Lipedema and Osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease most often affecting the knees, hips, lower back and neck, fingers and big toe.  It is the most common chronic joint condition and affects approximately 27 million Americans.  (1) Unfortunately, those of us with Lipedema, Lymphedema and Lipo-Lymphedema tend to have an accompanying OA condition as a result of the excessive weight we carry on our body, particularly below the waist and a genetic predisposition to the disease.

There is a firm rubbery material, called cartilage, that covers the end of each bone that acts like a cushion when two opposing bones move against each other.  This helps reduce the friction of bones moving by providing a gliding action that cushions the movement of each bone.

As OA progresses over time, the cartilage wears down or may develop growths, called bone spurs.  Pieces of bone or cartilage can also break off and float around the joint area, which can be benign or cause additional pain problems.  Inflammation of these affected areas can further damage the cartilage ending up with bone rubbing directly against the opposing bone.  This can lead to joint damage and increased pain levels.

Primarily considered a disease of those 65 and over, we are now seeing this show up in younger athletes and those with contributing OA factors.  Risk factors include aging, obesity, those with previous joint conditions, weak thigh muscles and genetics.

• One in two adults will develop symptoms of knee OA during their lives.
• One in four adults will development symptoms of hip OA by age 85.
• One in 12 people 60 years or older have hand OA. (1)

What Causes Osteoarthritis?

Science once believed OA was a disease caused by abnormal “wear and tear” on the joints over time.  However, a prevailing theory now believes OA is caused by the body’s failed attempt to repair cartilage damage.  In healthy cartilage there is a balance between the breakdown and build up of the tissue.  In OA this balance is lacking thus leading to complete cartilage breakdown over time.

There are several factors that can contribute to the early onset of OA:

Genetics

There are people born with various conditions whose bodies for some reason produce weak or faulty collagen, the protein that makes up cartilage.  With 80% of the body being made of collagen you can see how faulty collagen could cause extreme problems with our joints, particularly the knees and hips, especially when you add the extra weight to the equation.  (See my article on Exercising with Lipedema for more on collagen.)  Given those born with this genetic condition, OA could become an issue as early as age 20 or even younger.  This includes those of us born with Lipedema and/or other conditions/co-morbidities like Ehlers Danlos Syndrome (EDS).

Faulty collagen not only affects cartilage but supporting tendons and ligaments as well.  While evaluating your joint damage for cartilage damage, don’t forget the support structure that holds the joint together, namely the tendons and ligaments.  These could be a source of problems and pain before OA becomes the main problem.

Researchers have found that a gene called FAAH, previously linked to increased pain sensitivity, is higher in people with knee OA than in people who don’t have the disease. (1)

Weight

Here is a topic we know all to well.  Carrying around extra weight over time will cause your cartilage to break down faster.  Lipedema is an inflammatory disease.  Combine that with eating an inflammatory diet (high in sugar and carbohydrates) and you have a recipe for increased damage to all your joints, but particularly your hips and knees where you carry most of your excess weight.

Every pound of excess weight exerts about 4 pounds of extra pressure on the knees. So a person who is 10 pounds overweight has 40 pounds of extra pressure on his knees; if a person is 100 pounds overweight, that is 400 pounds of extra pressure on his knees. “So if you think about all the steps you take in a day, you can see why it would lead to premature damage in weight-bearing joints,” says Dr. Matteson. (2)

For those of us struggling with Lipedema, Lymphedema and Lipo-Lymphedema managing our weight is one of our toughest battles!  We know Lipedema is calorie and exercise resistant meaning counting calories and exercising all hours of the day yield little to no weight loss.  Therefore, we need to change our food plan to achieve any weight loss and management options coupled with strategic exercises to build good muscle tone.

Personal note: I am 300 pounds overweight, much of it Lipedema and Lymphedema weight, which means I am putting over 1,200 pounds of extra pressure on my knees.  I have severe OA in both knees with bone on bone partially in my right knee. It’s no wonder how I can barely walk from room to room in my home never mind the pain of an extended trip to the doctor’s office!

Injury and Overuse

Your body was meant to move.  However, repeated sudden or sharp movements, such as the case with athletes, can put unusual stress on the joints, tendons and ligaments causing them to breakdown faster, leading to early OA.

Certain types of jobs involve long periods of time sitting or standing, bending, lifting or other physical movements that are repetitive in nature that lend to cartilage, tendon and ligament breakdown.  These “repetitive use” injuries may perhaps start as muscular in nature, but over time without proper care can lead to cartilage breakdown and OA.  Be mindful on how you use your muscles and joints as well as the frequency of these movements to help prevent “repetitive use” injuries and OA.  Take breaks, alternate standing and sitting, avoid heavy lifting, and mix-up your routine to keep your muscles and joints working optimally.

What are the Symptoms of Osteoarthritis?

Symptoms of OA differ slightly depending which joint(s) is/are affected and the severity of affliction.  The most common symptoms are pain and stiffness, especially after long periods of rest or when you wake up.  Your joint(s) may also experience swelling after activity or overuse, which is very common in those who suffer with Lipedema and Lymphedema.

