Early-Onset Osteoarthritis: Causes, Symptoms, and Management

Soreness

Hello Dr.
Yang: I have several questions and would appreciate your prompt response.
Thank you! I am 37 years old, 160 cm tall, and weigh 63 kg (this is my first online consultation).
Earlier this year (around February), I started experiencing mild soreness in my knees (including the back of my knees), and sometimes my calves and ankles also felt sore.
I visited a rheumatologist and underwent various blood tests, all of which came back normal, including uric acid levels.
The doctor also examined my knees and found no issues but suggested taking a supplement for joint health.
However, my symptoms have been inconsistent, and recently, my knees (including the back of my knees), calves, and ankles have been swollen and painful, causing significant discomfort.
I am concerned about what might be wrong with my knees, so I consulted an orthopedic doctor.
However, the doctor quickly diagnosed me with arthritis based solely on my symptoms and prescribed anti-inflammatory pain relievers and muscle relaxants, advising me to take them as needed, but warned not to take them if I wasn't in pain.
Unfortunately, the medication has upset my stomach.
I feel that this diagnosis was rather hasty, so I insisted on getting an X-ray.
The X-ray was only done on my left leg, and the doctor concluded that both knees had degenerative arthritis, with the left knee being more severe, stating that the cartilage was worn down to the bone, which caused inflammation.
I was shocked and frightened to learn that I have degenerative arthritis—how could this be possible at my age? I have never had such severe knee issues before.
Reflecting on my past (before age 20), I lived in the countryside and often helped my mother with heavy chores, especially during busy farming seasons, and I loved hiking, going up the mountains regularly (1-2 times a month) without any issues.
Now, I am a working woman with a desk job, occasionally going out to buy groceries (carrying about 10 kg) and walking around.
My workplace is not far from home, so I walk to pick up my children (a round trip takes at least 20-40 minutes daily).
On weekends, I hike once a month, and I have a generally low level of physical activity, considering walking as my exercise.
I never expected that such a simple lifestyle could lead to overuse injuries.
Could it be that walking too much has caused early degeneration (isn't walking considered the best exercise)? I have the following questions for you:
Q1.
Why has the degenerative condition appeared early (the doctor was surprised)? What could be the underlying causes?
Q2.
Why do the pain relief and anti-inflammatory medications improve my symptoms (the swelling and pain decrease), but the symptoms return when I stop taking them? This does not seem like a fundamental solution (I can't take medication long-term!).

Q3.
How can I protect my knees? Should I wear cushioned shoes or knee braces while walking or climbing stairs? Can I wear knee braces for extended periods?
Q4.
Besides medication, are there other methods (since the medication makes my stomach uncomfortable) that could potentially cure my condition?
Q5.
What types of exercises are suitable for me? Which should I avoid? (I live on the third floor and have to climb stairs several times a day; will this cause more damage to my knees?)
Q6.
Will taking joint health supplements help? (How should I take them, and which brand should I choose to avoid counterfeit products?) Or how should I approach rehabilitation?
Q7.
Is it okay to use a sauna or hot springs?
Q8.
Does the early onset of degenerative arthritis indicate a calcium deficiency, premature aging, or other causes?
Q9.
What dietary changes should I make? What foods should I avoid?
Q10.
Why do different doctors provide varying diagnoses for my symptoms? A) Some say it's caused by nerve issues (spinal problems) and recommend physical therapy.
B) Physical examination seems fine (but I hear clicking sounds in my knees during stretching).
Why is that? C) Both legs have similar symptoms (but my left leg feels worse); why was only the left leg X-rayed? Is this diagnosis accurate? I am truly confused about which explanation to believe and feel very anxious and scared.
I would greatly appreciate your accurate answers to these numerous questions.
Thank you!

Annie, 30~39 year old female. Ask Date: 2004/05/27

Dr. Yang Zhengfan reply Orthopedics

Dear Annie,
You have quite a few questions, and I will address the key points as follows:
1.
The causes of arthritis were previously attributed to overexertion, but it is now recognized that individual physiological factors are also closely related.

