Q: Why did I all of a sudden get arthritis?
I get this question quite a bit in clinical practice. Arthritis is a common issue for just about everyone at some point in their lives. There are different types of arthritis but for the sake of this discussion we will focus on the most common form – OSTEOARTHRITIS (OA).
What is OA?
Osteoarthritis is the normal wear and tear of your body. It should make sense that the more activity and abuse you do throughout life, the faster things will wear out or break down.
How did it get there?
Believe it or not, as you age, your body will break down and begin to show signs of your past life coming back to haunt you. Most people begin to feel those old injuries in their 30’s and 40’s. Prior to 2021, it was believed that OA was mostly based on environmental causes. That means, we previously thought it was mostly related to the injuries sustained and the activity level you maintained that led to the degeneration.
In 2021 a paper that was published in the journal Cell, it documented over 100 genes that had been linked to arthritis. Our understanding now is that roughly 70% of arthritis is a genetic factor. I would encourage you to remember mom and dad during the holidays, so you can thank them properly for 70% of your arthritic knee/shoulder/back pain.
The other 30% is likely still your fault, so maybe cut them a little slack.
But why does it hurt NOW?
Returning to the original question, your arthritis took years to develop but only a split second to cause pain. Common things that flare up arthritis include new injuries, starting a new activity or gym routine, overdoing it, or just generally being unhealthy and trying to move.
Think of the scenario like driving your car. If you are anything like my wife, you probably saw a check engine light on your dash but didn’t do anything about it because the car was running fine. Then one day the car just dies on you and you think it happened out of the blue…
Osteoarthritis is similar to a gradually developing problem that will one day cause an issue, much like my wife and her car. Like the burning when you pee, ignoring it will only make things worse.
What can I do about it?
There are options to “control” arthritis but the only real “cure” is to replace it. The trick to prolonging the magic is to stay active throughout life. A sedentary life will only cause fatigue and weakness. You must keep your muscles strong because they offload the bones.
There are some braces on the market that can offer some support. The typical wear pattern for a knee is to collapse the “medial compartment” (the passenger side of the left knee, or the drivers side of the right knee). Using something like a custom fit “Medial off loader brace” can help with some mechanical issues. There are a ton of them on the market. Here is a typical example of one from Amazon.
You CAN ask your physician to prescribe a medial off loader brace for your medial joint space collapse but if you decide to buy one on your own, any of them will do. It comes down to comfort. IF you decide to ask your physician to order one for you, I would encourage you to ask your physician to document the “pseudolaxity” you have in your “valgus” deformity. Those are the keywords insurance companies are looking for. Not that I know what they need to justify claims…
The evidence
Here is a few images of actual arthritic knees All of them are age matched and female with their LEFT knee. The goal was to eliminate as many variables as possible. I’m not going to ruin the mystery. One of them is a retired professional athlete, another is an office worker who has done almost zero physical activity for life, and the other is your average weekend warrior with knee pain. To make things even more fun, one of them is completely pain free and it is not the one in the middle. All of the images have osteoarthritis. For the sake of patient privacy you get to decide…
