What causes arthritis?

High impact sports, which include running and jumping, can increase your risk of arthritis if you are genetically predisposed to it, says Dr. Abhishek Kumar Mishra, an orthopaedic and joint replacement surgeon at the Apollo Spectra Hospital in New Delhi. However, not losing mobility even when you start having joint pain is highly recommended.

Arthritis is a name given to about a 100 or more conditions which impact the joints and the tissues around the joints, and cause inflammation. Arthritis causes pain, stiffness, swelling, and difficulty in movement. These symptoms can progress over time and eventually make it harder for people to perform their daily chores.

According to the World Health Organisation (WHO), osteoarthritis, which is the most common form of arthritis, is one of the ten most disabling diseases in developed countries. “80% of those with osteoarthritis will have limitations in movement, and 25% cannot perform their major daily activities of life,” it says.

Arthritis is also not just a disease of the elderly as it is commonly perceived to be. Some types of arthritis, like rheumatoid arthritis, impact those between the age of 20-40 years. “The prevalence varies between 0.3% and 1% and is more common in women and in developed countries,” says the WHO.

We spoke to Dr. Mishra about what arthritis is, who does it impact, and whether activities like running, high impact sports, or walking on the treadmill, can cause joint pain or arthritis. Edited excerpts:

• What are arthritis and osteoarthritis?
• Is there a particular age that arthritis sets in?
• So, running and high-impact exercise make you more prone to arthritis?
• How can people prevent it?
• When should people avoid jogging, running, or the treadmill?

What are arthritis and osteoarthritis?

The word arthritis is made up of two words — arthos or joint and itis which means inflammation, it literally means inflammation of the joint. Arthritis is of many types, like — ankylosing spondylitis, gout, osteoarthritis, juvenile idiopathic arthritis, rheumatoid arthritis etc.

Osteoarthritis is a term given to degenerative arthritis; it is the most common form of arthritis. It is degenerative inflammation of the joint which happens with ageing, and it happens to everyone to some extent as the person ages. The other types of arthritis are purely inflammatory, and not age-related. These can happen at any age, at a very young age as well. Some types of arthritis like rheumatoid arthritis or ankylosing spondylitis can impact young people also.

There is also something called secondary osteoarthritis. This happens if a person has had a fall, rheumatoid arthritis, or an injury to the joint, due to which over a period of time, the joint has become degenerative.

All this can be a bit confusing for people. To simplify it — osteoarthritis is a degenerative disease of the joint, which happens mostly with ageing, whereas the other types are purely inflammatory in nature.

Is there a particular age that arthritis sets in? You said that arthritis can happen to everyone as they age, could you explain that further. We don’t usually hear about young people with arthritis, it is commonly associated with older people.

The degeneration of the joint usually starts after 55-60 years of age. But there are several factors which determine who is going to get it and who won’t, these factors also determine what age people will have arthritis. It can be dependent on how much you used your joints, how active you have been and whether you have played sports, especially high impact sports. They make you more prone to osteoarthritis at an earlier age. If you have had trauma in the past, if you have a family history of osteoarthritis, if your parents have it, the probability of you having it is more.

So, running and high-impact exercise make you more prone to arthritis?

The irony here is that generally we don’t expect people who are very active or people who play sports to develop joint problems, but it isn’t so. Think of the joint like a machine, if the machine has run more, it is bound to get wear and tear at an early stage. The same thing happens to the joints as well. If you have played high impact sports, which include running, jumping etc, then you are more likely to get osteoarthritis at an early age. But that isn’t necessary as it is also dependent on other factors.

Let’s take an example. Suppose there is an athlete who has done long distance running or high impact sports during his/her youth, but he or she is genetically blessed, and hasn’t got the genes which make him/her prone to arthritis. This person, despite abusing his/her knee, may not get osteoarthritis. However, if an athlete is genetically prone to it, he/she could get it at a very early age compared to the normal population. What I am trying to say is that there are many factors which come into play when we talk about pathogenesis or the causative factors of osteoarthritis. These factors work in synergy.

How can people prevent it?

You have to build up your muscles, especially muscles around the joint. You can do that by doing static exercises, or non weight bearing exercises. When you are doing non-weight bearing exercises, you are not forcing the joint to take any load, you are just strengthening the muscles around your joint. Once the muscles around your joint become stronger, they help take some load off your joints. This is all the extra load which the joint is not supposed to bear. This helps a person becomes less prone to osteoarthritis.

You have to build up your muscles, especially muscles around the joint. You can do that by doing static exercises, or non weight bearing exercises. When you are doing non-weight bearing exercises, you are not forcing the joint to take any load, you are just strengthening the muscles around your joint. Once the muscles around your joint become stronger, they help take some load off your joints.

There are also many misconceptions or myths out there about arthritis. Sometimes patients tell me that when they started experiencing knee pain, people advised them to stop walking. This is bad advice; howsoever bad the joint maybe, one should never lose mobility and never stop walking. Walking is like fuel to the joint, especially the knee joint. If you stop walking, your muscles become weaker, your sense of balance will wane. My suggestion is that even if your knee joints start hurting, you should still keep walking, continue non-weight bearing exercises, but just avoid jumping, jogging, and running on the treadmill, basically exercises which put high impact on the knee. 

Sometimes patients tell me that when they started experiencing knee pain, people advised them to stop walking. This is bad advice; howsoever bad the joint maybe, one should never lose mobility and never stop walking. Walking is like fuel to the joint, especially the knee joint.

The idea that you should stop climbing stairs etc is not relevant. If you have reached a point, where the joint has completely given way, you can consider surgery rather than stopping walking at all. Keep your joint healthy as long as you can, but if it reaches a point where it is interfering severely with your daily life, and you are taking painkillers very frequently, and you have become dependent on other people for your daily chores, then you can be fearless and you can consider surgery.

When you say that people should avoid the treadmill and not run or jog, is that for all age groups or only for people, who have started to feel pain in their joints?

This is a very pertinent question. Different people have different bodies obviously, and different people are programmed differently genetically. You need to listen to your body, and you have to do what your body tells you to do.

There are people who are active and even jogging at 70 or 75 years of age. For them it is fine to jog or walk on the treadmill. But if there is a person, who starts jogging and starts feeling pain in the knee, and it keeps coming back, this should raise an alarm. For this person, it is better to avoid high impact activities. If people are conducive to knee pain, they should avoid jumping, running, and sports like squash, lawn tennis, or badminton. They can walk, swim, and cycle. Swimming is very good for the back, and the whole body, cycling is good for the knees. Walking is great for your overall health.

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