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Arthritis, especially osteoarthritis, is one of the most common causes of joint pain, but it can also be caused by infection, injury, and conditions like lupus, fibromyalgia, or even cancer.
Even though joint pain and arthritis is associated with older people, an increasing number of young people in their 30s or 40s are affected as well, says Dr. Kaushal Malhan, director-orthopaedics and joint replacement, Fortis Hospital, Mulund. Joint pain also impacts a higher number of women compared to men. Dr Malhan says if someone notices pain, swelling, tenderness in the joints, they should seek medical attention.
According to the Arthritis Foundation, degenerative joint disease disorders such as osteoarthritis will impact at least 130 million people around the world by the 2050. It also says that women over 60 are almost twice as likely to be impacted by osteoarthritis compared to men.
Dr. Malhan spoke to Femoai about joint pain and arthritis. Edited excerpts:
What makes our joints pain? Could it be from a serious condition?
Joint pain can have a wide range of causes; it can be from mild inflammation, severe infection or even cancer. However, one of the most common causes of joint pain is arthritis. If a person starts experiencing pain when they walk or stand for a long time, it can be assumed that they have some damage in the joint and it may be arthritis. Arthritis is made up of two words, itis means inflammation and arth meaning joint. Any kind of inflammation in the joint is arthritis. There are more than a 100 kinds of arthritis and related conditions. People suffering from joint pain could have osteoarthritis, infective or inflammatory arthritis. Infective arthritis is a painful infection in the joint. It occurs when an infection from another part of your body spreads to a joint.
The more commonly occurring arthritis is osteoarthritis, which is caused by aging or overuse or damage to a joint over the years. It commonly impacts people’s wrists, hips, hands, and knees. Osteoarthritis causes joint pain due to the breakdown of the cartilage cushioning our joints.
Another important type of arthritis is inflammatory arthritis, which is caused by an overactive immune system; rheumatoid arthritis is an example. It is an autoimmune disorder that impacts multiple joints at the same time.
Rheumatoid arthritis is seen in a limited number of people, it is far less common than osteoarthritis. Osteoarthritis forms the bulk of the patients with joint pain; More than 90% of patients who have joint disorders, damage, and pain in the joint could be suffering from osteoarthritis.
However, not every painful joint is arthritis. It can also be referred pain. For example, if someone has a problem in the hip, they may feel pain in the knee. Someone with pain in the spine, may experience pain in the knee or in the hip. The patient may have a trapped nerve elsewhere or something else going on which can also present as joint pain.
Other causes of joint pain include injury, cancer, bursitis or inflammation of the bursae, which are fluid-filled sacs between bone and surrounding soft tissue, or bones and tendons. Joint pain can also be caused by lupus, gout, fibromyalgia (a chronic rheumatic condition that causes widespread pain), or tendinitis or inflammation of a tendon.
When should people see a doctor for joint pain? What are the symptoms we should look out for?
We often associate joint pain with older folks, but we are noticing an increasing number of younger people, in their 40s or mid to late 30s coming to us for joint pain as well. People, regardless of their age, should see a doctor if they have pain in the joints, if the joint area is swollen, tender, and the pain persists. This pain may also be accompanied by fever in some cases. If someone experiences a serious injury or notices a deformity in a joint, they should see a doctor immediately.
It is also important to understand that arthritis can be mild, moderate or severe. A patient with a very mild degree or form of arthritis, will simply experience a little stiffness in the joints, occasional pain when they engage in intense activity or feel pain when they climb stairs or go for a long walk. They will, otherwise, feel fine. As arthritis worsens, the amount of stiffness increases, patients start noticing they have more pain early in the day, when they wake up in the morning. Their knee or whichever joint is affected will feel stiff. As they move their knee, they feel better, but when they are static, in one position, the pain is worse. When they are moving, they feel the knee tends to loosen out a little and they feel better. These symptoms gradually tend to increase. In extreme stages, you may find patients with complete immobility or in a wheelchair. They may not be able to stand at all. There are also patients who get severe pain and deformities. Their joints may be in a particular position and they’ve limited movement.
We also see patients who have severe deformity. Their knee may be bent inwards or outwards because of the excessive loss of bone and wear. There could be varied presentations in various groups of people. This depends on the grade of arthritis they have or how severe the disease is. Arthritis starts with inflammation and swelling in the joint but over a period of time, this will gradually impact the cartilage and damage the cushion within the joints. Once the cushion starts getting damaged, the bone starts to erode. As the bone erodes, the ligaments start to wear away and the joint becomes unstable. The knee joint is the most common one to be affected.
Research suggests that seven out of 10 women over 35 have some kind of joint pain. Even osteoarthritis impacts more women. Why is that?
We do see a greater amount of arthritis in women. Even when it comes to joint replacement surgeries, we get far more women patients compared to men. There are multiple reasons for that. There may be some genetic reasons, there may be some relationship with the kind of tissues we have. Tissue laxity or tissue looseness is greater in women. Tissues are generally a little more elastic in women, a little more flexible. Researchers believe that fluctuations in hormone levels due to the menstrual cycle increase joint laxity in women, which can lead to injury, making women more prone to osteoarthritis.
Women may also experience a kind of joint stiffness during menopause called arthralgia which can be attributed to a reduction in estrogen levels.
Some people also suggest that the higher incidence of joint pain in women could be related to calcium or vitamin D deficiency or bone health. However, arthritis is not directly related to osteoporosis. Whether a weak bone will provide weaker support to the joint and therefore lead to arthritis, we don’t know yet. Osteoporosis is simply a bone which is more brittle and breaks more easily. The main complication and problem with osteoporosis is easy fractures. Osteoarthritis is not really a direct result of somebody having osteoporosis. There is no strong data to suggest that, However, a healthy diet, good protein intake contributes to healthy joints.
Also, other conditions that cause joint pain like rheumatoid arthritis and lupus impact more women compared to men.
Dr. Kaushal Malhan
Director, Orthopaedics and Joint Replacement
Fortis Hospital, Mulund
Dr. Kaushal Malhan is the Director Orthopaedic Surgeon at Fortis Hospital Mulund. He is a pioneer in the field of minimally invasive knee and hip surgery and has established the Regional Joint Replacement Centre for Western India, at Fortis Hospital Mulund.
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