Integrative and functional medicine for osteoarthritis

Many of us have likely experienced joint pain at one time or another—either acute joint pain or chronic joint pain—or know someone who suffers from chronic joint pain. The most common cause of chronic joint pain is osteoarthritis, which commonly affects the knee, hand, and hip. According to an authoritative global study, more than 607 million people had osteoarthritis in 2021 worldwide, and the disease is occurring at younger ages—more than half of all new-onset cases affect adults under 55 years of age (1). A similarly concerning trend is that the age at which people are undergoing total joint replacement surgeries is becoming increasingly younger (2).

In people with osteoarthritis, a leading cause of disability worldwide, is the progression of joint disease and joint pain an inevitable part of life and part of the natural course of disease? For people who have experienced the treatment of osteoarthritis under the conventional medicine paradigm, it certainly feels as if worsening is unavoidable or improvement is beyond reach. However, from the integrative and functional medicine perspective, the progression of joint disease and joint pain does not have to be an inevitable part of aging and course of disease. Why is there such as a divergence between the treatment efficacy of osteoarthritis using the conventional medicine paradigm versus a root-cause approach using integrative medicine and functional medicine principles? We will start exploring this question in this blog, the first of a multi-blog series on osteoarthritis.

Current limitations in conventional medicine treatments for osteoarthritis

The currently available conventional Western (allopathic) medicine treatments for osteoarthritis only target pain, and none have been proven to improve the structure of the joints or affect the progression of disease (3). Physician experts in the field recognize that conventional pharmacologic treatments for osteoarthritis have only modest effects. There is evidence that non-pharmacologic interventions for osteoarthritis are more likely to improve symptoms in the long term, and more likely to prevent or delay a person’s decline in their ability to function in daily activities (4). Because all currently available medications for osteoarthritis do not slow down, stop, or reverse the progression of the joint disease, medications should only be used when symptoms are present. Joint replacements can alleviate pain when all else fails, but it is notable that knee pain is not relieved by joint replacements in about 20-30% of people (2).

The main drugs used for the treatment of osteoarthritis include oral and topical nonsteroid anti-inflammatory drugs (NSAIDs) that are available by prescription or over the counter, such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), indomethacin (Indocin), and diclofenac (Voltaren). However, their well-known side effects limit their use. These side effects include increased risks of stomach and intestinal ulcers and bleeding, kidney injury, increased blood pressure, and cardiovascular events such as heart attack and stroke. Therefore, experts agree that an effective medication that can improve both symptoms and joint structures in osteoarthritis remains the dominant unmet need in conventional medicine (3). However, this current lack of such a medication does not mean that patients with osteoarthritis are destined to live with chronic pain or disability. I continue to witness the successful resolution or significant alleviation of chronic joint pain in patients through a proper holistic approach, without the chronic need to use pain medications regularly.

Integrative and functional medicine for osteoarthritis

An integrative and functional medicine approach to the treatment of osteoarthritis addresses the disease at a much more fundamental level, by individualizing care tailored to each patient’s “modifiable risk factors”, including obesity, dietary pattern, gut microbiome, metabolic dysfunction, environmental factors, physical activity, sleep, and inflammation (1, 3). Advances in osteoarthritis research continue to shed more light on the contributions of modifiable risk factors to osteoarthritis, and the newest advances continue to affirm the wisdom of a holistic approach to the treatment and prevention of osteoarthritis (3). Because of this, the steps and the scope of a holistic approach to osteoarthritis care will continue to expand as new knowledge is added by the latest clinical research.

It is notable that recommendations for osteoarthritis treatment in the setting of conventional medicine visits often do not include proper dietary change or even any discussions on dietary change. However, in my experience practicing integrative and functional medicine over the years, dietary changes make a significant difference in the treatment of osteoarthritis, when done properly as part of a holistic treatment plan that addresses whole-person health. When dietary changes are not seen as making an impact, it is often a result of incorrect change or inadequate level of intensity—in other words, wrong intervention or inadequate dose of the intervention (5). However, the attempt to carry out an intensive dietary intervention, for the purpose of treating and reversing disease, should be done under the close guidance of a physician trained and experienced in the use of lifestyle interventions. (In some extreme cases, I have seen some blatantly wrong, self-prescribed dietary changes, only to promote further inflammation in the body.) Concurrent use of other non-pharmacologic interventions, such as acupuncture, can also make the difference between healing or not. The New England Journal of Medicine and many medical societies agree on the importance of emphasizing non-pharmacologic therapy over pharmacologic therapy in osteoarthritis (4, 6). However, in the typical ten- to fifteen-minute visits of the conventional health care setting, many clinicians will probably find it hard to see dramatic results using non-pharmacologic therapy in osteoarthritis, because the approach truly needs to be holistic and whole-person-based—a goal often difficult to attain with the typical, limiting patient-visit structures. (The systemic issue of misplaced incentives in the current health care system is a whole different topic beyond the scope of this blog, though no less worthy of attention [7].)

