How to prevent osteoarthritis: the disease that affects one in five people

Life expectancy is increasing in much of the world . In Chile, according to National Institute of Statistics (INE) tripled in the last century: in 1900, it was just 23.6 years for women and 23.5 years for men, while in 2020 the estimate reached 82.1 and 77.3 years respectively.

But promises often contain fine print. Living longer does not guarantee a healthy life. With aging also come chronic illnesses, ailments, and physical ailments. And the most common example is osteoarthritis – also known as osteoarthritis – a condition that changes with life expectancy.

according to Institute for Health Metrics and Evaluation (IHME), in the past 30 years, osteoarthritis has more than doubled the number of cases worldwide, from 256 million in 1990 to 595 million in 2020. And over the next three decades, the trend will continue. : one billion people are expected to suffer by 2050.

Chile’s figures are no less painful: the country is the third country with the most cases in Latin America. There National Health Survey 2016-2017 It is estimated that more than 50% of the population over the age of 50 suffers from osteoarthritis in a relevant joint. The most common ? Knee.

It is the most common form of arthritis in the world, a degenerative disease characterized by the progressive wear and tear of cartilage, the flexible tissue that covers the bones. According to the World Health Organization (WHO), it is one of the ten most disabling diseases in developed countries.

Its main symptom is inflammation of the joints, which leads to stiffness in the arms, hands and legs, as well as a feeling of pain that can range from moderate to severe. The more intense it is, the more it will affect the functionality of the body and the autonomy of the person. From then on, the physical discomfort quickly becomes psychological.

“The main complications for patients are joint pain, functional impotence, sleep disturbances and the psychological complications that this discomfort entails”, explains Daniel Cáceres, kinesiologist at the Catholic University of Maule.

“Often adults with osteoarthritis find themselves alone, which can lead to difficulties in carrying out their normal activities and alter their abilities,” adds Juanjosé Valderrama, traumatologist at Clínica INDISA. The lack of autonomy, as we know, accelerates the aging of people, generating a vicious circle from which it is not easy to get out.

But to come back to the physical aspect, the pain in the joint functions caused by osteoarthritis means that the rest of the body must compensate to carry out activities as daily as sitting, standing or opening a door. “In osteoarthritis of the knee, the claudication becomes very marked to avoid pain,” explains Cáceres. “It also causes early wear on the other knee.”

Osteoarthritis of the lower joints, such as the hip, knees or ankles, directly increases the risk of falls, Valderrama points out, “generating even greater damage in people”.

In the country, the prevalence of osteoarthritis of the hip, knee or both is estimated at around 20% of the population; Women over 65 are most likely to suffer from it. This is also happening in the rest of the world: in 2020, for example, only 39% of osteoarthritis cases affected men.

Why does osteoarthritis affect women more than men? Science is still unable to answer with certainty. “For now, this is attributed to hormonal factors, biomechanical and genetic differences,” says Cristóbal Díaz, orthopedic surgeon at the NúcleoSalud clinic. “Some studies suggest a relationship between estrogen – female sex hormones – and the characteristics of synovial fluid, which is the joint’s own lubricant,” adds Daniel Cáceres.

Some studies suggest that osteoarthritis is a typical pathology of the post-industrial era: that is to say, it has been on the increase since the middle of the 20th century.

In 2017, American university researchers compared over 1,500 cadavers from the early industrial era (19th century) and over 900 from the post-industrial era (20th century), finding that the latter had significantly more cases of knee osteoarthritis than the former. The greater longevity of the world’s population is therefore not enough to explain the increase in the prevalence of this disease: lifestyle is apparently just as important.

What these results suggest, explains Carla Lazo, a rheumatologist at the German Clinic, “is that living in urban centers – this is how most people in the world live, at least since 2014 – is a factor risk of osteoarthritis. , and would explain this upward trend”. This is clearly associated “with a more sedentary life and less muscle development, which acts as a protective factor for the joints”.

This thesis could explain why the signs of osteoarthritis increase in people who have not yet reached their senior years or who have not even passed the mark of 50 years.

