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​How to cope with OA at a young age

23rd August 2018

Osteoarthritis (OA) is a condition that is usually associated with individuals over the age of 45 years. This situation is changing and now an increasing number of younger people are diagnosed with the condition. There are thought to be several reasons for this.

What causes OA in younger people?

One possible reason is that people are remaining more active into their forties and this is putting a strain on their joints. Young people who pursued demanding sports (football, hockey, rugby) in their teens and twenties are finding that they are suffering OA symptoms in the following two decades. Young athletes who suffered meniscus injuries of the knee and rotator cuff injuries of the shoulder, are more likely to develop OA.

Increasing rates of obesity are putting a strain on joints and there is clear medical evidence that shows that obesity is associated with an increased chance of developing OA. Obesity levels are rising in many developed countries, including the UK, and youth obesity is a particular issue.

Symptoms of OA in younger people

Younger adults are less likely to be aware of the symptoms of OA and so they may not understand the significance of their symptoms. Also, younger people sometimes have a higher pain tolerance and will dismiss symptoms that an older person would seek medical attention for. Medical professionals are not so accustomed to considering a diagnosis of OA in a younger person. These factors combined, can lead to a delay in diagnosis.

A younger person with OA will commonly experience pain and reduced range of movement in the affected joint. There may also be crepitation (a crackling and rattling sound when the joint moves) and changes in the way the joint looks. The joints most commonly affected in younger adults are the hips, shoulders and knees.

Joint replacement is not usually the best treatment. A total joint replacement is rarely the treatment of choice in a younger patient. This is because when the procedure is carried out in younger patients it is associated with a high number of early failures and it needs to be done again. Every time it is carried out, there is a greater chance of complications because the bones have been damaged. The usual life-expectancy for an artificial joint is around 15 years, so a person in their twenties would need several in their lifetime.

After joint replacements, most surgeons will advise a limitation of sporting activities and even avoiding high-impact sports all together. You may also be advised to move carefully in everyday life. This will impact a young person’s life greatly. Other treatment and management options are usually preferred.

Weight management

OA is caused by the wear and tear of cartilage in joints. That is, the cushion of softer tissue at the end of bones. It stops the two bones in a joint from banging or scraping together as we move. Being overweight makes you more likely to get OA, and once you have it, makes the symptoms worse and the condition progress faster. Weight management is therefore an important way of managing OA in younger people.

The knee joint is especially vulnerable in obese people. If you are overweight, you are nearly five times more likely to develop OA knee. Once you have developed OA, losing weight will ease the pressure on joints such as the hips and knees. Every 10 pounds you lose will relieve up to 40 pounds of pressure from your joint. The bones won't press together so much and thus the pain is reduced and mobility increased.

An added benefit is that by changing your diet you can lower the levels of protein in your body that cause swelling. Fat cells create protein and this leads to more swelling. By reducing the fat cells, you can reduce the swelling. The research into weight loss and OA is impressive. Patients who lost 10% of their body weight (that’s 30 pounds for a 300-pound person) found that they halved the pain they were experiencing. It has been shown that weight loss can delay, and in some cases reverse, the progression of OA in knee joints.

Bracing

Bracing is an option if you have OA of the knee joint. Braces work by reducing the biomechanical load away from the most damaged area of the knee and making the whole joint more stable. This reduces pain and therefore allows you to walk further and even participate in sport. There are many different designs of knee brace and they can be made from rigid or flexible material. The most common materials used in knee braces are metal, plastic or a composite material used to provide a firm structure together with synthetic rubber or foam against the skin for comfort. It is important to get a well-fitted brace to avoid discomfort and blistering. A brace is most useful when used in conjunction with weight loss management and an exercise regime.

Exercise

A chartered physiotherapist will be able to put together a personalised exercise programme to help with pain and mobility.

Aerobic exercise. Exercise that strengthens your heart and lungs will help with weight management and make you feel better. You need to take part in low-impact exercise that will not put additional strain on your affected joints. Some good options include walking, swimming and cycling. Start slowly with just 10 minutes at a time with a final goal of 30 minutes of aerobic exercise, 5 times every week.

Strengthening exercises. Leg-strengthening exercises will take pressure off the hip and knee joints. You may be given exercises such as sitting in a chair and slowly standing up then sitting back down again for 30 seconds at a time.

Range of movement exercises. For the knee, you may be asked to sit in a chair and slowly extend one leg as much as you can, hold for 1 to 2 seconds, and then lower it. For the hip, you may be asked to stand and step one foot forward so that your feet are hips-distance apart. Then bend your back leg and front knee and hold for a few seconds. This is a hip flexor stretch.

Medication

Painkillers (analgesics) are very useful, especially in the short term and whilst you are using a combination of weight management, exercise and bracing to manage the condition. They are most beneficial for short-term use and you should not take painkillers long term without consulting your doctor. Paracetamol is a popular option and is available over-the-counter. On days when the pain is more severe, your doctor may recommend a combined pain killer such as co-codamol. Non-steroidal anti-inflammatory drugs (NSAIDs) are useful because they can help to reduce swelling and relieve pain. The general rule with medication is that the stronger the medication the more likely you are to suffer some side-effects. Creams and gels are applied directly to the skin and have fewer side-effects than oral analgesics. Some patients have found Capsaicin cream (made from Capsicum, the pepper plant) to be very useful.

Hot and cold (ice) packs, steroid injections and hyaluronic acid injections can also be helpful. Transcutaneous electrical nerve stimulation (TENS) works by generating electrical signals in nerve endings that interfere with pain messages arriving at the brain.

Minimally invasive surgery

While a total joint replacement may not be the best approach, there are other minimally invasive surgical techniques that are suitable for younger patients.

Arthroscopic lavage and debridement is a safe and straightforward treatment. It is a type of keyhole surgery for joints and is carried out using small instruments and through small cuts in the skin. Loose parts of material within the joint are removed by injecting fluid and then sucking them out. It is most useful for patents who find that their joints are ‘locking’.

Another possible treatment option for younger OA sufferers is microfracture. This is also performed through an arthroscope and involves making tiny drill holes in the bone with the aim of releasing stem cells from the marrow which will replace damaged tissue.

Finally, chondrocyte implantation may be useful especially where the OA has arisen because of trauma to the joint such as a sporting injury. It involves growing special cells in a laboratory and inserting the into the affected joint where they form new cartilage. However, this is a fairly new technique and there is on-going research to establish how useful it can be in all cases.

The overall aim of management of OA in a young person is to relieve pain and increase mobility so that they can enjoy an active life for as long as possible. A combination of weight management and lifestyle changes together with prescribed exercises, medication and bracing is often sufficient. For persistent problems, injections directly into the joint or minimally invasive surgery is recommended in some cases. Every case is different and careful assessment by a doctor is needed.

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