Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered Podcast. I'm Dr Neha Pathak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine. Joint pain is one of those things many of us quietly accept as a normal part of aging. We might minimize it, find a way to live with it, or consider it something we just have to push through.
But for so many people, joint pain doesn't just hurt. It limits independence, it changes our daily routines, and it affects our quality of life in ways that ripple through our families, especially for those of us caring for aging parents while also thinking about our own long-term health. Today's episode is an important one because we're taking a step-by-step approach to what joint pain in aging really means and what we can do about it.
We'll talk mostly about osteoarthritis, the most common joint condition in older adults. We'll talk about how to recognize it, how it differs from inflammatory arthritis conditions, and why your experience with pain and function matters more than what an X-ray shows.
We also explore practical, evidence-based strategies for movement, weight management, and nutrition to physical therapy that can help people stay mobile, independent, and engaged in their lives at every age. First, let me introduce my guest, Dr Una Makris. Drawn to both rheumatology and geriatrics, Dr Makris completed her fellowship in rheumatology at Yale University with a clinical research focus on degenerative musculoskeletal conditions that affect older adults. She's particularly interested in the study of musculoskeletal pain in older adults and in developing effective interdisciplinary behavioral interventions with the goal of ultimately improving outcomes.
Welcome to the WebMD Health Discovered Podcast.

Una Makris, MD, MSc: Thanks so much for having me. I'm looking forward to this discussion.

Pathak: Before we dig into all of my questions for today, I'd love to ask about your own health discovery, whether that relates to your work with patients or your research. How did you come to this particular work?

Makris: So I have always been passionate about taking care of older adults in rheumatology. And so this has really been the perfect opportunity to bridge rheumatology and geriatrics by kind of focusing on how to improve outcomes that matter most to older adults with these conditions.

Pathak: That's great. And, you know, I will say that this is becoming a topic of more and more interest to me. So I'm not only a primary care physician, but someone that's sort of living in my real life at the intersection of caring for older parents and then also looking at my younger children and trying to prevent them and me from developing some of the conditions we're seeing in our household.
So as a really concrete example, my mom, who is in generally very good health, recently, you know, I've noticed her kind of hobbling around her apartment a little bit more than usual, but I had recently taken her out to go shopping and I noticed she was limping so hard she had a hard time even just getting from the sidewalk to the road where our car was without assistance.
Then, when I asked her what was going on, she said, oh, well, my knee has been bothering me and this has really been something that's bothered me for years, and now it's just to a point where I just can't move as freely as I used to, and that's just something I expect to happen as I age. And so she hasn't said anything to me about it and we haven't really done anything to help her.
So what you do is so interesting to me at the intersection of aging and joint disease.

Makris: And I think the scenario that you just highlighted is incredibly common. I'm in a similar situation, that sandwich generation, raising younger kids, also helping out with my aging parents, and mobility and joint pain really contribute to quality of life and functional status. So I think this is a really kind of timely conversation to have.

Pathak: So what are some of the most common joint problems that you see in your clinic or that people experience as they age?

Makris: The most common joint problem is osteoarthritis, and that really does increase with age. About 25% of individuals in their fifties will report symptomatic osteoarthritis, and this increases to nearly 50% for those in their sixties and seventies. Osteoarthritis is commonly found in the knees, the spine, the hips, hands — nearly any joint can develop osteoarthritis.
And I would say that multi-site OA is most common. Other types of arthritis can include crystal arthritis. These include gout and calcium pyrophosphate, or pseudogout, as well as rheumatoid arthritis, which is the prototypical autoimmune inflammatory arthritis. We see a bimodal distribution.
What this means is rheumatoid arthritis can be diagnosed at both younger and older ages. And then there are quite a few other inflammatory arthritis conditions such as psoriatic arthritis as well as inflammatory spine pain or axial spondyloarthritis. And a lot of what I do in my clinic is try to distinguish between a younger patient diagnosed with an arthritis aging with that condition versus an older adult who comes to me with a new onset of arthritis.
And that does make a difference.