• Sore or stiff joints
• Limited range of motion that goes away after movement
• Cracking or popping noise when bending the joint
• Slippage feeling around affected joint(s) (knees in particular)
• Swelling around the joint area
• Pain or aching after activity or overuse

Pain, swelling and stiffness can make every day tasks difficult to accomplish.  These include simple items like grasping a can of food, opening a box, holding something (or someone) in your arms and typing on a keyboard.  It can also include walking, climbing stairs, driving a care or lifting objects or even holding a job.  Many aspects of your once normal life’s activities may prove challenging if your OA becomes too debilitating.

For some people their symptoms are so severe they can no longer work outside the home and may even have limited abilities getting around within their home.  They may need to file for Social Security Disability to help make ends meet.   This is what happened to me in 2014 when my severe Lipo-Lymphedema and severe OA (and other comorbidities) prevented me from walking more than about 25 feet before excruciating pain forced me back to bed or my recliner with ice packs and pain medication.

When severe OA occurs it can lead to social isolation.  People are either unable or unwilling to deal with the intense pain of OA that they rarely leave their home for social events and lack the ability to entertain in-house.   If you have a loved one or know someone with severe OA (and Lipedema) and notice you don’t see them socialize very much, please pay them a visit and offer any services you think might help.  They don’t want to be unsocial!  It’s the disease and ensuing pain that keeps them prisoner.

Another symptom of OA could be falls.  We are at greater risks for falls with weaker muscles in the hips, thighs and legs combined with OA in the hips or knees.  People with OA experience as much as 30 percent more falls and have a 20 percent greater risk of fracture than those without OA. (1) This is also true if taking strong pain medications for OA.  It could make one dizzy or unbalanced making them more prone to a fall.

Diagnosing Osteoarthritis

Your doctor will collect information about your family history, perform a physical examination and probably order lab tests to look at the affected area(s).  They will also look at your personal medical history, medications you are or have taken, reports of the type of pain you’ve been experiencing and if you are experiencing any stiffness or swelling in the affected area(s).  They may also order one or more of the following tests:

• Joint aspiration – fluid is drawn out of the affected joint(s) once it is numbed and examined for crystals or deterioration.  This test can exclude other medical conditions.
• X-ray – can show evidence of changes to the joint space and how much cartilage still remains in the affected area(s). This is especially useful to see the rate of change when comparing to previous x-rays of the same area.
• MRI – more expensive but a better view of the joint space and structure.  It can show a better image of how OA is affecting the joint, cartilage and surrounding support structure.

Treatment Options for Osteoarthritis

There is no cure for OA but there are several management options available to make living with OA more comfortable. These include options for managing pain, stiffness and swelling, and improving joint mobility and flexibility as well as mitigating factors such as weight management and exercise.

Medications

There are several options available from pills to creams to injections to help mitigate OA pain. Options include:

• Analgesics – these are pain relievers or pain killers that can be either be purchased over the counter or by a physician’s prescription.  They include acetaminophen (Tylenol), opioids or narcotics (Vicodin or Tramadol), and capsaicin creams, lotions or patches.
• NSAIDS (Nonsteroidal anti-inflammatory drugs) – these are the most common type of pain relievers as they also reduce inflammation and can be either be purchased over the counter or by a physician’s prescription.  NSAIDS are not meant to be taken long-term as they can cause stomach bleeding and kidney problems for some people.  You should also discuss this option with your physician if you are taking blood thinner medications.  NSAIDS include ibuprofen, aspirin, naproxen, Advil and Celecoxib.
• Corticosteroids – these are powerful steroid based pain relievers that can be applied topically or via an intra-articular injection (directly into the joint) in your physician’s office.  They are available over the counter or by a physician’s prescription.  They include hydrocortisone, prednisone and kenalog to name a few.
• Hyaluronic acid – hyaluronic acid is a critical component of the synovial fluid found naturally in the joint which acts as a lubricant when bones move against each other.  The U.S. Food and Drug Administration (FDA) has approved these injections for treating OA in the knees with promising results.  Other joint injection sites has not been as successful. (3)

Personal note: I opted for corticosteroid injections (kenalog) every three months to help reduce my excruciating pain in both my knees when  common analgesics weren’t strong enough and I couldn’t take most NSAIDS due to allergies. However, since giving up gluten, lowering my carbohydrate intake and moving towards a Ketogenic plan, I have significantly reduced my inflammation levels to the point of not needing the quarterly corticosteroid injections and taking only an opioid as needed for bad pain.

Non-Medication Treatment

• Natural Methods – some people opt for treatments that do not involve long-term medications and the risk of their side effects.  Instead they choose to use nutritional supplements, acupuncture or acupressure, massage, relaxation techniques (meditation, yoga, pilates, Reiki, etc.) and hydrotherapy (spa or hot tub), and other treatments for pain relief and management.
• Physical or Occupational Therapy – some may choose to consult a therapist to actively work on strengthening the joint, learning stretching and moving techniques to improve range of motion, experimenting with hot and cold therapies, pool activities, and investigating other supportive technologies for their joint needs.
• Assistive Devices – these devices can be used to help ease pain and improve function or mobility with most being available at your local medical supply store or through your physician’s or therapist’s office.  These include walkers, canes, scooters, braces, orthotics and helper aids such as grippers, bath chairs, and grab bars.  Some items are available as generic off the shelf items while others may need to be custom made to your needs by your physician or therapist’s office.
• Surgery – this option may be an alternative for those experiencing a total breakdown of the joint cartilage or supportive space.  Consult with your physician to see if this is your best option for regaining functionality or mobility.  Hip and knee replacements surgeries are the most common procedures.

