Arthritis isn't just a condition affecting older people, it likely starts much earlier

This article is part of our series on older people’s health. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.

Arthritis is an umbrella term for over 100 conditions affecting the joints. All result in pain and often severely limit the activities a person can do. There are many different types of arthritis, each with a different cause.

Arthritis is a major cause of disability in Australia and world-wide. It also presents a significant cost to the community. In Australia, arthritis costs $55.8 billion per year.

Most people think of arthritis as a disease of the elderly. While this is where it’s most commonly seen, it’s not where it starts. No-one wakes up with arthritis at 65. The different types of arthritis have different causes, but most of these start much earlier in life with mild symptoms that often go unnoticed. It’s usually only as the condition worsens over time that symptoms are noticed, and this is usually in older age.

Two of the most common types of arthritis are osteoarthritis and gout.

Osteoarthritis

Osteoarthritis is common as people age, and most frequently affects the hands, neck, back, knees and hips. Many people get osteoarthritis due to a familial tendency to develop it. Clearly we can’t change this.

We describe osteoarthritis as a disease of ageing, but it often begins many decades before a person has joint problems. In the past it was thought osteoarthritis was due to “wear and tear” of the joints and was thus inevitable. We now know this is not the case and there are a number of causes of osteoarthritis, with obesity being one of the most common contributing factors.

Osteoarthritis is more common in women than men, and is exacerbated by age. Over the age of 60 years, more than 30% of people have osteoarthritis.

It was previously thought that obesity affects joints because of the extra load the person carries, but this wouldn’t explain osteoarthritis in the hands. We now know obesity also causes inflammation in the joints as well as the extra loading. Obesity affects joints across all of the life span, so damage is already present in middle age, but becomes worse over time.

Hormones and injuries to joints also play a part in osteoarthritis. Many women develop hand osteoarthritis at menopause.

Maintaining a healthy weight, avoiding injuries to joints and regular exercise in order to strengthen muscles around the joints, are all important for the prevention of osteoarthritis.

Muscle strengthening exercises are very effective for reducing pain in osteoarthritis. Anti-inflammatory creams have been shown to improve joint pain. Medications such as paracetamol and anti-inflammatory tablets should only be used in the short term, and with advice from a doctor.

Gout

Gout is a very different type of arthritis. It results from a build-up of uric acid in the body. Uric acid is normally produced in the body, but some people don’t process uric acid effectively, so it builds up. Under some circumstances, such as changes in the diet, medications such as diuretics or excess intake of alcohol, this build-up can be deposited in the joints. This causes arthritis, experienced as a very painful, swollen joint.

Gout is more common in men than women, although women catch up after menopause. As with osteoarthritis, it tends to run in families. Gout becomes more common as we age because uric acid is able to accumulate with time. This is mainly because the kidneys cannot eliminate it as well as they used to, often as a result of other conditions such as diabetes or high blood pressure that over years may effect the kidneys. Some commonly used medications such as diuretics (or “water tablets”) can make this worse.

Diet is important for preventing gout. Alcohol needs to be taken in moderation, especially beer, both to prevent development of gout and to reduce the number of episodes. There are some types of food such as offal (liver, kidney) and shell fish that may result in an increased production of uric acid in the body and precipitate gout. One new risk factor for gout is a high intake of fructose, a sweetener commonly used in many soft drinks. Obesity can also make gout worse, so needs to be prevented as part of gout treatment.

Many people will also need medications to keep their gout in check. Gout can readily be treated with medications such as anti-inflammatories or colchicine. If gout occurs repeatedly, medication can also be prescribed to prevent this.

Read other articles in the series here.

Flavia Cicuttini receives funding from NHMRC, MOVE Australia, Australian Arthritis Foundation, Monash University, The Alfred Foundation, Medibank Health Research Fund Member of the RMA