Pathak: So, yeah, that's really helpful. So when you are thinking about that patient in that category of someone who's developing arthritis as an older adult or someone who's aging, what are you thinking about to distinguish between these different categories?

Makris: So a lot of what I do in my clinical practice and what we do in rheumatology is distinguishing inflammatory versus non-inflammatory conditions. And so osteoarthritis is the most common arthritis. It is traditionally thought of as non-inflammatory, but I will say at the cellular level there are quite a few inflammatory markers, but it can't compare to the inflammation that we see in a condition like rheumatoid arthritis.
So I'm really looking at, for example, how much morning stiffness a patient has. If you have five minutes or 10 minutes of stiffness in your hands or your knees, that lends more towards osteoarthritis. If you have more than 30 to 60 minutes of stiffness that involves, let's say, certain joints in your hands in a certain distribution, I might consider rheumatoid arthritis. So it's really the character of the pain, how much stiffness, and the distribution of the pain that helps us distinguish type of arthritis.

Pathak: That's really helpful. And then are there certain lab tests or other types of tests that you're going to use to help distinguish further?

Makris: Certainly, I base everything on the history that a patient tells me along with my physical exam, and then use that to guide which laboratory tests to check and then what imaging could help also confirm the diagnosis or lead me in a different direction. So, for example, in rheumatoid arthritis, the tests I like to check for are rheumatoid factor and anti–citrullinated protein antibodies — that is highly specific for RA.
Those, interestingly, can be negative in older adults with RA, so it's not 100%, but those are typically very helpful if they're positive to feel confident we have rheumatoid arthritis in the appropriate clinical scenario. Similarly, I have other kind of rheumatologic review of systems that might lead me to check an ANA, anti-nuclear antibodies, that might lead me to diagnose another connective tissue disease like lupus or Sjogren's or scleroderma, which may be a different discussion from today's.

Pathak: I think that that is really helpful and really important as we sort of then shift gears to really focus on the arthritis that's most common in aging, which is osteoarthritis. So help us understand a little bit about what is going on inside of the joint of someone with osteoarthritis.

Makris: Osteoarthritis is actually a very complex condition. It's an interplay of mechanical and biochemical and cellular processes that lead to progressive joint degeneration. And so it's a combination of cartilage breakdown. It's also a combination of how we respond and try to repair.

Makris: There also is some what we call synovial inflammation and underlying bone changes. What we end up seeing on X-rays is joint space narrowing, and then what the patient reports to us is typically pain. Now, I think it's really, really critical to recognize that the majority of older adults might have radiographic findings of osteoarthritis or joint space narrowing. However, in the absence of pain or other symptoms, that doesn't make me concerned about osteoarthritis, so I don't use the X-rays to necessarily diagnose the OA. I'm really listening to the patient about their symptoms and functional status because the majority of patients may have radiographic or X-ray findings of arthritis, but it's all about the clinical symptoms.

Pathak: And then I'd sort of love to shift to a question that a lot of patients ask, which is, is there anything I can do as I'm aging to prevent developing symptomatic osteoarthritis? So is it just that if my mom has a really severe case, I'm going to have it? Or if I had an injury to my knee in my youth, then as I age it's just going to worsen over time? Can you talk to us a little bit about whether or not this is something we can prevent with regard to progression?

Makris: It is such a good question, and I think that's what I love most about working with my patients over time to improve outcomes for joint pain, because a lot of them ask, what can my child do to prevent this? And I think that what it boils down to is actually lifestyle. And I think that lifestyle truly is an important component of joint health and can potentially prevent progression of OA.
So when I think of lifestyle, these are things that encompass all aspects of health that we may be able to control to some extent. So, for example, when I think of lifestyle, I think of physical activity and exercise and moving the body. We also think about joint injury prevention. I think about weight wellness also under the umbrella of lifestyle as well as nutrition and all the various ways we fuel our bodies. And then I think about other aspects of behavioral health such as mood and our attitude, which is so critical to how we show up each and every day, and this contributes to how we manage chronic diseases, including arthritis.
So many of these lifestyle components are something we can integrate early on as children, as habits, as lifestyle factors. And then as we get into our twenties and thirties, fifties and sixties, I really think that it will contribute to reducing the severity of joint pain.