“At least 10 years before the age of 50, it is possible to see changes in images of healthy people that show that osteoarthritis begins long before it is clinically obvious.” How is it possible?

“There are young patients who develop osteoarthritis idiopathically, that is to say without a known cause. In many cases, this is attributed to a genetic factor. In the knees, injuries at an early age, such as a rupture of the anterior cruciate ligament with affect of the menisci, can determine that osteoarthritis develops 20 or 30 years after this injury,” explains Juanjosé Valderrama.

Lazo adds that anatomical malformations, such as hip dysplasia or poor knee alignment, are also the cause of significant osteoarthritis in young people. “Especially if this is combined with a sedentary lifestyle or obesity.”

Obesity is indeed pointed out by science as the main risk factor associated with osteoarthritis. And not just on your knees, but also on your hands and wrists. According to the IHME, 20% of osteoarthritis cases recorded in 2020 occurred in obese people. Other studies support that the eating disorder increases between five and seven times the risks of developing a rheumatic pathology.

The IHME study establishes that the concentration of adipokines, a protein important in the development of inflammation and insulin resistance, could help predict knee osteoarthritis, without it being necessary to pay attention to the body mass index.

However, being overweight and lifestyle are not the only risk factors for the development of osteoarthritis. As we’ve pointed out, genetics, gender, age, and lifelong joint damage can predispose to pregnancy. Certain occupations with high physical demands: mining, construction and agricultural work can also have an impact on knee osteoarthritis, according to Lazo.

Osteoarthritis may not be fatal, but Lazo says some studies “strongly suggest” that it increases the risk of death from cardiovascular causes. “As osteoarthritis limits activities and physical exercise and chronicles the use of anti-inflammatories or painkillers,” the odds increase. Osteoarthritis is also associated with diabetes mellitus and depression.

It is also a chronic, incurable disease. Treatment, according to Cristóbal Díaz, includes “pain management, physiotherapy, medication and, in severe cases, surgery.” In other words, osteoarthritis is quite expensive.

According to a 2022 study, the annual cost of musculoskeletal pain in Chile is $1,387 million; knee osteoarthritis alone explains 27.1% of this expenditure. To get a clearer idea, the most serious injuries may require an operation called arthroplasty, where a joint prosthesis is implanted. One of these knee operations can cost between 5 and 10 million pesos.

When the injuries are not so severe, treatment relies on the regular use of medication, some covered by the GES, and kinesiology. “In mild cases, it can be a small but permanent cost, which will impact a family’s economy,” says Lazo.

Since it is an incurable disease, the only thing we can do to avoid suffering from it is to prevent it. “Arthrosis is usually a slow and progressive process, which is why prevention must target risk factors that can be modified,” explains Daniel Cáceres. Here are some tips for that:

• Maintain an appropriate weight: Being overweight directly affects the joints, mainly the knees and hips.
• Take care of your posture : If we work in front of a computer, says Cáceres, “we must do it with good lumbar support and an appropriate height for the screen, which allows us to look at the horizon and not downwards”. Also, the height of the chair should allow the hips and knees to be in a natural position and the feet fully supported on the floor.
• Moderate habits that are harmful to health: Like tobacco and alcohol consumption because they promote inflammation throughout the body. The same goes for the consumption of sugar and ultra-processed foods.
• Do some physical activity: Moderate sports practice protects the joints by strengthening and flexing the muscles that cover the cartilage. Cáceres advises the use of appropriate instruments for each practice, such as the use of appropriate footwear for each sport, knee pads, elbow pads and, in general, the “necessary protective elements”.

Meanwhile, those who see the first signs of arthrosis in their body should consult specialists for an accurate diagnosis. In the early stages of the disease, Cáceres explains, protecting the joints is key. This implies, on the one hand, “having good muscle tone” and, on the other hand, “maintaining joint mobility”.

“It is recommended to achieve this increase in muscle tone by avoiding the practice of high impact sports, through low impact exercises, such as swimming, walking, cycling, yoga, tai chi, Pilates , etc. The practice of frequent and controlled physical activity ensures joint hygiene and will preserve the “useful life” of the joint for longer,” concludes the kinesiologist.