increased stress in the bones of the spine can also play a role in causing back pain. Obesity can also increase the risk of pre-existing back problems such as disc herniation, exaggerated lordosis (low back curve), lumbar spondylosis and sciatica.

Weight loss and arthritis

Now we know how excess weight causes arthritis and other musculoskeletal disorders. However, does decreasing weight have an impact on joint disorders? The answer is yes. One Framingham study shows that in women though being even slightly overweight significantly increased the incidence of OA, losing 11 pounds decreased risk of knee OA by half. Another study tells us that in patients with RA, maintaining a low body weight is associated with better recovery and outcomes.

Getting rid of excess weight is the key to stay away from obesity related arthritis. Weight loss is primarily achieved by diet modification and exercise.

Dietary measures:

• Avoiding the unhealthy diet which includes processed sugar, vegetable oil, trans fats, and excessive carbohydrate food.
• Eating low-fat and low-carbohydrate food.
• Drink adequate water

Physical activity:

• Incorporate exercises for at-least 30 minutes/day, 5 days a week. Start with simple, low impact exercises like walking and jogging.
• Also incorporate strength training, preferably with a trainer to ensure that you do not damage your joints while performing strengthening exercises.
• Yoga or acupuncture helps to deal with the inflammation and the pain.
• Learn and perform core strengthening exercises to reduce back pain.

Some pointers:

• Do not exercise during an acute exacerbation of rheumatoid arthritis or when in excess pain.
• Make sure you take adequate rest periods between workouts.
• If you have joint pain which may limit you from doing exercise, your doctor may ask you to wear a brace (eg: knee brace) while doing exercise.

References

https://www.ncbi.nlm.nih.gov/pubmed/19037063

https://newsnetwork.mayoclinic.org/discussion/complications-of-rheumatoid-arthritis/

https://www.mayoclinic.org/diseases-conditions/osteoarthritis/symptoms-causes/syc-20351925