Pathak: I love what you're saying. One, because I am a lifestyle medicine physician, but also because I think this really gives folks actionable information, an actionable framework that is going to be beneficial in so many aspects of their life before they may experience symptoms. So let's work our way through some of the lifestyle pieces that you mentioned.
So let's start with the impact of weight, which itself has some factors related to lifestyle. So can you tell us a little bit about how weight plays a role in joint health?

Makris: Certainly. So carrying more weight can increase mechanical stress on weight-bearing joints. And typically we think of the knees, the hips, the spine, and this might accelerate osteoarthritis. We also are gaining more understanding around how adipose tissue produces inflammatory cytokines or proteins. And this can also influence systemic inflammation and can lead to joint pain. So I think that weight management is absolutely a critical aspect of managing joint pain. And what I usually tell my patients in clinic is that losing one pound reduces knee load by three to four pounds per step. So if you lose 10 pounds, that's nearly 30 to 40 pounds less on the knee per step. And so we know that less stress mechanically on the hips, the spine, the knees, the ankles also improves mobility, and that can reduce discomfort. And what the literature really shows is that a combination of weight loss and exercise really produces the best outcomes for pain reduction and improving function. And some studies even show slower radiographic or X-ray progression of knee osteoarthritis in people who lose weight.

Pathak: That's great, and I'm glad you brought that up because I want to ask a question about follow-up. So should the takeaway be that, you know, as you're losing weight, you're really sort of thinking about and looking at how you're feeling, how your symptoms are, rather than a follow-up X-ray to show some change in the amount of degenerative disease because you're not necessarily going to see that. Is that correct?

Makris: That's right. I think that it's a terrific question. What does success look like when we're managing joint pain? I don't think that it's all about the X-ray or the lab value. It's really how do you, as the patient, feel? Are you able to do the things you want to do, need to do in your day-to-day life? And so I tend to focus the conversation around function. Pain greatly impacts function and we tend to emphasize pain so much — you know, what's your pain intensity, zero to 10. But I like to reframe the conversation around, okay, great, what are you able to do? Let's talk about your functional goals. And so I like to follow those functional goals or, in simple terms, you know, what matters most to you. Are we able to achieve that by working on various aspects of the joint pain?

Pathak: I love how you have sort of talked about reframing the goal. I'm gonna shift us then to exercise a little bit more. Can you tell us a little bit more in depth? We are seeing so many more media stories about the data coming out around exercise and the benefits for degenerative joint disease. So tell us a little bit about what we should know.

Makris: Absolutely. So I'll just put it out there. You know, I think that there's been a longstanding myth that physical activity or exercise is harmful for patients with arthritis. And the fact is that research shows that movement and exercise are beneficial for arthritis and that regular appropriate activity can help reduce the pain, it can improve joint function, and may even slow disease progression when started early. And so I really try to focus on, you know, certainly we can talk about the types of exercise for joint health, but then we wanna talk about how much exercise or physical activity, and then we wanna talk about how to promote it, enhance it, how to motivate our patients to actually do it. And a lot of my research actually focuses on that aspect.

So when I talk about the types of exercises for joint health, we're really looking at low-impact aerobic activities. These can include walking, cycling, swimming, the elliptical, and that improves cardiovascular health without putting excessive stress on the joints. Another type of exercise is strength training, and that could be body weight exercises or resistance bands, and that really supports the message that strong muscles support and stabilize the joints, and that will help reduce the strain. I also talk about flexibility and stretching. In this category, we encourage yoga, sometimes modified, or Pilates or gentle stretching, and that maintains range of motion and reduces stiffness. We encourage balance and stability exercises. For example, Tai Chi has been shown to prevent falls and that could reduce joint injuries. And then a lot of our patients with osteoarthritis enjoy aquatic exercises because the water reduces joint load while allowing full movement.

