What is osteoarthritis and why it impacts more women

Estimated reading time: 6 minutes

Osteoarthritis, the most common form of arthritis, is a degenerative joint disease that occurs mostly in the hands, hips, and knees. It usually impacts older people, especially women, but factors such as injury or pre-existing conditions like rheumatoid arthritis can make young people vulnerable to it as well, says orthopedic surgeon Dr. Abhishek Kumar Mishra.

According to the National Health Portal, Osteoarthritis is the second most common rheumatologic problem and it impacts about 22% to 39% of people in India. It affects nearly 45% of women over the age of 65.

We spoke to Dr. Mishra about the causes behind the disease and how can people manage their symptoms. Edited excerpts:

What is osteoarthritis and how common is it?

Osteoarthritis, also called osteoarthrosis, is a degenerative disorder. Osteo means bone, and the word arthritis comes from arthos meaning joint and itis which means inflammation. Arthritis is the inflammation of the joints. Broadly, osteoarthritis means inflammation of the bones and joints. Though it is a bit of misnomer because osteoarthritis is not a hardcore inflammatory disorder, per say. It is more of a degenerative condition, which happens with ageing and the incidence is high in women, as compared to men

One of the commonest joints to be affected by this condition is the knee joint. It usually impacts the larger joints — the knee joint and the hip joint. In India, the knee joint is more commonly impacted.

There are various factors that decide who is going to get osteoarthritis. There is a genetic or hereditary predisposition; if your parents have it, you have a higher chance to having it too. If you have indulged in a lot of sports, it could be one of the factors that decide whether you have osteoarthritis. If you are a lot into running, you are more likely to have it compared to those who haven’t used their knee as much. 

The third thing that decides the predisposition for osteoarthritis is an injury in the past; if you have had an injury to the knee and you have damaged your cushioning, the meniscus or any other ligaments around the knee at some point of time in your life, you are more predisposed to get osteoarthritis later.

A person’s weight has a major role to play as well. If you are on the higher side of the scale, then you are more likely to get it.

All these factors put together decide whether someone is going to have osteoarthritis. Sometimes, despite an absence of any predisposing factor, you still can have it. That is the idiopathic type, wherein you don’t know the cause. It is an interplay of genes, predisposition, and lifestyle factors.

Is it more common in older people?

It’s a degenerative disorder; often it’s just a part of aging. The older you are, the more is the likelihood that you’ll have osteoarthritis.

Generally when we talk about arthritis, we talk of the knee and the hip. However, there is a similar variant in the spine, a degenerative condition that’s called spondylosis. It is also a degenerative condition that happens with ageing.

The reason that I mention lumbar spondylosis or spondylosis here is because I wanted to reiterate the fact that most of these are related to ageing as these are degenerative disorders, as you age, the more wear and tear your joints have and the more you’re likely to get osteoarthritis or spondylosis.

But there are younger people who suffer from osteoarthritis as well.

Yes, it does happen to younger people as well mainly because of some strong predisposing factors, like an injury. If somebody has had a sports injury, let’s say they tore their ligament or meniscus, they can get arthritis at an early age.

There is also a condition called rheumatoid arthritis which is an inflammatory condition of the joint. If someone has rheumatoid arthritis, it can gradually lead to osteoarthritis; patients with severe rheumatoid arthritis can get osteoarthritis at a very early age.

In these patients, the joint does not degenerate because of aging but because of the bad effects that rheumatoid arthritis causes to the joint. This leads to the early degeneration of the joint. People with rheumatoid arthritis can sometimes get osteoarthritis in their 30s or 40s.

Talking of the hip, there is a condition called avascular necrosis (AVN) or osteonecrosis, that can lead to early osteoarthritis of the hip. AVM can happen in the knee as well but it’s more common in the hip. And sometimes people get AVN at a very early age even in their teens or 20s. In this condition, the joint degenerates and the patient may get osteoarthritis.

The youngest person that I have done a hip replacement on was 18 years old.

So, there are certain conditions which can lead to very early osteoarthritis as compared to typical osteoarthritis which happens in people over 55 or 60 years of age.

Why does osteoarthritis impact more women?

Honestly, 100% of the reason is not known but there are some hormonal factors which are supposed to play a role. Post menopause, the female hormone levels go down and that can lead to increased chances of osteoarthritis in women. So far, the hormone aspect is the only thing that we can attribute to a high incidence of osteoarthritis in women.

Talk to us about the symptoms of osteoarthritis and how can people manage their pain especially in winter when the cold makes it worse?

Typically any pain tends to gets exacerbated in colder environments. especially arthritis pain. Osteoarthritis usually presents with a mild pain or some kind of stiffness in the joints in the beginning. And later the patient starts developing swelling, difficulty in movement, range of motion gets restricted, and the patient is not able to bend the joint fully or straighten it. The patient may also develop a deformity.

Pain is the most common symptom of osteoarthritis. It is one of the factors that decides the treatment because sometimes the X-ray may look really bad but the patient does not have significant pain. At other times, the X-ray looks okay, but the pain is severe.

These factors decide the management of pain. The patient can start with milder anti-inflammatories, off and on, but they need to keep in mind that anti inflammatory or painkillers should not be taken very frequently. Besides that, physiotherapy modalities, hot fermentation, local ointment application, all of these help in alleviating the pain to some extent. But of course, if the pain is very severe, and debilitating, the patient should consider some kind of intervention in the form of injections or in the form of some kind of surgery.

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