Epigenetic Modification in Osteoarthritis through Physical Activity – From Palliation to Prevention

Momcheva I, Gonchev V and Valkov M

Published on: 2025-02-12

Abstract

The heterogeneity of joint structures is a limiting factor for effective treatment of osteoarthritis (OA). The ineffectiveness of available therapies at this stage is also due to challenges such as long-term stability, safety, and efficacy. At the same time, patients suffering from osteoarthritis prefer therapeutic strategies that involve medication and joint replacement, rather than engaging in preventive measures. Most of them are not motivated to step out of their comfort zone, change their stereotypes, make new decisions, and follow through with them, becoming proactive in managing their disease. There is a need for a transformation in the disease management strategy: from treating the symptomatic end stage of OA to finding biomarkers for "pre-osteoarthritis", that is, from palliation to prevention.

Physical activity (PA) modulates epigenetic mechanisms related to various chronic diseases. Moderate exercise alters the levels of pro- and anti-inflammatory cytokines, regulating immune responses through the activation and differentiation of lymphocytes. The report discusses the mechanisms by which PA modifies gene expression: from influencing mitochondrial biogenesis, telomere length, production of pro- and anti-inflammatory cytokines, to anabolic and catabolic processes in hyaline cartilage, synovium, muscle, vascular, and adipose tissue. Numerous studies show that PA programs can significantly improve mobility in people with osteoarthritis, even in the elderly. Personalized PA programs, developed by a multidisciplinary team, induce metabolic changes and improve the condition of arthritic joints, clinical symptoms, and functional capacity. They are an inexpensive and accessible method for maintaining physical and cognitive health.