Healthcare Professionals

About Osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis worldwide1, affecting 7% of the global population2. It is often referred to as degenerative joint disease or ‘wear and tear’ arthritis.

OA is a leading cause of disability in older adults and negatively impacts quality of life. OA related joint pain can cause functional limitations such as loss of independence, fatigue, low mood and poor sleep1. OA is a common reason for consultation in general practice, with 1/3 of adults aged 45 years and over having sought treatment for symptoms1. Classical treatments for OA, often focus on symptom relief only and not the root cause. Long term use of many of these medications can cause serious side effects4.

What happens in a joint with osteoarthritis?

Cartilage is a firm, slippery tissue than cushions the ends of bones and enables smooth joint movement. OA begins when this protective cartilage breaks down and wears away, eventually causing friction and damage to the whole joint structure.

Whilst OA can affect any joint, it most commonly affects joints in the hands, knees, hips and spine. Changes to the joint usually occur gradually and can get worse over time.


The severity of OA symptoms can vary from person to person and between affected joints.


Stiffness of the joints may be more noticeable upon awakening or after long periods of inactivity

Bone Spurs (Osteophytes)

Extra bits of bone can form around the affected joint. Often, they may feel like hard lumps under the skin


Inflammation and an increase in synovial fluid within the joint may cause swelling

Loss of flexibility and range of motion

Joints may not move as freely or as far as normal


Joints may hurt during of after movement or at the end of the day

Grating sensation

Movement of the joint may cause a crackling or grating sensation


Joints may feel tender when light pressure is applied

Arthelio - Stages --03

What are the risk factors for osteoarthritis?

Bone Density

High bone density has been found to be associated with OA at the knee and hip.


 Being overweight or obese puts more stress on joints, particularly weight bearing joints like the hips and knees.
Obesity may also have metabolic effects and cause low grade inflammation, a factor now thought to contribute to the
development of OA.

Joint injury

 Injury, overuse of a joint causing repetitive stress, or joint surgery may lead to OA at that site later in life.


Genetics are a key risk factor for OA of the hands and play a smaller role in OA of the hips and knees


Certain occupations that involve physically demanding work and repetitive movements can cause excessive stress on a joint and increase the risk of OA


Onset of OA is more common in people in their 40s and increases with age


OA is more common in women than in men for most joints. It often starts after the menopause

Arthelio - Stages --02

What are the stages of osteoarthritis?12

Stage 1

Minimum loss of cartilage, doubtful narrowing of joint space

Stage 2

Cartilage beginning to break down, Joint-space narrowing, occurrence of bone spurs

Stage 3

Moderate joint-space reduction, multiple bone spurs, possible deformity of bone ends

Stage 4

Joint-space greatly reduced, large bone spurs, definite deformity of bone ends

The Gut Microbiota and Osteoarthritis

In addition to mechanical and other risk factors, accumulating evidence suggests that the presence of chronic low-grade inflammation has a role in the development of osteoarthritis. This low-grade inflammation appears to be related to the composition of the gut microbiota¹¹.

An imbalance of the gut microbiota, known as dysbiosis, can lead to increased permeability of the intestinal wall. This facilitates the movements of pro-inflammatory molecules such as endotoxins into the blood. These endotoxins can activate the immune system and cause systemic low-grade inflammation, which may ultimately lead to breakdown of the joint structure5 6 7.

Osteoarthritis @3x

The link between dysbiosis and osteoarthritis offers new therapeutic opportunities to help patients manage the condition. By modulating the composition of the gut bacteria it may be possible to reduce the progression of osteoarthritis5.

† Dysbiosis: Adverse alterations in the diversity, structure or function of gut microbiota that is associated with disease

Microbiome Based Strategies

An insight into mechanisms

Specific bacterial strains and their metabolic components
can reduce translocation of endotoxins across the intestinal barrier, into general circulation 8,9

May reduce Inflammation within
the cartilage 9

Bifidobacterium longum CBi0703:

Bifidobacterium longum CBi0703 has been fully characterised and selected for use in osteoarthritis based on its immunomodulatory properties 13 14

Preclinical Data

Preclinical model of primary osteoarthritis9
  • Control group: received H20
  • Intervention group: received inactivated culture of Bifidobacterium Longum  CBi0703

Results: % of moderate to severe osteoarthritis

CONCLUSION - CBi0703 reduced cartilage structural lesions and cartilage degradation markers, providing an overall joint protective effect.

User Study: Evaluation of therapeutic satisfaction of the product10
(Bifidobacterium Longum CBi0703 + Vitamin C)

3 month 
 user study

320 male and females with mild-moderate osteoarthritis

1 capsule/day (Bifidobacterium longum CBi0703 + Vitamin C)

Outcome Measures

Frequency of flare up

Duration of flare up

Pain Intensity

(Visual Analogue Scale (VAS))

Analgesic/ NSAID use

CONCLUSION - The combination of Bifidobacterium Longum CBi0703 + Vitamin C reduced the frequency, duration and intenstiy of painful flare ups in patients with OA and reduced the consumption of pain and anti-inflammatory medication

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  1. Hawker GA (2019) Clinical and Experimental Rheumatology 120(5), 3-6.
  2. Hunter DJ et al. (2020) The Lancet 396, 1711-1712
  3. Arthritis Research UK (2013) Osteoarthritis in general practice.
  4. Reijman M et al. (2005) Arthritis and Rheumatism 52(10), 3137-3142
  5. Favazzo LJ et al. (2020) Current Opinion in Rheumatology 32(1), 92-101
  6. Huang Z et al. (2016) Nature Reviews Rheumatology 12(2), 123-129
  7. Hao X et al. (2021) Arthritis Research and Therapy 23(42)
  8. Romond MB et al. (2008) Anaerobe 14(1), 43-48
  9. Henrotin Y et al. (2019) Cartilage. doi: 10.1177/1947603519841674
  10. Internal data
  11. Chisari E et al. (2021) PLoS ONE 16(12).
  12. Kellgren J, Lawrence J. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957;16:494-502.
  13. Scuotto et al. (2016) International Journal of Biological Macromolecules 82 653-662
  14. Henrotin Y et al. (2019) Cartilage. doi: 10.1177/1947603519841674
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