Oxidative Stress and Arthritis: The Missing Link

Oxidative stress is like a spark
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There are two main categories of chronic, inflammatory arthritis. The first, osteoarthritis, is typically thought to be an inevitable result of wear and tear on the joint from aging or after injury. The second is autoimmune inflammatory arthritis, of which rheumatoid arthritis (RA) is the most common. In RA, the cells of the immune system and their released messengers (cytokines are one example), attack the tissue inside the joints triggering inflammation.

Both can result in joint damage and deformity—so much so that it affects people’s quality of life. But if you have arthritis, you’re probably all too familiar with that last part. What may not be familiar to you, though, is that both types of arthritis involve something called oxidative stress in the joints—and this underlying trigger for the joint damage is something that you can influence.

Understanding Oxidative Stress

Oxidative stress is a very normal process that results from your body’s day-to-day functioning. As your cells do their work, they make free radicals, which I think of as “sparks” or mini fires. Then your body’s antioxidant defense system puts them out, much like a fire hose spraying a flame.

Low levels of oxidative stress are actually useful for your routine activities. Because quenching free radicals is a normal process, nature gave us an abundance of antioxidants in the food we eat—compounds found in fruits and vegetables—a variety of which are represented by all the bright and varied colors of these foods.

Every day, you should be eating antioxidant foods to supply your body with the antidote to these free radicals. However, if you don’t bring enough antioxidants into your body to keep up with all the sparks that are created, eventually the free radicals will win, the sparks become a fire and the fire fuels inflammation, tissue damage, and ultimately disease.

Oxidative stress can affect your immune cells, in particular, because they are very active, and create and release free radicals when doing their daily work protecting you. This is also the process by which we believe RA and other inflammatory arthritis conditions, including osteoarthritis, takes hold and flourishes.

The Connection to Arthritis

A large number of studies have shown that people with RA have increased levels of molecules called highly reactive oxygen species (ROS), free radicals that have the potential to damage lipids, proteins, and DNA in joint tissue.

Under normal conditions, ROS are controlled by a variety of your body’s antioxidant defense systems. In people with RA, however, the antioxidants can’t keep up and the free radicals are able to run amok and cause tissue damage. When combined with the ongoing attack on your joints by your immune system, this high level of oxidative stress continues to fuel inflammation. The whole process can ultimately lead to the destruction of bone, joints, and articular cartilage.

When researchers from the Aligarh Muslim University in India compared oxidative stress in people diagnosed with RA to people without this disease, the RA sufferers had high levels of oxidative stress, including increased ROS production, DNA damage, impaired antioxidant defense systems, and other markers. They also had low levels of two antioxidants: glutathione and vitamin C. Glutathione is probably the most important antioxidant in the body because it functions inside all your cells to protect your body from ROS damage. Interestingly, RA sufferers who had more pain and disability and who had RA the longest had higher levels oxidative stress and lower levels of antioxidants. Studies consistently back up this connection between lower levels of specific antioxidants and increased markers of free radicals in people with RA.

Osteoarthritis (OA) is linked to high levels of oxidative stress, too. It is believed that people who are obese or have excess visceral body fat (the kind of fat that is inside your abdomen, wrapping around your inner organs) have more oxidative stress throughout their bodies, and there is a strong link between obesity and OA.

It is believed that the continuous exposure to free radicals causes the chondrocytes (cells that make cartilage) to produce reactive oxygen species (ROS), and these directly damage cartilage collagen and change fluid inside joints by making it thinner and less protective. Studies suggest that low levels of vitamin C are associated with a higher risk of knee OA and that increasing your intake may keep radiographic knee OA and pain from getting worse. The good news is that studies show that losing the body fat will result in reduced joint pain and inflammation.

How You Can Take Action

Using food as medicine is always the first step to reducing inflammation and oxidative stress. Here we focus on improving the antioxidant activity in your body. Your antioxidant system uses many different enzymes to manage oxidative stress, such as superoxide dismutase (SOD), and these enzymes require their own vitamins, minerals, and amino acids to do their best work. 

To quench free radicals, antioxidants in food are also critical, and these include known vitamins like beta-carotene and vitamins A, E, and C, as well as the powerhouse polyphenols especially abundant in the brightly colored vegetables and fruits, and dark leafy greens you should be eating every day, with every meal.

In addition to improving your intake of antioxidants, to truly reverse and heal your arthritis, you must also address the environmental exposures and triggers that are likely to be adding oxidative stress to your system. These stressors include gut dysbiosis (alterations in the gut microbiome), exposure to toxins, infections, and/or too much belly fat.

Treating the gut microbiome and leaky gut has the most research behind it as a foundational approach to treating arthritis because it appears that oxidative stress and inflammation often begin there and then travel to distant parts of your body, including your joints.

Remember, arthritis is a system-wide condition, and the pain you feel is being triggered by inflammation and oxidative stress that originates elsewhere in your body. If you find and treat the source, you will feel better without medication.  And that’s the goal.

Dr. Blum is the author of “Healing Arthritis,” which discusses how to heal the gut and treat the triggers of oxidative stress (Scribner 2017).

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