Osteoarthritis: It’s not just old age

Clarice* woke up to yet another morning of severely stiff joints. She sat on her bed holding her pelvic floor muscles tightly to suppress the urge to void her bladder. The full bladder had woken her up but now all she could do was sit there, counting down from 10, willing her knees to cooperate so that she could make it to the toilet before her bladder sphincter gave.

It took about 15 minutes before she could gingerly hobble to the toilet and relieve herself. As she sat on the toilet bowl doing her business, she inspected her knees. They were slightly swollen and though the stiffness was wearing off, she knew it would be another day of pain. She quickly shelved her plans of going to the office and settled in to work from home.

This has become her daily routine. At first, she attributed it to the change in lifestyle that was occasioned by the Covid-19 pandemic, spending long hours in the house and unable to go to the gym. But two years on, Clarice has slowly accepted her new disposition. She is grateful that her employer has continued to support working from home.

Clarice is only 42. She has struggled with osteoarthritis for the past four years. She was way more fearful of the condition than she lets on. She watched her late mother struggle with osteoarthritis almost all her life. She remembers the constant painkillers, the repeat physiotherapy sessions and the eventual knee replacement surgery and she whispers yet another prayer to the Lord above to give her an easier journey.

Osteoarthritis, a chronic condition of the joints that results in joint aches, stiffness and swelling, affects at least 15 per cent of our population. It commonly affects the weight-bearing joints including the hips and knees but it also does involve the hands, particularly the joints of the fingers.

This condition has been assumed to be a result of aging, leading to a general assumption that as we all get older, it is expected to catch up with all of us. What then, becomes the cutoff age?

Osteoarthritis has been understood to be a dysfunction of the various components that make up a joint; the cartilage, the surrounding bones, the synovial fluid, and the muscles that hold the joint together.

The affected joints are generally highly mobile. In order to protect the bones from grinding against each other during motion, there is a padding between the bones known as cartilage that separates them. This is lubricated by synovial fluid, a protein-rich liquid that provides nutrition to the cartilage.

In osteoarthritis, there is wear and tear of the cartilage, triggering inflammation, resulting in the pain and swelling. The cartilage wears off, reducing the protection it offers and in the long term, the bones grind against each other, breaking and down and trying to reconstruct, with loss of normal architecture. The joints eventually become deformed, affecting motion and function.

What triggers osteoarthritis? The more straight-forward causes include injury to the joint. For those who have had infection in the joint, inflammatory conditions like gout, trauma to the joint and surgical interventions within the joint, they run an extremely high risk of development of secondary osteoarthritis.

This also applies for those whose lifestyle exposes them to sustained low-grade continuous trauma such as professional athletes or those whose jobs involve heavy lifting and repetitive weight bearing on the hip and knee joints such as manual labourers.

However, for many others, there is no identifiable trigger. These are the ones among whom research has demonstrated a clear genetic predisposition in the development of osteoarthritis. These are the ones who demonstrate a family history of osteoarthritis like Clarice. They tend to have untriggered, early onset arthritis with no clear risk factors. Having additional risks makes the illness even more aggressive.

Prevention of osteoarthritis may be almost impossible. However, one’s lifestyle can help minimise the frequency, duration and severity of the flares. Prevention of obesity, optimal management of other chronic illnesses such as diabetes and gout and avoidance of unnecessary weight-bearing activities.

The mainstay of treatment is pain management and reduction of inflammation. Non-pharmacologic options include use of hot and cold compresses, physiotherapy and occupational therapy. Exercises such as yoga and swimming are also very effective. Pain and anti-inflammatory medication is prescribed where needed, together with injection of steroids into the joints to alleviate excessive inflammation.

Surgery is a last option. This includes procedures done to relieve the joint of excessive swelling and wash out debris accumulated from inflammation, trim off excessive bone tissue to relieve disability and where necessary, replacing the entire joint with a metal prosthesis.

It isn’t always about age, sometimes, nature just dealt you a bad hand of cards, in this case, genes.

Dr Bosire is an obstetrician/gynaecologist