How Osteoarthritis Is Diagnosed And Treated In Young Adults

Joint pain can make it challenging to tackle everyday activities. Simple tasks like getting out of bed and bending down to pick up the paper can be painful and stressful. But when is joint pain something to worry about?

Unfortunately, joint pain can sometimes signify osteoarthritis — a lifelong joint condition. While many of us think of arthritis as an "older people" disease, a significant number of arthritis patients are young. And this disease can have an impact on their mental well-being, social behaviors, and overall quality of life.

Here's what you need to know about osteoarthritis in young adults.

What is osteoarthritis?

Arthritis is a group of conditions that affect the joints. Osteoarthritis (OA) refers to a type of arthritis that happens when wear-and-tear or injury breaks down the cartilage between bones. Every joint in our body has a natural "shock absorber" called hyaline cartilage, which allows that joint to glide smoothly and create motion. Over time, this cartilage can wear away, causing your joint bone to rub against its connected bone.

Technically, OA can affect any joint in your body. However, most cases involve the knees, neck, lower back, hips, and extremities. And while most cases of OA can be attributed to long-term wear and tear, some aren't. OA can affect anyone at any age.

When does osteoarthritis start to develop?

Advanced age is the biggest risk factor for osteoarthritis, and it's estimated that 20 to 45% of those over 45 have some degree of OA. Most people who develop osteoarthritis are in their 40s, 50s, and 60s, though there is no "average" age for OA.

While age is a risk, other factors also increase your risk of osteoarthritis, including:

• Injuries to joints

• Obesity

• Other inflammatory conditions (e.g., gout, other arthritis, etc.)

• Paget's disease

• Genetic predisposition via gene mutations

• Abnormal joint structures or cartilage thickness

• Abnormal leg lengths

• Infections

Some occupations — usually those that involve repetitive joint motions or heavy lifting — also increase the risk¹ of joint damage. Certain types of arthritis are also more common in women than in men.

Is osteoarthritis genetic?

Some cases of osteoarthritis are strongly influenced by genetics. A recent study on female twins demonstrated that the genetic contribution in OA cases (hand and knee) ranges between 40 - 65%². In this sense, family history and family cluttering studies show that having a close family member with OA makes a person 2 to 4 times³ more likely to acquire it at some point in their lives. Gene clustering studies⁴ suggest some gene (e.g., AGC1, IGF-1, TGF beta, etc.) mutations increase your risk.

Importantly, genetics can lead to physical abnormalities that predispose people to OA. For example, being born with abnormal joint structures or cartilage thickness may cause additional "wear and tear" to your joints.

Research into OA genetics is still relatively new. And there is plenty of information we still don't know. However, most researchers agree that a significant number of osteoarthritis cases are partially due to genetics.

Can you prevent osteoarthritis?

Both genetic and lifestyle factors can cause osteoarthritis. Some cases of osteoarthritis are considered more preventable than others. Here are a few avoidable causes of OA:

• Leading a sedentary lifestyle

• Working in an occupation with heavy lifting or repetitive motions

• Playing high-impact sports (e.g., football, rugby, etc.) or doing extreme amounts of exercise (e.g., powerlifting, marathon running, etc.)

• Not controlling your blood sugar levels

• Not exercising or maintaining a poor posture during sitting hours

Unfortunately, there are also non-preventable factors that cause OA.

Other osteoarthritis risk factors

Not every case of osteoarthritis is caused by lifestyle, and plenty of diseases and genetic abnormalities can cause OA. There are a few non-preventable risk factors for OA. These include:

• Other inflammatory conditions (e.g., gout, other arthritis, etc.)

• Paget's disease

• Genetic predisposition via gene mutations

• Abnormal joint structures or cartilage thickness

• Abnormal leg lengths (often caused by hip dysplasia)

• Hormonal growth disorders

Researchers constantly look for new connections between arthritis and diseases, genetic conditions, and physical joint structures.

How does osteoarthritis affect young people?

While 25 percent of people develop symptomatic OA at some point during their lives, some develop it earlier than others. Around 30%⁵ of osteoarthritis cases happen in people under 40. Some children even develop osteoarthritis, though this is exceedingly rare.

Having OA as a teen or young adult can be especially challenging. Everyone with OA suffers from similar symptoms. But teens and young adults are at a different period in their lives. Many feel

 ostracized from sports and other social activities, and certain jobs may feel out-of-reach. And teens and young adults are more likely to develop mental health issues related to their diagnosis.

If you feel stressed, worried, sad, or anxious about your OA diagnosis, you should contact your doctor or mental health provider. While osteoarthritis is often a lifelong condition, proper management reduces symptoms and improves your quality of life.

