Clues to the Cause of Degenerative Joint Disease

Reviews of the degenerative diseases, spinal disc herniation and osteoarthritis, show some interesting correlations. Those often cited are obesity, genetics, prior injury, overuse and certain drugs. But there are other clues that something else is going on.

Patients with these conditions often have high blood sugar; high CRP (C-reactive protein, a marker for chronic inflammation); a low carotenoid index (measure of amount of healthy whole fruits and vegetables eaten.) MRI of joints in these patients show inflammatory changes in metaphysical bone (the bone adjacent to joints.) Anthropological studies show little evidence of these diseases in people from prior times, but few lived into old age. Studies of current primitive societies and third world populations show little chronic joint disease even in older people.

Those with sciatica or spinal disc disease typically have much higher rates of vascular disease and high cholesterol. Discs and spinal nerves are very sensitive to poor blood supply and chronic inflammation. Blocked spinal arteries lead to degeneration, disc rupture and pain. In western societies this vascular disease now starts in childhood as does early disc degeneration.

Patients with joint pain who have an MRI are typically shown to have cartilage loss and irregularity, sometimes a torn meniscus. An obvious approach has been arthroscopic repair of a meniscus or cartilage irregularity. Some improved but results were disappointing. Then science intervened after  hundreds of thousands of these procedures. A group of patients with these MRI diagnoses were randomized to arthroscopic repair or a sham procedure where the patient had an incision and some probing but no repair. Surprise-- no difference in results. The patients' pain was not due to an arthroscopically correctable cause of joint disease. In spite of this surgeons continue to perform these procedures often citing personal experience to justify an expensive procedure which has been proven to be ineffective. The apparent answer then is analgesics, anti-inflammatory drugs, don't use the joint, or "suck it up and live with it" until you have the joint replaced. But that's wrong!