Today I Learned@lemmy.worldbyJayleneSlide@lemmy.world
1 day

TIL Inflammation Causes Cartilage Loss

pmc.ncbi.nlm.nih.gov English

“inflammation is now understood to be a key mediator of OA that contributes to cartilage loss and progressive degeneration of affected joints… OA is no longer considered a noninflammatory arthritis or a ‘wear and tear’ disease”

I heretofore thought age-related cartilage loss was the cause of osteoarthritis and inflammation. Turns out it’s the other way around: the inflammation degrades cartilage. Okay, no more slogging through joint pains for me, regardless of how small.

Edit: added a phrase for clarity

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    Topical Diclofenac, an Efficacious Treatment for Osteoarthritis: A Narrative Review
    pmc.ncbi.nlm.nih.gov
    Multiple head-to-head trials have demonstrated that topical nonsteroidal anti-inflammatory drugs (NSAIDs), including topical diclofenac, provide at least equivalent analgesia, improvement in physical function, and reduction of stiffness compared ...
    • LincolnsDogFido@lemmy.zipEnglish
      1 day

      This is a field I study. Its more complicated than yes/no. OA is caused by inflammation. However, inflammation when introduced into a joint space raises the friction coefficient between surfaces within the joint. More friction leads to mechanical stress and deterioration.

      The friction coefficient for synovial joints ranges from 0.0015 - 0.01 depending on the study. Essentially frictionless. That’s why when inflammation enters the synovial fluid, you hear crepitus or “creaking”. Friction goes up and tendons vibrate like strings on a violin. For reference, ice on a Teflon pan has a friction coefficient of 0.05 - 0.10. Roughly ×5 the conservative estimate for synovial joints.

      • fiat_lux 🆕 🏠@lemmy.zipEnglish
        15 hours

        So when people told me as a kid not to worry about my crepitus, they were in fact completely wrong? If so, I’m feeling vindicated but also sore, but that’s better than only sore.

        • LincolnsDogFido@lemmy.zipEnglish
          14 hours

          Well, I guess it depends entirely on what you could do about it. If the crepitus was brought about by chronic malmechanics then yes. If it was hereditarily driven then there’s nothing you could do about it. Typically, I preach to my patients that popping, clicking, snapping, etc. are only notable if they induce pain or if they were brought about by a change in activity.

          A secondary note on pain is that it’s part of the human condition. Pain is relative and inevitable. If you live your life in a bubble then a sprained ankle is going to feel like a gunshot wound. There will always be some form pain or soreness. The trick is to address it as it comes about and shift it to the next weakest link in the chain. If you have low back pain, strengthen your core to treat it. Then that pain may shift to your hips where you have overactive or weak abductors, then it may be your neck. Who knows. But there’s few things as debilitating as chronic pain in one location. The more painful it gets, the less you’ll want to use it and you end up building a positive feedback loop.

          • fiat_lux 🆕 🏠@lemmy.zipEnglish
            3 hours

            Fair. In my case I wish someone had not overlooked the systemic inflammation (from a different condition that has been recently correlated with OA, somewhat unexpectedly) and the malmechanics I was experiencing, so that I might have avoided some of the further issues, but, so it goes.

            I manage to shift some of the chronic pain, but sadly society really likes to build worlds that have only one blessed way of doing certain things, which makes it impossible to shift more consistently. So I will have to mostly content myself with smugly sore.

            Given you appear to be a doctor though, I do have one favor to ask. If you ever get a flexible kid with crepitus come through your doors, maybe add a CRP test to their blood work, just on the off-chance and even if only for the chain of evidence.

      • lefty7283@lemmy.worldEnglish
        1 day

        Had the chance to do cadaver dissections and synovial fluid is some fascinating stuff! Slightly mucusy, but incredibly slick

    • yenahmik@lemmy.worldEnglish
      1 day

      Me reading this while rubbing my chronically sore knees from sports training…

    • teyrnon@sh.itjust.worksEnglish
      1 day

      It has long been known that certain bacterial infections like strep can cause horrible debilitating pain in your joints, most common I believe like knees and stuff, but other people like shoulders and elbows. Not just strep though.

      They treat it with cortico steroids, which are bad to take in high doses for long periods of time, which this is. Very very bad. Perhaps not as bad as horrible debilitating chronic pain.