So a lot of organizations will recommend 150 minutes per week of moderate-intensity exercise. That includes strength training sessions, flexibility, and balance. And what I tell my patients is really, something is better than nothing, and start somewhere and build up safely. So I think it's really important not to make exercise or physical activity as a concept overwhelming to patients. I don't think that you need fancy outfits. You don't need the fancy tennis shoes or the gym membership. I think that you can incorporate physical activity into your day to day in a way that is cost effective and sustainable because ultimately we want our patients to engage in it, and really asking how can we incorporate these modalities into your daily life is probably the most important.

You can use the phrase, if you don't use it, you're gonna lose it, meaning if you don't use the muscles and kind of improve range of motion of your joints, they may become more stiff or less strong. I think other messages you can use are move in ways you enjoy — fun makes it easier to stick with — or start where you are and progress at your own pace. I really think that how we communicate to our patients the importance of activity is critical. So I also encourage my patients to set smaller goals that are more achievable because if they are successful, that becomes a feedback loop for them. I also encourage them to use tracking devices so they can track their progress, whether it's an app or if they prefer to write it down on a piece of paper or a journal or to even put it in their cell phone. And then I really love if my patients buddy up and have social support with their physical activity. I think that walking with a friend, a relative, a caregiver, really anybody makes it more fun potentially and also provides accountability.

Pathak: Does your counseling shift as people age? So you mentioned sort of slowly ramping up to what can become sustainable in your own life, but I'm curious about how you counsel older patients. What is the role for using physical therapy? And how do you counsel around using pain as a signal for what to do and what to sort of limit?

Makris: These are great questions. So I feel like every patient I see should go to physical therapy. So I get along very well with the physical therapist, and it's really important to find a physical therapist who understands musculoskeletal pain and aging. And I think that PT really is essential for muscle strengthening, for flexibility, for range of motion, but also teaching the patient how to do this correctly at home. Because the concept of going to PT is terrific while you go to the physical therapy office, but once those sessions are over, the critical part and the hard part is maintaining the home exercise program at home and doing this correctly and not causing injury. So I think that using pain as a guide, as a kind of reminder of maybe when to stop pushing and when to pause is important.

When I think about my aging patients, sometimes I don't wanna make assumptions, but sometimes my older adults need a mobility device because they're at high risk for falling. So how do you incorporate a walking program safely that includes a cane or a mobility device? I don't think that my patients should avoid walking or physical activity. I just think we need to modify it, keeping in mind maybe some of the risks associated with sarcopenia — lower muscle strength and quality with age. So how do we adapt some of these physical activity suggestions for our older adult?

Pathak: Can you talk to us a little bit about where does the evidence stand with food, with diet? We did talk about at the beginning of the episode the difference between inflammatory arthritities or types of inflammatory arthritis like rheumatoid or psoriatic, and we're really focusing more on osteoarthritis, but there is still that inflammatory component. So can you talk to us a little bit about what we know around nutrition?

Makris: Yes, so nutrition plays a key role in joint and bone health. And so what we're learning more these days is — and I'll be specific about the types of foods here — foods rich in calcium and vitamin D, like dairy, leafy greens, fortified products, support strong bones while lean proteins help maintain muscle that can protect the joints. When we talk about an anti-inflammatory diet or eating pattern, these typically emphasize omega-3 fatty acids, and that you can find in foods like salmon, walnuts, flax seed. You can find them in colorful fruits and vegetables, whole grains, and spices like turmeric. These can help reduce inflammation and potentially pain. And I think it's really important to also be aware of the flip side of limiting processed foods, sugary drinks, and excessive red meat, which also supports overall joint health. And those foods actually contribute to more inflammation.

Pathak: I will say, one of the most common questions I get from patients, family members, others is, well, should I get this supplement or should I get this capsule? You mentioned turmeric, which is a very traditional part of cooking from my cultural tradition, but I'll still get questions about along with it in my food, should I get a capsule? So can you talk to us a little bit about how you counsel your patients around these types of questions?

