That terrible pain in the joints

ARTHRITIS IN THE YOUNG

That terrible pain in the joints

Osteoarthritis of the knee and hip joints is not a rarity among the young anymore, says Dr Jayateerth Kulkarni

Even though considered an age-related ailment that gets worse over time, chronic joint pain is also affecting people in their most productive years, compromising quality of work and life. But effective treatment is now available

It is a scene that we might have encountered at least once and wondered about it too — a person in her early 40s walking up a staircase at snail’s pace because her knee joints seem to be giving her trouble. Or a young man complains of not being able to lead a normal life because of the excruciating pain in his hips.

Osteoarthritis, the most common type of arthritis, has always been known to be more prevalent among the elderly population. And for decades we ignored it as it was considered part of the rigours of aging. But Osteoarthritis (OA) of the knee and hip joints is not a rarity among young and middle-aged people anymore and drastically affects their quality of life, say medical experts.

According to a World Health Organization report, this degenerative ailment affects at least 70 million Indians.

Inflammatory arthritis like rheumatoid arthritis (RA) and ankylosing spondylitis are another major cause of disability in the younger population.     

Osteoarthritis is a progressive disease that causes inflammation, pain, stiffness and swelling of joints. The joints of the body are the areas where two or more bones meet.
The ends of the bones are protected by a tissue called cartilage, which helps bones to move easily without damaging bone tissue. In osteoarthritis, the cartilage gradually wears out, resulting in the ends of the bones rubbing against each other during movement, causing friction. The fluid in the joints, called synovial fluid, also loses its shock-absorbing qualities and causes inflammation.     

Causes

Osteoarthritis is typically a disease of wear and tear and age has always been considered as the biggest risk factor for OA. While the incidence of arthritis has not really gone up, in younger people, wear and tear may happen due to high impact sports, injuries from contact sports, road traffic accidents and so on. Long term dose of steroid medications, taken because of some other health problem can also lead to joint pain.
Being overweight is also a major risk factor for arthritis, and as obesity rates go up across the world, osteoarthritis also seems to be taking its toll, especially on the younger population.

Inflammatory type of arthritis occurs due to abnormal activation of the immune system of the body which attacks the joints.

Developmental disorders like hip dysplasia and disturbances of the growing ends of bones (slipped capital femoral epiphysis) also cause arthritis.

When young people develop arthritis, it is not just a physical affliction. Apart from the fact that their quality of life suffers, they face a lot of difficulty workwise. Their confidence takes a beating and psychologically also, they might get depressed and draw themselves into a shell. This was more a reality earlier because there was no option but to suffer.
People in their productive years who would seek medical help for joint pain were advised to bear with it and take pain medication and would be sent back just like that.

But unlike earlier, arthritis can be managed and treated better these days, because of the advancement in techniques.  

In terms of treatment modality, pain medication is suggested in the beginning if the pain is bearable. Patients are also offered physiotherapy and exercise to reduce stiffness in the joints. But if the pain becomes chronic and excruciating, the only option is joint replacement surgery. Joint replacement surgery was not an option earlier for young people as the implants would wear out soon and revision surgery was less successful and more complicated to perform. But that has changed with advanced technology available in the field of arthroplasty now.

Treatment

Joint replacement surgery, or arthroplasty, is a surgical procedure in which joints are replaced with artificial parts made from metals or plastic. The replacement could involve one side of the knee or the entire knee. Implants available these days include metal on polyethylene, ceramic on polyethylene and ceramic on ceramic and metal on metal. Joint replacement surgery is usually reserved for people over age 50 with severe osteoarthritis, but is now being offered to younger people who have tried everything else and have failed. The surgery may need to be repeated later if the joint wears out again after several years. Revision surgery has also become advanced, with technology such as trabecular metal implants revolutionising this technique.

These days minimally invasive procedures and computer navigated operations have changed the face of joint replacement, making it much more viable for younger patients. Techniques like partial knee replacement or unicompartmental knee arthroplasty is also a good option for younger patients.  

(The writer is Joint Replacement Surgeon, Fortis Hospitals.)

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