Arthritis at 30: price of an unfit lifestyle

Doctors in the UAE are seeing an increase in younger patients with degenerative arthritis.

DUBAI // Obesity, lack of exercise and Vitamin D deficiency are causing degenerative arthritis at a younger age.

Up to 70 per cent of sufferers are in their thirties, which is considered early for a disease with an average global onset age after 40.

The most common complaint is osteoarthritis, a degenerative disease of the joints in which the cartilage that protects the ends of the bones deteriorates. This can cause stiffness, pain and loss of movement.

"Before we only used to see elderly patients with degenerative diseases, but now I'm seeing a significant number of younger patients in their thirties," said Iman Al Janahi, an Emirati physiotherapist at Al Baraha Hospital in Dubai.

"This is because of the modern lifestyle and the very bad ergonomics they live in, so these diseases are now starting very early."

Nearly a quarter of Ms Al Janahi's patients are younger than 40, with the most common complaints affecting the knees and back.

"Before, people were exercising, even when they didn't mean to. They were walking, doing housework and engaging in more physical work. This was all considered very good strengthening and stretching exercises," Ms Al Janahi said. "Now we are working while we are sitting and we have people doing the work for us."

Ms Al Janahi is not alone in seeing younger patients develop a disease that was once thought to be limited to old people.

Dr Salman Hameed, a specialist orthopaedic surgeon at Medcare Orthopaedics and Spine Hospital, said nearly 70 per cent of his patients are under 40. The main culprit, he said, was obesity, which affects about a third of the population.

Childhood weight gain and obesity predispose adults to bone and joint problems. A recent study by UAE University of 1,440 children between the ages of 6 and 19 found that one in three was overweight or obese.

"It may not be a problem in their adolescent years, but it could eventually catch up with them," he said.

The extra weight places pressure on the joints causing the muscles that support them to become weak, said Dr Humeira Badsha, rheumatologist and founder of the Emirates Arthritis Foundation. For every kilogram gained, about four times that in pressure burdens the knees and six times the pressure on the hips.

"In the case of the knees, for example, the muscles that support the kneecap will weaken and so the kneecap will become unstable and keep moving around," she said. "That's why many of these patients will hear a clicking noise in their knees."

Nearly one in five of Dr Badsha's patients is under 40. And although the UAE is not alone in the increasing number of younger patients with degenerative arthritis, causes of the disease differ according to location, said Dr Batcha, who previously practised in the United States.

"Life there is different, people are more active and do their own chores be it cleaning or doing the laundry," Dr Batcha said. "People might not think this amounts to anything, but doing this on a routine basis has an impact.

"Even if you look at the elderly patients, they have a more positive outlook and are more active. The most an elderly patient would want to do here is go for a walk, and sometimes that's not enough."

In contrast, trauma and sports injuries are the common causes for degenerative arthritis in younger patients in the west. Similar cases are becoming visible in the UAE, Dr Hameed said.

"You have people who are obese and who already have weak joints, and then they suddenly decide to go to the gym and start intensive exercise too soon and end up with problems,' he said. "It needs to be a gradual process."

Most cases of degenerative arthritis can be treated with weight loss, physiotherapy and exercise. Severe cases, which are less common among younger patients, may require joint replacement surgery.

Vitamin D deficiency, which is also a problem specific to the UAE, is another factor. About 60 per cent of men and 65 per cent of women are Vitamin D deficient, weakening bone and cartilage.

But doctors saying having this information now can prevent development of the disease later.

"Unlike rheumatoid arthritis, which is a systematic auto-immune disorder, degenerative arthritis is often caused by environmental factors that we can control," Dr Badsha said. "The problem is people will usually wait until there's a problem before they make a change.

"Many times it will be too late and they may have to live with the condition for the rest of their lives, whereas if they were careful from the beginning, they could have avoided it altogether."