Makris: Absolutely. Again, I look forward to the day where we have more evidence that supports the specific dose and administration of some of these supplements. For example, patients will often come to me in the context of knee osteoarthritis asking about glucosamine chondroitin, for example. And so they'll come to me and ask, you know, what do you think about this? And I'll say, are you already taking this medicine? And they'll say, yes. And then I will ask, does it help you? And the key is many of them say, no, it doesn't. And then I will reflect that that is consistent with the literature. The literature does not suggest that it improves pain or function. However, some patients do say it helps, and if they can afford the medicine and if it's actually helping with pain and potentially function, I'm all for it as long as it's not harmful or providing toxicity or drug-drug interactions. So that's where I stand. I'm very open if patients want to try certain supplements, but very commonly these may be heavily marketed with limited outcomes available, yet very expensive and potentially interact with some of the other medications that can cause abnormalities, for example, in the liver.

Pathak: I'd love to kind of move us towards other things that I would love your thoughts and insights on. So things like posture, sleeping position — is there data, is there literature to help us understand what we should know about the way we sit, stand, sleep? If we have, I hear a lot about people with flat feet — if you have flat feet, should you be looking for orthotics to correct that so that you don't have long-term joint issues? Can you give us a little bit of insights around what we know around posture?

Makris: Absolutely. So poor posture, as you suggested, can certainly lead to uneven weight distribution, increased wear and tear on joints over time, especially in the spine, hips, and knees, and maintaining good posture helps keep the joints in their natural position that can support balance and even prevent pain or long-term damage. So I think it's really important to be aware of our muscles and joints, whether we're slouching or leaning forward, where we hold our tension. All of this is important, and I think this is in part what mindfulness teaches us to do, and I do think that there may be small changes in what we do every day that make a difference. So how we sit, stand, and sleep can impact joint health. Maintaining good posture while sitting, so keeping your feet flat, your shoulders relaxed — I know a lot of us keep our tension in our shoulders — and then avoiding slouching all reduces strain on the spine and the hips. Then when standing, distributing your weight evenly, too, and avoiding locking your knees. For sleep, I think choosing supportive mattresses and pillows that keep the spine aligned and avoid positions that twist the joints — I think these simple adjustments help reduce tension, prevent unnecessary stress, and support long-term joint comfort and mobility. You mentioned flat feet and pes planus, which is incredibly common. So sometimes I do talk about footwear, and I just kind of point out the shoes that I see in clinic that may not have arch supports. So I am a fan of, you know, ordering arch supports for my patients who have flat feet because I do think it can contribute, especially to some strain and potentially tendonitis in the lower legs. And I think that all feeds in from a mechanical standpoint to more upstream and more proximal symptoms in the knee, for example. So whatever is happening in the feet, if you have flat feet, if you have ankle pain, that typically can also impact the joint above it because of compensatory mechanisms, for example. We all try to kind of compensate if we have pain or discomfort on one side or in one area, so it might emphasize and load another joint in a different way over time.

Pathak: What I love about our discussion today is that you have really helped us see some of these lifestyle interventions as treatment, but that when we start early in life, they can also play a role in prevention. So let's kind of get deep into that sandwich now and think about our kids. How do you think about preventing long-term joint risks or the risks for joint pain in younger people with regard to injury prevention or healthy movement? How do you think about this, and how do you practice this in your real life?