Osteoarthritis is not just a disease of the joint

“Osteoarthritis is a serious disease.” These searing words are a recent verdict given by experts from the University of California San Francisco, Boston University, Washington University in St. Louis, and University of Oslo, Norway, writing collaboratively to review the latest scientific evidence on this prevalent disease (2).

Many people—even doctors and specialists who treat osteoarthritis—make the mistake of regarding osteoarthritis as a disease of the joint or of the local tissues surrounding the joint. Experts in the field are working to promote “a holistic framework that defines OA [osteoarthritis] as a disease of the whole organism rather than of a single joint” (2). Evidence from laboratory research and clinical studies is driving a revolutionary shift in understanding osteoarthritis as a disease of the whole person rather than just a disease of the joint.

Unlike rheumatoid arthritis, which is an autoimmune disease of the joints that involves progressive joint destruction due to inappropriate attack by the body’s immune system on the joints, osteoarthritis was historically thought of as an inevitable part of aging as a result of gradual wear and tear on the joints.

When I was in medical school and residency years ago, this was the concept of osteoarthritis that was taught to medical trainees, and treatments focused on the joint itself rather than the whole body. However, the initiation and development of osteoarthritis is much more complex than just wear and tear on the joint. Research evidence has come together to paint a picture of osteoarthritis onset and progression as being driven by the exchange of signals among joint tissues, immune pathways, and systemic factors such as aging, obesity, and sex-specific biology (2). So in recent years, the understanding in the field of osteoarthritis has evolved to characterize it as a systemic disease—that is, a whole-body condition.

In essence, the understanding and treatment of osteoarthritis in conventional medicine has started to shift toward an approach similar to integrative medicine and functional medicine, taking on a more holistic view. In fact, I have observed—and leaders in functional medicine have commented—that integrative and functional medicine tends to lead the practice of medicine by a decade or more in therapeutic understanding and approaches, and conventional medicine eventually catches up to what functional medicine physicians have understood and championed for years.

Osteoarthritis is not an inevitable part of aging

Despite a common misconception, osteoarthritis is not an inevitable part of aging. There are people who do not have knee pain or structural damage as they age, so aging and osteoarthritis can be two different processes (8).

A shift in understanding the true nature of osteoarthritis as a disease of the whole person, as we have begun to explore in this blog, is the first step to preventing, treating, and managing this chronic and potentially debilitating joint disease fundamentally and holistically.

In the next blog, we will discuss in more detail what is happening at the whole-person level in osteoarthritis. 

References

1.  Golightly YM, Sheree SS, Allen KD. Epidemiology of osteoarthritis: 2026 update of the evidence. Osteoarthritis Cartilage. 2026;34(10):1412-24.

2.  Collins KH, Haugen IK, Neogi T, Guilak F. Osteoarthritis as a systemic disease. Nat Rev Rheumatol. 2026;22(2):105-17.

3.  Kloppenburg M, Namane M, Cicuttini F. Osteoarthritis. Lancet. 2025;405(10472):71-85.

4.  Sharma L. Osteoarthritis of the Knee. N Engl J Med. 2021;384(1):51-9.

5.  Rosenfeld RM, Kelly JH, Agarwal M, Aspry K, Barnett T, Davis BC, et al. Dietary Interventions to Treat Type 2 Diabetes in Adults with a Goal of Remission: An Expert Consensus Statement from the American College of Lifestyle Medicine. Am J Lifestyle Med. 2022;16(3):342-62.

6.  Katz JN, Arant KR, Loeser RF. Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. Jama. 2021;325(6):568-78.

7.  Saini V, Garcia-Armesto S, Klemperer D, Paris V, Elshaug AG, Brownlee S, et al. Drivers of poor medical care. Lancet. 2017;390(10090):178-90.

8.  Loeser RF, Collins JA, Diekman BO. Ageing and the pathogenesis of osteoarthritis. Nat Rev Rheumatol. 2016;12(7):412-20.