    • xep@discuss.onlineEnglish
      1 day

      When I started on a low inflammation elimination diet it did wonders for my joint pain. Can recommend.

      • ryannathans@aussie.zoneEnglish
        1 day

        This.

        Have met people in the coeliac community that had their arthritis go away entirely after strictly stopping gluten

      • teyrnon@sh.itjust.worksEnglish
        1 day

        May I ask what a low inflammation diet is? Wild Mexican yams? I say that because yams have corticosteroid precursors in them, they first created corticosteroids from Mexican wild yams and that is the go-to treatment for inflammation.

          • xep@discuss.onlineEnglish
            1 day

            I took that a step further and eat only beef, salt, and water, but if you figure out what causes the inflammation you don’t have to go this far.

            • MalReynolds@slrpnk.netEnglish
              22 hours

              Same, tried the AID diet first without significant effect. Two weeks of beef salt water got me there and I started identifying foods ([chicken] eggs and [cow] cheese being worst, but carbs being problematic in general, hence AID failure). I now do it yearly after Christmas to check foods I’m suspicious of. It’s extreme, but pretty much guaranteed to work, barring Lyme disease, basically no-one has an inflammatory reaction to beef.

              For those of you contemplating this, trick I found is when I eat an inflammatory food while hydrating properly I put on a Kg + of water weight within 24 hours (remember, inflammation of an injury makes it swell, with water). Easy to measure.

    • Reyali@lemmy.worldEnglish
      1 day

      Here I am staring at my sausage-like thumb that’s been swollen like this for three days thanks to rheumatoid arthritis. This article gives good context for why RA often results in OA at a younger age. Maybe I will go take a prednisone and apply another dose of diclofenac to try to knock this inflammation down…

      • roofuskit@lemmy.worldEnglish
        1 day

        There have been some good medications for RA created in the last decade or so. Has your rheumatologist prescribed anything longer term than prednisone? Prednisone is not really a long term safe solution.

        • Reyali@lemmy.worldEnglish
          23 hours

          Prednisone is my rescue medication for flares, not my normal treatment. Hence why I thought I might take it just today.

          I’m on two meds, one that came out in 2019. I’ve been diagnosed for a year this month, and I have cycled through five or so drugs to finally land on a combo that actually controls the pain. The current inflammation is unlike what I’ve experienced regularly before, in that it is purely swelling with no pain, but I also have a reasonable theory as to the cause. I plan to bring it up at my next appointment regardless.

      • JayleneSlide@lemmy.worldEnglish
        1 day

        RA… oof. That shit is a curse*, a giant FU from the universe. I hope you get the relief/management you need. Tangential: does the prednisone get you all hyper?

        *My aunt had it. In my pre-teens, my mother sent me to live with and care for her in final years (it wasn’t the RA that got her), so I deeply empathize with your health struggles.

        • Reyali@lemmy.worldEnglish
          23 hours

          Thankfully an RA diagnosis today is extremely different than one even 20 years ago, and I’ve only had it since the start of 2025. There are a lot of good options for meds, and there are some very promising long-term treatments on the horizon.

          If actuarial tables estimate correctly, I’ll have around 40 years to live with this shit. My hope is for a cure before that happens (there has been enough advancement in autoimmune treatment even in just the last 5 years that it’s not a total pipe dream).

          All that said, after spending most of 2025 with intolerable pain in my hands, I know if something prevents me from getting treatment long-term (like a societal collapse, not like pharmacy challenges), I expect I would find a way to …opt out. I was losing my mind until I found treatment that works (at least most of the time… this week is thankfully the exception now).

          As for prednisone, I have extremely few side effects from it and no hyperactivity at all. I took it often from my diagnosis last May through this January. The first time was doses from 2.5–30 mg a day (normally 10–15) for most of 3 months straight. I had zero complaints while on it; however, upon stopping I was exhausted for about three days straight. Tired to the bone kind of feeling.

          I ended up back on it for another 3 months, at or below 10 mg daily and I tapered more slowly, so the tiredness was much more manageable that time.

          Like another commenter said, that’s a lot to expect of a pre-teen. I’m sorry you had to see that so young.