Makris: It's a great question. I don't know that I get it right all the time. I have two daughters, ages 16 and 14, who are both athletes. I try to role model, but I think the key is, you know, parents can help children prevent future joint pain by promoting physical activity, promoting the lifestyle changes that we've talked about, teaching safe movement, encouraging flexibility and strength, supporting healthy weight, and modeling joint-friendly habits. I think that conversations with our children, with our family members, should be age-appropriate, positive, fun, focusing really on the lifespan and focusing on health and function rather than kind of fear of injury and pain. So I think that one of my goals is really to help my children develop lifelong habits for joint health. And I think that what I try to incorporate, and this is very concrete, is we do family activities together that include something physical like walking or biking or hiking, whatever you have access to. Everyone needs to keep moving. We plan meals together, and sometimes my kids teach me about kind of meal prep that's popular these days and nutrient-rich foods. And then I like to encourage a variety where we mix sports and active play and flexibility exercises. Then what we try to do in our family is really talk about what worked and celebrate the small wins. You praise your children on kind of consistency, not just performance or a medal, but it's about consistency and habit formation. And then when there's an inevitable setback — someone gets sick, someone gets injured — I think normalizing rest and recovery and explaining that, you know, muscles and joints need time to grow and stay healthy is important. And then lastly, I'm really big on sleep. I think it's really something that we underestimate, how important it is for children and parents and grandparents to all have restorative sleep because it's our time to recover during those hours of rest.

Pathak: Well, I just wanna thank you so much for this conversation. I'd love to cede our last few minutes to you. When it comes to having that conversation around whatever your question is with regard to joint pain, whether you're managing chronic pain or you are thinking about what you can do to prevent it in the future, what do you suggest are the best steps to talk about it in the office with your healthcare provider?

Makris: Sure. I think that one thing I actually love, and I've started to embrace, as my patients look to artificial intelligence and Google and AI, they come to me and they ask very pointed questions, intelligent questions that all lead to one question: that is, doctor, how can I improve my own outcomes? And when a patient comes to me asking, how can I be engaged in such a way to improve my own outcomes, I know this is going to be a great partnership because they are already motivated to do the hard things at home. You know, when I see them in clinic, that's only, you know, a small 30-minute snapshot. But how can they take this back into their community, into their home setting? So the things I would encourage my patients when they ask, how can I improve my outcomes, are: one, engaging in regular physical activity is essential for maintaining joint function and overall musculoskeletal health. Incorporating short bouts of walking, stair climbing, low-impact exercise, whether it's swimming, cycling, yoga, several times per week to promote mobility and cardiovascular fitness is key. Strengthening exercises such as body-weight movements, balance training combined with stretching routines is incredibly helpful for various muscle groups and can preserve flexibility and stability. The next would be nutritional strategies that include a diet rich in fruits, vegetables, lean proteins, and whole grains. Also supports weight management, reduces mechanical stress on joints, and then joint protection measures such as maintaining proper posture, using supportive footwear, pacing activities, minimizing strain, and preventing injury are all critical, and I think that integrating these behaviors into family time and family routines really enhances adherence and long-term outcomes. And I'll just end by saying that consistent, incremental changes rather than perfection are really key to sustaining joint health across the lifespan.

Pathak: Really, really helpful. I wanna thank you so much for all of that advice.

Makris: You're very welcome. Thank you for inviting me.

Pathak: I'd like to close this episode with three of my key takeaways. First, joint pain isn't just part of aging. Osteoarthritis is common as we get older, but pain, stiffness that limit daily activities are not something we have to accept without help. Treatment success should be measured by improvements in function and quality of life, not imaging results. Second, movement is medicine, even when your joints hurt. One of the biggest myths we addressed today is that exercise worsens arthritis. In reality, regular low-impact movement — everything from walking to swimming, strength training, or flexibility exercises — can actually reduce pain, improve joint stability, and help maintain independence. Physical therapy plays a key role in teaching a safe, personalized movement we can continue at home for the long haul. Finally, small sustainable lifestyle changes can protect joints across the lifespan. Weight management, healthy nutrition, posture, supportive footwear, and adequate sleep all influence joint health. So even modest weight loss can significantly reduce stress on the knees, and healthful eating patterns may support both pain control and function in our joints. As we often say on this podcast, the goal isn't perfection. It's consistent incremental changes that support long-term mobility for you and the people you care about. To find out more information about joint pain, Dr Una Makris and her work, make sure to check out our show notes. Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform. If you'd like to send me an email about topics you are interested in or questions for future guests, please send me a note at [email protected]. This is Dr Neha Pathak for the WebMD Health Discovered Podcast.