Orthopaedic specialist Markus Klingenberg: Osteoarthritis also comes from the stomach: What your intestines have to do with joint pain

For a long time, osteoarthritis was considered a purely mechanical disease of joint wear and tear. However, current research shows that our gut microbiome, the entirety of microorganisms in the digestive tract, plays a surprisingly important role in the health of our joints. The so-called "gut-joint axis" is increasingly becoming the focus of orthopedics and sports medicine – offering exciting prospects for prevention and treatment.

Markus Klingenberg is a specialist in orthopedics and trauma surgery, specializing in arthroscopic surgery of the shoulder, elbow, hand, knee, and ankle, as well as foot surgery. He holds additional qualifications in sports medicine, chiropractic/manual medicine, and emergency medicine. After studying medicine in Bonn and Zurich and spending time in London, Innsbruck, and Boston, he completed his residency. Since 2014, he has been the chief physician at the Beta Clinic in Bonn, specializing in arthroscopy, foot surgery, and sports medicine. Visit his website: www.markusklingenberg.de .

The term "gut-joint axis" describes the interaction between the microbiome, the immune system, and joint health. Changes in the gut microbiome—for example, due to an unbalanced diet, medication, or stress—can promote systemic inflammation, which in turn damages the joints.

Yes, the data is clear: Dysbiosis in the gut is associated with increased inflammation, more severe joint pain, and faster progression of osteoarthritis. Obesity, which is considered a risk factor for osteoarthritis , appears to damage joints not only through mechanical overload, but also through disrupted intestinal flora and chronic inflammation. This connection has also been observed in non-weight-bearing joints such as the hands.

Research in this area is dynamic, and initial therapeutic approaches are showing promising results:

• Prebiotics and probiotics: In animal models and initial human studies, prebiotics (e.g., oligofructose) and probiotics were able to restore the balance of the intestinal flora, reduce inflammation, and have a positive effect on the progression of osteoarthritis.
• Dietary changes: A high-fiber, plant-based diet promotes the production of short-chain fatty acids in the intestine, which have anti-inflammatory effects. Studies show that a Mediterranean or anti-inflammatory diet can reduce the risk of osteoarthritis and alleviate symptoms.
• Nutraceuticals: Certain dietary supplements such as omega-3 fatty acids, polyphenols (e.g. from turmeric or resveratrol) and secondary plant substances can have a beneficial effect on the microbiome and inhibit inflammation.
• Fecal microbiota transplantation: In individual cases, the transfer of a healthy microbiome is also being discussed, but so far it has mainly been tested in chronic inflammatory bowel diseases.

Although research is ongoing, patients with osteoarthritis can already positively influence their microbiome and thus their joint health:

• Eat fiber-rich foods: Whole grain products, legumes, vegetables, and berries promote “good” gut bacteria and the production of anti-inflammatory fatty acids.
• Prefer healthy fats: Omega-3 fatty acids from fish, linseed or walnut oil have an anti-inflammatory effect.
• Incorporate fermented foods: Yogurt, kefir, sauerkraut, or kimchi contain natural probiotics.
• Reduce sugar and highly processed foods: They promote inflammatory bacteria and should be avoided.
• Avoid being overweight: Every kilo you lose relieves pressure on your joints and improves your intestinal flora.
• Regular exercise: Moderate exercise not only supports joint function but also a healthy microbiome.
• Only use antibiotics in a targeted manner: They can permanently disrupt the microbiome and should not be taken unnecessarily.

Conclusion: The gut-joint axis opens up new perspectives in orthopedics and sports medicine. A disrupted microbiome can promote inflammation and osteoarthritis, while targeted interventions on the intestinal flora can slow the progression of the disease and alleviate symptoms.

Diet, lifestyle, and—in the future—possibly even personalized microbiome therapies offer new hope for patients with osteoarthritis. Therefore, anyone who wants to protect their joints should also pay attention to their gut—and vice versa.

This article is from the EXPERTS Circle – a network of selected experts with in-depth knowledge and many years of experience. The content is based on individual assessments and is aligned with the current state of science and practice.