Our emerging view of joint pain and osteoarthritis suggests that part of the disorder may be related to altered blood vessel function.

This involves some of the same factors that are linked to heart disease.  Doctors writing in the journal Rheumatology described a scenario in which 1) blood vessels become narrowed over time, 2) narrowed vessels cause restricted blood flow to the bone that lies beneath the joint cartilage, 3) circulation of blood and nutrients to cartilage suffers, and 4) cartilage begins to deteriorate.  Left long enough, the bone and the cartilage that are deprived of blood, nutrients, and oxygen, can lead to osteoarthritis.

[Findlay, DM. Vascular pathology and osteoarthritis. Rheumatology (Oxford). 2007 Dec;46(12):1763-8.]

In a very large study of 3,585 people with osteoarthritis of the hand, doctors wanted to better understand the metabolic factors that might be at work.  Metabolic factors were of interest because joints of the hand do not suffer from excessive weight (or loading) on joints like the knee in overweight people.  These doctors found that osteoarthritis of the hand was increasingly common when overweight occurs together with hypertension and diabetes.  This was especially true when occurred at a relatively young age.

[Dahaghin, S, Bierma-Zeinstra, SM, Koes, BW, et al.  Do metabolic factors add to the effect of overweight on hand osteoarthritis? The Rotterdam Study. Ann Rheum Dis. 2007 Jul;66(7):916-20.]

High blood pressure, hypertension, is among the blood vessel disorders that is now thought to adversely affect joints.  It is a serious health problem for several reasons: it is very common with wide-spread consequences and can remain asymptomatic (undiagnosed) until relatively late in its course. Numerous studies have proven that Insulin Resistance and resulting hyperinsulinemia (elevated insulin in the blood) cause increases in blood pressure. This is because elevated levels of insulin can cause atherosclerosis, which directly affects the diameter of the inside of the blood vessels by the build-up of plaque on the artery walls.

Blood pressure is determined by cardiac output - how much blood the heart is pumping per beat, total peripheral resistance and how easily the blood is pumped to the farthest points of the body. Blood pressure itself is affected by various factors, such as genetics, lifestyle and environment. The higher the blood pressure, the greater the chances of sustaining kidney damage and suffering a heart attack or stroke.

Think of your vascular system as a complex, interlocking web of hoses, similar to the garden variety. The smaller the size of the hose, the more pressure on all of the other hoses as less blood flows through per minute. The heart must pump harder to get blood to distant sites while facing the decreased diameter of vessels. This increases the pressure on the entire cardiovascular system, causing elevated blood pressure.

Atherosclerosis occurs when deposits of fatty substances like cholesterol, cellular waste products and other material build up in the inner lining of an artery. This build-up is commonly called plaque and most scientists agree it begins with damage to the innermost layer of the artery wall. Causes of this damage come from elevated levels of LDL "bad" cholesterol and fat-carrying blood lipids called triglycerides in the blood, as well as high blood pressure, tobacco smoke and Pre-Diabetes.

Pre-Diabetes, Metabolic Syndrome, and OA

Insulin abnormalities and the pre-diabetic state may have a strong relationship to joint problems and osteoarthritis.  This might be because having joint pain causes some people to limit their activities, thus becoming overweight.  It may also be because insulin, glucose, and blood vessel problems actually lead to developing OA.

In a recent study, 1,350 people over the age of 45 with osteoarthritis were studied.  Doctors found that 82 percent had metabolic syndrome, or pre-diabetes.  They also found that those with metabolic syndrome developed their osteoarthritis earlier than those who did not have metabolic syndrome.  In addition, those who developed OA earlier had more generalized joint disease, more joint inflammation, and more intensive pain in the joints. This likely means that paying attention to weight, insulin resistance, and blood glucose could be important in preventing the development of osteoarthritis.

[Korochina, IE, Bagirova, GG. Metabolic syndrome and a course of osteoarthrosis. Ter Arkh. 2007;79(10):13-20. [Article in Russian]

Chronic elevations of glucose and insulin levels are classic symptoms of Insulin Resistance, which is an underlying feature of Pre-Diabetes. One of the primary risk factors for atherosclerosis is an elevated level of triglycerides. The biggest risk factor, in turn, for increasing the production of triglycerides is the rate of your insulin secretion.

As excess insulin caused by Insulin Resistance comes in contact with the interior wall of the arteries, it is damaging to the tissue, causing the initial injury that can lead to plaque. As plaque builds up on the interior wall of the arteries, the circumference of the arteries decreases, thus increasing the pressure of the blood rushing through the entire vascular system.

This complex interaction becomes a serious health concern because, as high blood pressure rises, the chances of life-threatening medical conditions also increase.

Another factor in Pre-Diabetes and heart disease may be the role of inflammation, which is part of the body's immune system.

Inflammation triggers a defense response to harmful stimuli or injury by sending specialised blood cells to damaged areas where they attack "invaders" like the renegade molecules called "free radicals" and clean up dead and dying cells.

In the case of inflammation and Pre-and Type 2 Diabetes, the "invader" is thought to be excess levels of insulin, which can be caused by the imbalance of blood glucose and insulin called Insulin Resistance.

Inflammation can take an external form like the reddened, tender skin which draws attention to a splinter in your finger. Or it can be an unseen, internal process in response to something harmful like high blood pressure.

To combat internal harm, inflammation produces C-reactive protein (CRP), which, unfortunately, can damage the arteries by helping to form plaque while attempting to tackle a long-term condition like high blood pressure - often an accompanying symptom of Pre-Diabetes.

Plaque is a substance that attaches itself to artery walls, damaging those walls and seriously impairing blood flow, which can lead to a heart attack or stroke. A blood test measures CRP levels and the higher that level is, the more at risk you are from cardiovascular disease. There's contradictory evidence about whether CRP levels and Insulin Resistance are closely linked.

Research about inflammation is often cutting edge material that still needs ample verification. But scientists are gathering data that inflammation precedes and may predict reversible Pre-Diabetes, which, if left unchecked, can lead to the onset of Type 2 Diabetes.

Previous research had already linked inflammation to heart disease and obesity, which are both common in people with osteoarthritis.

Hypertension makes your heart work harder than normal and, as a result, both the heart and arteries are more prone to injury. High blood pressure increases the risk of heart attacks, stroke, kidney failure, eye damage and congestive heart failure. If you have hypertension, are obese, smoke or have high blood cholesterol levels or Pre-Diabetes, your risk of heart attack or stroke goes up dramatically.

Untreated high blood pressure forces your heart to work harder to pump enough blood and oxygen to your body's organs and tissues. It also damages arteries and arterioles, the very small arteries that connect larger arteries to tiny capillaries. Arterial damage is a serious health issue because hardened or narrowed arteries may not be able to supply enough blood to your body's organs, thus reducing their ability to function properly. In addition, plaque may dislodge from the sides of the artery wall, forming a blockage in another part of your body and causing a heart attack or stroke.

Although there are pharmaceuticals that can help lower blood pressure, the Insulite Osteoarthritis Support System addresses some of the diet, nutrition, lifestyle, and exercise plans that can naturally benefit blood pressure control.