Add to those things the multiple injuries and such that have occurred (fractures, tendon and ligament tears, etc).
So, basically her approach is as I kind of thought... which is to approach the inflammatory and GI aspect of it and
- Reduce inflammatory food intake - refined sugars/carbs, gluten, processed meats, saturated fats, etc...
- Support gut microbiome - a lot of times with inflammatory diseases, she'll see SIBO and other bacterial overgrowth that keep your body from uptaking supportive nutrients... which can be balanced with elimination dieting and then adding probiotics and healthy-gut things like lots of ferments to your diet.
- Add lots of supportive foods - dark leafy greens, red/blue fruits (anthocyanins), nut and fish fats (including fish, cod liver, salmon oil supplementation), etc...
- Supplementation-wise: curcumin (turmeric compound) that has piperine (black pepper compound), boswelia, quercetin, hyalurnoic acid, biotin, and collagen - look for forms of these that are highly bio-available, and, of course, look into any contraindications or interactions with whatever you're taking already.
I've got RA/synovitis issues from Lyme disease... the efficacy of just a highly bio-available curcumin/piperine supplement is pretty amazing with managing it. I took a few different supplements for a while with little effect, but once I started using one from the brand Integrative Therapeutics, I really noticed a difference.
Also yoga. Any little bit you can do makes a difference. My mom's wife is in a wheelchair with basically an entirely fused back, both knees replaced, all sorts of etc. (horrible car accident in her 30's and generally poor health maintenance, plus 40+ years of smoking)... her condition and quality of life got worlds better when her PT gave her some chair yoga exercises to do.
Realize it's a lot to swallow (also just an overview) and maybe you've heard a lot of it before... but.. figured I'd give you our perspective. Might give you some things to look into on some of those sleepless nights.
edit: Oh, and WATER! Almost no one, myself included, drinks enough water consistently. So many of my wife's clients see a huge improvement by just putting periodic reminders on their phones to drink a glass of water.