For decades, patients have been told a simple story about knee osteoarthritis: it is a disease of “wear and tear.” You used your knees too much, you got older, the cartilage wore down like the tread on a tire, and now it hurts.

But what if I told you that for a significant number of patients, this story is incomplete, or even flat-out wrong?

At the Madras Joint Rejuvenation Centre (MJRC), we see many patients whose pain seems disproportionate to their physical activity or age. They have tried painkillers, braces, and physiotherapy, but the deep, throbbing ache remains.

In my latest video presentation (embedded below), I explain the reason why: we have moved past the simple “wear and tear” model and now understand a distinct, aggressive phenotype known as Metabolic Osteoarthritis.

To understand metabolic arthritis, you must understand inflammation.

Acute inflammation is necessary. If you cut your finger, your body rushes immune cells to the area to fight bacteria and heal the wound. Once healed, the inflammation stops.

In metabolic osteoarthritis, that “stop” signal never comes.

Think of your immune system like a fire alarm in a building. When there is smoke, the alarm blares, and the sprinklers turn on. But imagine if the alarm gets stuck “ON” even after the fire is out. The sprinklers keep running, eventually rotting the wood and destroying the building’s structure.

In your knee, this chronic, low-grade inflammation acts like those sprinklers. It slowly degrades cartilage and irritates the joint lining (synovium), causing persistent pain that mechanical fixes cannot solve.

The Culprit: When Fat Turns Against You

Where does this constant inflammatory signal come from? In metabolic osteoarthritis, it often comes from our own adipose tissue—body fat.

For years, medicine treated fat as inert storage. We now know that adipose tissue acts like an endocrine organ. It is biologically active. Excess fat tissue, particularly visceral fat around the abdomen, secretes powerful inflammatory proteins called adipokines and cytokines.

These chemical messengers travel through your bloodstream and attack vulnerable tissues—including the cartilage in your knees. This is why obesity is linked to arthritis not just because of heavy load-bearing, but because the body is in a state of systemic inflammation.

The “Skinny Fat” Paradox: It’s Not Just About Weight

This is the most crucial point for many patients: You do not have to be morbidly obese to have metabolic arthritis.

In the video, I share a case study of a patient with a normal BMI. Their routine blood tests showed normal fasting glucose. Their doctor told them they were fine.

However, when we ran deeper metabolic panels at MJRC, we found their fasting insulin was dangerously high. Their pancreas was working overtime just to keep blood sugar normal, flooding their body with insulin—a major driver of inflammation.

This patient didn’t need a knee brace; they needed to address their metabolic dysfunction.

Why Conventional Treatments Fail

If the root cause of your knee pain is a metabolic “fire,” you cannot fix it with purely mechanical tools.

• Painkillers (NSAIDs) temporarily mask the signal but do not stop the fire.

• Braces provides support but do not stop the chemical attack on the cartilage.

• Arthroscopic “clean-ups” often fail because the inflammation returns immediately.

The Future: Treating the Chemistry, Not Just the Mechanics

Understanding that osteoarthritis has a metabolic basis is the first step toward real relief. If we can identify that your body is in an inflammatory state, we can change the treatment plan.

At MJRC, we focus on Orthobiologics and protocols like PRASAD™, which are designed not just to patch up the damage, but to alter the biological environment of the joint, helping to turn off that stuck “fire alarm.”

In my next article and video, I will explain exactly how these biologic treatments attempt to influence this inflammatory memory and promote healing.

Are you frustrated with knee pain that won’t resolve? You may be dealing with Metabolic Osteoarthritis. Contact the Madras Joint Rejuvenation Centre today for a comprehensive evaluation that looks beyond just “wear and tear.”

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Scientific references  for the  video

Scientific References

• Systemic Inflammation & OA:

  • Berenbaum F. et al. “Osteoarthritis as a systemic disease.” Nature Reviews Rheumatology, 2013.

• Adipokines & Cartilage:

  • Gualillo O. et al. “Obesity and osteoarthritis: more than just mechanics.” Osteoarthritis and Cartilage, 2007.

  • Conde J. et al. “Adipokines: novel players in rheumatic diseases.” Nature Reviews Rheumatology, 2011.

• Alarmins & Immune Response:

  • Hotamisligil G.S. “Inflammation and metabolic disorders.” Nature, 2006.

• Inflammatory Memory:

  • Serhan C.N. “Pro-resolving lipid mediators are leads for resolution physiology.” Nature, 2014.

• Metabolic Syndrome & Joint Pain:

  • Sellam J., Berenbaum F. “The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis.” Nature Reviews Rheumatology, 2010.

  • Courties A. et al. “Metabolic stress-induced joint inflammation and osteoarthritis.” Nature Reviews Rheumatology, 2015.