Osteoarthritis in the young: what can be done?

With the prevalence of early onset osteoarthritis rising globally, a program is targeting two modifiable risk factors for knee osteoarthritis: joint injury and weight gain. The program focuses on young people with an athletic knee injury and are at risk of developing osteoarthritis at a young age. “Young people who have a knee injury are at an about six times greater risk of developing post-traumatic osteoarthritis than people who don’t have a knee injury,” said Jackie Whittaker, a physiotherapist and associate professor at the University of British Columbia and senior scientist at Arthritis Research Canada in Vancouver. “We’ve seen an increase in the number of knee injuries over the last several years, or an increase in the reporting of knee injuries over the last several years, so there is a concern that there’s an increased number of people that are going to develop osteoarthritis.”It takes about five to 10 years to develop osteoarthritis after a knee injury, Whittaker said. The most common type is an anterior cruciate ligament (ACL) tear, common in player of sports where there’s a lot of pivoting, like soccer or basketball.The opportunity to reduce the risk for osteoarthritis is after the injury and before osteoarthritis, Whittaker said. Read: Drug delays onset of clinical RA symptoms in high-risk patientsWhittaker and colleagues at the Arthritis Research Centre have developed SOAR (Stop Osteoarthritis Program), designed to help patients understand the risks of osteoarthritis and reduce their risk through personalized exercise programs monitored by a physiotherapist. Participants meet regularly with physiotherapists and set specific goals. The program ensures people use exercise to feed the cartilage so it’s less likely to deteriorate, to build muscles around the joint and to control weight gain. The physiotherapist helps people embrace weight-bearing exercise after an injury when many people have been told to avoid it. The SOAR program is six months long and carried out online. “The goal is to make people as independent as possible and paying attention to their knee health early after their injury, knowing they’ve got this elevated risk of developing osteoarthritis,” Whittaker explained. “Just like if you knew you had an increased risk for developing diabetes, you’d be probably doing some things to reduce that risk.”The program is not currently available to the public because it’s still being evaluated. A feasibility study showed that the program has good adherence and outcomes. Whittaker and colleagues are now starting a randomized clinical trial which will include more than 170 participants, with one group joining the SOAR program immediately after their injury and the other group participating in another exercise program. The researchers will follow the participants for two years and record changes in MRI, pain and other variables.Read: Asthma and eczema found to be linked to osteoarthritisInterventions to control weight gain and reduce risks after injury may become more important as more young people suffer osteoarthritis. The worldwide incidence and prevalence of early onset osteoarthritis has doubled in the last 30 years, results from a new analysis of the Global Burden of Diseases suggest. The analysis focused on people aged 30 to 54 years who had symptomatic osteoarthritis in any joint confirmed by x-ray. The prevalence rose by 200% in this patient group between 1990 and 2019. Obesity may be a factor in the increase. The researchers found that years lived with disability that were attributable to obesity (defined by high BMI) in patients with early onset osteoarthritis increased from 9.41% to 15.29% during the study period.“Early onset osteoarthritis is a global health problem, leading to substantial disease burdens and economic costs,” wrote Qianlin Weng, of Xiangya Hospital at Central South University in China and colleagues in their paper in Annals of the Rheumatic Diseases. “This trend is expected to continue with the rise in overweight and obesity among young and middle-aged adults. The findings show that osteoarthritis is no longer a disease confined to older people but is increasingly affecting younger people at productive ages. Effective strategies for prevention at a young age are required.”A second analysis published in the Lancet in September 2023 looked at the overall prevalence of symptomatic osteoarthritis confirmed by X-rays, based on data from the Global Burden of Disease Study 2021. The prevalence of osteoarthritis in people of any age in 2020 was 7.6%, an increase of 132.2% compared to 1990. The prevalence in people aged 30 to 60 years old was 3.5%, with knee osteoarthritis as the most common form of osteoarthritis. Obesity (defined by high BMI) contributed to 20.4% of osteoarthritis cases. “Given high BMI accounted for just 20% of osteoarthritis burden, it will be an important future direction to quantify the contribution of history of injuries, occupational risk, prior joint-related surgeries, and other potentially modifiable risk factors to osteoarthritis burden,” the authors of The Lancet study wrote.More information on the SOAR program is available on the Arthritis Research Canada website. A feasibility study of the SOAR program was published in Osteoarthritis and Cartilage in 2022. The protocol for the study was published in BMC Musculoskeletal Disorders.Read: 1 in 10 will be affected by osteoarthritis by 2050

Osteoarthritis in the young: what can be done?

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