By Nabilah Saleh
KUALA LUMPUR: The perception that only the elderly are predisposed to osteoarthritis (OA) is incorrect as even young people can suffer from the disorder.
According to UM Specialist Centre (UMSC) sports medicine physician Associate Prof Dr Abdul Halim Mokhtar, OA can strike young people who are serious sportsmen or due to occupational-related causes.
Describing sportsmen as “joint abusers”, he explained that they may overuse and overload the joints, thus predisposing them to microtrauma which later leads to OA.
Microtrauma refers to small injuries, which include micro-tearing of muscle fibres, the sheath around the muscle and the connective tissue. It can also include stress to the tendons as well as bones.
As for occupational-related causes, those who do not get enough exercise and whose occupations require them to stand, sit or squat for long periods of time while performing their daily tasks may also overload their joints.
“While we are supposed to say that exercise can protect someone, we should also be aware that when you over-exercise, it will definitely put more pressure on the joints and may, in particular, damage the cartilage,” Dr Abdul Halim told Bernama in an interview recently.
Advising sportsmen to rest in between training to allow the body to heal itself and the cartilage to regenerate, he said if they go overboard in their training, they may end up getting OA at a young age.
Meanwhile, people who do a lot of squatting, standing, walking or climbing up and down the stairs in their daily work routine must also take sufficient rest in between to prevent overloading and putting pressure on their joints.
“If this persists long enough, they will start to have an achy pain (in the front of the knee and around the kneecap) at their joints, most likely a condition called patellofemoral joint pain syndrome which is similar to OA but a milder version,” said Dr Abdul Halim.
Common causes
OA is the most common form of arthritis; it occurs when the cartilage protecting the ends of bones wears down over time.
Although OA can damage any joint, the disorder commonly affects joints in the knees, ankles, hips, spine, hands and shoulders.
Globally, OA is the most common articular disease. While there is no study on the number of Malaysians suffering from OA, it is estimated that more than 60 per cent of the worldwide population aged 65 and above have some form of the disease, with women more commonly affected.
The impairment to the joints may not be reversed but the condition can certainly be well managed, according to UMSC medical experts.
The causes may vary from one person to another, depending on their age, lifestyle, profession, genetics and physical condition.
UMSC orthopaedic surgeon Prof Dr Azlina Amir Abbas said most of the elderly OA patients were aware of their condition when they came for treatment.
“I’ve always given the analogy of a car tyre when explaining their condition to them. When you don’t drive your car all the time, the tyres will be nice and new. If you use it every day, then the tyres will wear out,” said Dr Azlina, who has vast expertise in orthopaedics (hip and knee replacements, trauma and autologous chondrocyte transplantation).
One’s body weight can also be a factor in causing OA. The heavier a person is, the higher the amount of stress his/her lower limb joints would have to bear, especially at the knee because it is the one that supports the body weight.
Secondary OA
UMSC consultant rheumatologist Dr Raja Jasmin Begum Raja Mohamed, meanwhile, said OA commonly affects the knees, hips, hand joints and shoulders.
Speaking from a rheumatologist’s point of view, she said the risk factors are more variable and could lead to secondary OA conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis and crystal arthropathies (gout/pseudogout).
Rheumatoid arthritis causes inflammation, swelling and pain in and around the joints and other body organs, while psoriatic arthritis is a form of arthritis that affects people who have psoriasis, a condition that causes red patches topped with silvery scales to appear on the skin.
Ankylosing spondylitis affects the spine while crystal arthropathies is a class of joint disorder that is characterised by accumulation of tiny crystals in one or more joints.
“OA could be due to the consequences of modifiable and non-modifiable factors such as advancing age, genetics, trauma, metabolic diseases and inflammatory diseases.
“In fact, autoimmune inflammatory conditions and crystal arthropathies which commonly start at a younger age (age of onset 30 to 50) can be a cause of secondary OA over the years,” explained Dr Raja Jasmin Begum.
Thus, there is an urgent need for consultations to take place first before any treatment is given to the patient, who should be told that taking pain killers is not the permanent solution to their problem.
“As time goes by, if the disease is not well-controlled, eventually damage to the joints in terms of cartilage loss, contracture and loss of functions can happen.
“In this case, pain killers are not a permanent solution. Besides, anti-inflammatory medications need to be used with caution, especially among the elderly due to the risk of peptic ulcers and kidney impairment. Opiates too need to be used with caution as they may cause side effects such as giddiness,” she added.
Traditional vs modern treatment
A little known fact about OA is that there is actually no cure for the disease.
According to Dr Azlina, Malaysians are drawn towards traditional therapies which they perceive as safer and more effective.
“One has to be wary of traditional medicines which may contain hidden steroids that can make people feel better but can cause some serious side effects in the long term,” she warned.
Dr Raja Jasmin Begum said not many people are aware that currently there are no effective pharmaceutical treatments for patients suffering from pain and functional disability.
“The main treatment strategy is using pain relief medications and maintaining or improving muscle strength through exercise and physiotherapy. Walking and other physical exercise help to improve muscle strength. Tai Chi, for example, helps with muscle control and balance,” she said.
Dr Abdul Halim does not recommend supplements as not all of them are supported by good clinical evidence.
“I’m not keen on this (giving or advising patients to take supplements). We are deeply concerned about safety as there is no concrete, quality research that supports their effectiveness. Acupuncture can provide some pain relief but it is not really a cure,” he said.
Educating patients
Citing the UK-based National Institute for Health and Care Excellence’s guidelines on the management of OA, Dr Azlina said patient education is one of the top recommendations when it comes to OA management.
“The guidelines prioritise patient-centredness. As a surgeon myself, I need to look at the patient holistically to see how OA has affected them in terms of their lifestyle, mood, sleep and how it works with or against their other medical problems (for example, heart or kidney disease or diabetes).
“Because the idea is that it is not only the patient’s knee that needs to be fixed or some muscles that need to be strengthened or some blood tests that have to be done. We have to look at the patient holistically,” she added.
Dr Raja Jasmin Begum said alongside medications, therapists are also at hand to help OA patients.
“It is very important to have a physiotherapist on board, as well as an occupational therapist (to provide functional mobility care and special shoes and walking aids). These are the important people who help to assist holistically too,” she added. – Bernama