          • Tollana1234567@lemmy.todayEnglish
            22 hours

            i think prednisone’s side effect is more apparent if you are on higher doses for longer periods of time, 80-100mg per day. i took it for 2 weeks for severe atopic dermatitis, dint cause any symptoms, since it was a taper too.

            for RA, you should request biologic medications, theres a couple out for them already. Likewise with people with psoriasis/psoriatic arthiritis.

            • Reyali@lemmy.worldEnglish
              15 hours

              I started on biologics after diagnosis and they didn’t work for me. I am on a daily JAK inhibitor and a twice-daily NSAID and that has my pain controlled. The current swelling is something new, and is not painful.

              The long-term prednisone use was to help me manage the pain while seeing if a biologic would work. It helped, but I still had to take ~15 mg of prednisone a day or I was in debilitating pain.

        • kamenlady@lemmy.worldEnglish
          1 day

          In my pre-teens, my mother sent me to live with and care for her in final years

          I imagine this to be no easy task for anyone, especially a pre-teen.

        • teyrnon@sh.itjust.worksEnglish
          1 day

          No rheumatoid arthritis here but took Prednisone for an issue I had for a few weeks and I did not notice any sort of hyperactivity. And most others I talked to did not either although several did.

    • bizarroland@lemmy.worldEnglish
      1 day

      Sounds like it might be a good idea to suggest people taking glucosamine and turmeric early.

      • Reyali@lemmy.worldEnglish
        22 hours

        Turmeric is questionable. A lot of early studies touting its benefits were published by the same person/group, and they had financial motivations behind it. Some has been straight debunked, and skepticism is a good stance to hold on it. Plus it’s been shown that turmeric supplements are a major source of lead, so the risk may outweigh the possible benefits.

      • roofuskit@lemmy.worldEnglish
        1 day

        Low impact exercise is a great tool for reducing inflammation. Vitamin D is also an important part of regulating your immune system. Anything that supports a healthy immune system will help regulate its response and reduce inflammation.

          • roofuskit@lemmy.worldEnglish
            1 day

            It helps your body strengthen your T cells which are the regulatory captains of your immune system. I have an auto-immune disease and doctors are always commenting on how good my wife and kids vitamin D levels are. I insist they take a good daily dose. Vitamin D is also pretty difficult to overdose on over the counter. You have to take an unreasonable amount of pills to cause any harm even if you buy the higher dose pills. Its not like other vitamins, it’s more like a hormone to your body.

            • Reyali@lemmy.worldEnglish
              22 hours

              Plus it recently came out that the recommended daily values of vitamin D were based on a typo and are off by a factor of at least 10 (source).

    • leoj@piefed.socialEnglish
      1 day

      Link above just forces me to do captchas over and over again… am I really that bad at finding the stairs, or is this a bug?

      • leoj@piefed.socialEnglish
        16 hours

        For some reason it didn’t like firefox but loaded up just fine in Opera…

    • digitalFatteh@lemmy.caEnglish
      1 day

      My back and knees tingle reading this. Just waiting on the knee cortisone inflammation to ease off 😉

      • JayleneSlide@lemmy.worldEnglish
        1 day

        Bruddah/sistah/non-binaryah, I know your pain intimately. I got my first shot in the knee 3 months ago. “And to think… I hesitated.” Sending warm recovery thoughts your way. What kind of physical therapy regimen does the sawbones have you on?

        • digitalFatteh@lemmy.caEnglish
          1 day

          Arthritis in both knees more severe with the one and the torn cartilage which I’m only on my second injection so far while I await a specialist. Can do any exercise as long as it’s not impact oriented so no running, jogging or fast walks. Can still row and cycle. Then there’s the OA in the lower back which just gives way when I look at things wrong.

          Kind’a kneeew it was coming and put off getting it checked out whilst I was young. Things catch up eventually 😉

          Thankfully I live in a place with universal healthcare. Takes a little longer but I’m not out of pocket.

        • Onomatopoeia@lemmy.cafeEnglish
          1 day

          Read up on cortisone - related cartilage/tendon concerns.

          Your doc probably overstates the risk a great deal. Check NLM for studies, it looks like there’s a risk, but all the studies are of patients with injury and on-going degeneration. By the time you get to injections you’ve exhausted other treatments.