What causes osteoarthritis in young people?

Most young adults don't get osteoarthritis from repetitive wear-and-tear like older adults. The majority of osteoarthritis cases in young adults can be put down to one of the following:

• Joint injuries from high-impact sports, motor vehicle accidents, or falls

• Genetic joint malformations

• Obesity

While young adults often suffer from the same symptoms as older adults, they tend to have a higher pain tolerance, and this often leads to delayed diagnosis.

What are the early warning signs of osteoarthritis?

The majority of young people are unfamiliar with osteoarthritis. Unfortunately, early warning signs of arthritis are vague. What’s more, they're easy to mistake for acute injury. Common early warning signs include:

• Reduced range of motion

• Localized pain or swelling in joints

• Joints that make a clicking or rattling sound (called "crepitation")

• Stiffness in joints

Young people typically experience arthritis symptoms in weight-bearing joints, such as feet, hips, and knees. However, injuries to the lower back and neck can also cause osteoarthritis.

When should you see a doctor?

It's a good idea to schedule an appointment with your GP if you have symptoms of OA. If your GP suspects arthritis is the cause of said symptoms, they will likely send you to a sports medicine doctor for further testing.

Most cases of osteoarthritis are diagnosed using one of the following tests:

• Physical examinations to assess mobility, tenderness, and stiffness of joints

• X-rays, which can show:

• A narrow gap between the bones and joint to signify cartilage loss

• Bone spurs caused by joint misalignments

• An increase in bone density to account for the missing cartilage (called "sclerosis")

• Fluid-filled cavities (caused by bone grinding from lack of cartilage)

• MRIs, which can show:

• Inflammation in soft tissues around the joint

• Any small bone fragments or pieces of cartilage

• Swelling caused by fluid build-up

• Blood tests to diagnose gout or rule out other types of arthritis

Remember, OA can be more challenging to diagnose than other arthritis conditions. There is no blood test for OA, and teens and young adults are rarely suspected of having arthritis. So, while a blood test or non-imaging test may seem unnecessary, doctors are using them to rule out other conditions.

How is osteoarthritis treated in young people?

There is no "cure" for osteoarthritis. But those with OA have a normalized life expectancy, and many successfully reduce symptoms for long periods. OA symptoms can be managed in most young people, allowing the person to return to playing sports or other physical activities.

The following treatments have high-quality evidence supporting their efficacy:

Disease-related education

Understanding your disease is an important part of treating it. In fact, proper disease education may improve clinical benefits in up to 50%⁶ of patients. Young people often have different educational preferences and many prefer⁷ online disease education.

Exercise programs

Most people with OA are prescribed a physical therapist to assist them with recovery and treatment. Physical therapy exercise programs — which are specifically designed to improve OA symptoms and joint function — have a proven track record with a significant number of high-quality studies backing their efficacy.

Weight loss

Overweight people are 4 to 5 times⁸ more likely to develop OA, and up to 25%⁹ of OA cases are attributed to being overweight. Excess weight puts exceptional pressure and stress on weight-bearing joints, and this additional weight multiplies the impact of any stress-related activity on those joints. Losing weight can reduce the burden on your joints, which can improve the efficacy of exercise programs for treatment management.

Mental health support

For those suffering from stress, anxiety, or depression relating to their symptoms, support groups, therapy, and medication all have proven track records. Disease-related education can also contain information on the emotional and social impact of chronic pain and how to best treat it.

Does osteoarthritis require surgery?

Most cases of OA do not require surgery. In some rare cases, joint-conserving or joint replacement surgery may be warranted. But those surgeries are saved for the most extreme cases where standard lifestyle changes do not reduce symptoms.

Recent meta-analyses suggest¹⁰ that arthroscopy does not show any clinical benefits in OA. However, biomechanical interventions (e.g., knee braces) can significantly reduce symptoms¹¹ and slow down disease progression.

Should you take medication for osteoarthritis?

There is no medication available that can prevent OA or regrow cartilage. However, pain medications can help reduce pain-related symptoms. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen are often used for young adults. Analgesic opiates (which include oxycodone and hydrocodone) should be avoided unless absolutely necessary.

The lowdown

Osteoarthritis is a condition marked by reduced cartilage around joints. Most OA patients are older, but up to 30% of cases happen in those under 40. Young adults with OA often suffer from reduced joint mobility, inflammation, and pain. Once OA is diagnosed, young adults have a variety of effective treatment options available. Lifestyle changes usually reduce symptoms, but joint-saving surgery is considered in some cases.