2.
Arthritis cannot be cured, but symptoms can be improved.
Medications (including glucosamine) can alleviate symptoms, and treatments such as heat therapy and exercise rehabilitation are also effective for arthritis.

3.
There are many accessible books available on the market that provide in-depth introductions to arthritis.
I recommend finding one to study carefully, as it will greatly help clarify your doubts.

Reply Date: 2004/05/27

More Info

Understanding early-onset osteoarthritis (OA) can be quite complex, especially when symptoms arise unexpectedly at a relatively young age. Your concerns about knee pain, swelling, and the diagnosis of degenerative joint disease are valid, and it’s important to address each of your questions thoroughly.

Q1: Why is the degenerative condition appearing early?
Early-onset osteoarthritis can be attributed to several factors, including genetic predisposition, previous injuries, obesity, and repetitive stress on the joints. Your history of physical activity, such as farming and hiking, may have contributed to joint wear and tear over time. Even if you have a relatively sedentary job now, the cumulative effects of past physical stress can manifest as OA symptoms later in life.

Q2: Why do pain relief medications improve symptoms?
Pain relief medications, such as NSAIDs (non-steroidal anti-inflammatory drugs), work by reducing inflammation and alleviating pain. While they can provide symptomatic relief, they do not address the underlying cause of osteoarthritis. Long-term use of these medications is not advisable due to potential side effects, including gastrointestinal discomfort, as you've experienced.

Q3: How to protect the knees?
Wearing supportive footwear, such as cushioned shoes, can help reduce stress on your knees. Knee braces can provide additional support, especially during activities that involve walking or climbing stairs. However, it’s essential to ensure that any support you use is comfortable and does not restrict movement excessively.

Q4: What alternatives to medication exist?
Physical therapy can be beneficial in strengthening the muscles around the knee, improving flexibility, and enhancing overall joint function. Low-impact exercises, such as swimming or cycling, can also be effective without putting too much strain on your knees. Additionally, weight management is crucial, as excess weight can exacerbate joint stress.

Q5: What exercises are suitable?
Low-impact activities like swimming, cycling, and walking are generally recommended. However, high-impact activities, such as running or jumping, should be avoided as they can worsen symptoms. Strengthening exercises targeting the quadriceps and hamstrings can also help support the knee joint.

Q6: Will supplements like glucosamine help?
Glucosamine and chondroitin supplements may provide some relief for joint pain in some individuals, although scientific evidence is mixed. If you decide to try these, consult with a healthcare provider for guidance on appropriate dosages and reputable brands.

Q7: Is it okay to use saunas or hot springs?
Heat therapy can help relax muscles and alleviate stiffness, making it a suitable option for some individuals with OA. However, be cautious not to overdo it, as excessive heat can lead to swelling in some cases.

Q8: Does early-onset OA indicate calcium deficiency or premature aging?
While calcium deficiency can contribute to bone health issues, early-onset OA is more commonly linked to joint stress and genetic factors rather than solely nutritional deficiencies. Aging is a factor, but it’s not the only cause.

Q9: What dietary changes should be made?
A diet rich in anti-inflammatory foods, such as fruits, vegetables, whole grains, and omega-3 fatty acids (found in fish), can be beneficial. Conversely, it’s wise to limit processed foods, sugars, and excessive salt, which can contribute to inflammation.

Q10: Why do different doctors provide varying diagnoses?
Variability in diagnoses can stem from differences in clinical experience, interpretation of symptoms, and diagnostic methods. It’s crucial to seek a second opinion if you feel uncertain about your diagnosis. A comprehensive evaluation, including imaging studies and possibly referrals to specialists like rheumatologists or orthopedic surgeons, can help clarify your condition.

In conclusion, early-onset osteoarthritis can be a challenging diagnosis, but understanding its causes, symptoms, and management strategies can empower you to take control of your health. Regular follow-ups with healthcare providers, adherence to recommended treatments, and lifestyle modifications can significantly improve your quality of life. If you continue to experience anxiety about your condition, consider discussing your concerns with a mental health professional to help manage the emotional aspects of living with chronic pain.

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