Managing Your Osteoarthritis

You have several options for treating your OA once properly diagnosed by your physician as we have discussed above.  In addition to medication and non-medication treatments there are things you can do to help you manage your pain and functionality.  These include maintaining a healthy weight and getting proper exercise to support the OA in your joint(s).

Healthy Weight Management

Managing a healthy weight may involve changing your lifestyle, which is something you need to be prepared to do if you want to minimize your pain and regain lost functionality of mobility.  I will not tell you which diet plan works best for your body, but there are some simple principles you can apply to help your body heal.  The first thing is to eat real whole food that is preferably organic and non-gmo. If it comes from a box it is not real food.  I mean lots of fresh vegetables, fruits, meats (unless you’re a vegan) and low carbohydrates, especially those containing mostly sugars.  Sugar is an inflammatory agent, which is the very thing you are trying to eliminate and/or control.

Once you start eating more healthy any excess weight you’ve been carrying around will soon start to disappear.  As I mentioned above getting any excess weight off your joints will help improve your situation. Do your research and figure out which food plan works best for your body and helps you shed any excess weight.  The plan needs to be an anti-inflammatory solution so you can heal your body from the inside.  Work with your physician or nutritionist to help determine what will work best for you, but do your own research first.

Physical Activity

One of the best things you can do to help your joint(s) is to move it.  You need to carefully move, stretch or use the joint to avoid stiffness and pain.  However, be careful not to overdue your exercise. This includes not engaging in an activity too strenuous for your joint or pushing yourself too long in an activity where you overuse the joint(s).  Small walks around your neighborhood, the local mall or local school track might be enough to keep the joint(s) properly exercised.  However, if this proves too much then walk around your home as much as can to keep the joint(s) in motion.

Some find stretching exercises to be the right balance of movement without negatively impacting the joint(s).  You can do those at home or find a local class on yoga, pilates or basic stretching to help you with your physical activity.  Building up and maintaining supportive muscles around affected joints will help reduce the pain and inflammation giving you greater relief and increased functionality or mobility.

Summary

Osteoarthritis is a degenerative joint disease we generally find comorbid in those with Lipedema, Lymphedema and Lipo-Lymphedema. This is due to the increased size of our limbs and pressure from accumulated adipose fat tissue and lymph fluid in our system.  It is also due to the faulty collagen we inherited that creates weak connective tissues, which are found in our cartilage, tendons and ligaments, all the things that comprise our joints.  The hips and knees are the most commonly affected OA areas, but can occur in any joint(s) in our body.

Once diagnosed by a physician we can choose treatment options to help manage the pain and inflammation of OA.  Depending on the severity and location of the OA we can choose medication and non-medication options.  Medication options include topical capcaisin creams, oral pain relievers and anti-inflammatories, or corticosteriod injections.  Non-medication alternatives include physical therapies, natural supplements and treatments, assistive devices and surgical joint replacements. Our physician will help monitored our OA condition by determining if treatments are effective and if the OA is progressing towards a total joint breakdown.

Losing excess weight and maintaining a healthy body and weight will help in reducing inflammation and pain in our affected joint(s).  This may require a lifestyle change, but isn’t increased functionality or mobility and reduced pain and inflammation worth the change?  Do your research and consult with your physician or nutritionist for a food plan that works for your.

Getting enough physical activity to properly work the affected joint(s) area is key to keeping a good range of motion and reducing swelling and stiffness of the joint(s).  Just remember not to engage in anything strenuous that puts additional pressure on the joint(s).  Instead engage in stretching and low key exercises, such as walking or swimming, building a good support structure in the muscles around the affected joint(s).

Remember to keep a positive attitude and outlook if you’re diagnosed with OA.  Studies have shown those with positive attitudes can boost their immune system, which in turn helps the body handle pain.  There are many treatment and lifestyle changes you can make to help with reducing pain and inflammation and increasing your functionality and mobility so that you can start to enjoy life again.  Partner with your physician to find the best and safest road-map for you in actively managing your OA.

 

To Your Improved Health!

 

References:

• (1) Arthritis Foundation – What is Osteoarthritis?
• (2) Arthritis Foundation – How Fat Affects Arthritis
• (3) Arthritis Foundation – Hyaluronic Acid Injections for Osteoarthritis

 

Resources:

• ResearchGate – Lipedema: A Clinical Challenge-revisited
• US National Library of Medicine – Osteoarthritis
• Arthritis Research and Therapy – Early blockade of joint inflammation with a fatty acid amide hydrolase inhibitor decreases end-stage osteoarthritis pain and peripheral neuropathy in mice
• Arthritis Foundation – Osteoarthritis Blog