Body Weight and Arthritis, Any Link?

Arthritis this, Arthritis that, there are lots of misconceptions and outright falsehoods amongst Nigerians concerning this issue.

To shed more light on this and more, Adebukola Aluko speaks with Dr Ajibola Oladiran, a Lecturer and Consultant Orthopaedic and Trauma Surgeon with a subspecialty in Athroscopy (Joint Replacement) and Sports Medicine at the College of Medicine and the University College Hospital, UCH, Ibadan.

Here are excerpts from the interview,

Q: What is Arthritis?

A: Arthritis is a disease of the joints, and actually means inflammation of the joints.

Q: What are the predisposing factors to Arthritis?

A: There are different types of arthritis. The most common form is osteoarthritis, which is a degenerative condition of the joints and the bone next to the joints. It results in wearing of the cartilage on the surface of the joints.

To explain what the cartilage is, the way we like to eat chicken, after we are done with the flesh, when you open the joint, you will realize that there’s this white, very smooth, crunchy part that we all like to eat, called the cartilage. In a healthy joint, the surface of the cartilage with the fluid that lubricates the joint is the smoothest surface known to man.

Degeneration of the joints is osteoarthritis. Other forms of arthritis are rheumatoid arthritis which is an autoimmune condition where the body is essentially destroying its own cells, resulting in inflammation and erosion of the joints. Another form is septic arthritis in which is an infection. All of them have some form of inflammation, but they all have different causes.

Q: Is Arthritis hereditary?

A: There’s a hereditary component. People who have a family history of arthritis are at a higher risk of developing more severe arthritis earlier in life. We may find that out of two persons who have identical lifestyles and identical body weight, one develops arthritis earlier than the other, because there’s a family history that makes the joints degenerate earlier and faster. But other than the hereditary components, like I mentioned, previous infection or rheumatoid arthritis that causes damage to the joint, trauma or obesity are also factors. the heavier the person is, the more load is being put on the joints. it’s like the chassis of the vehicle, if you keep loading the vehicle, the chassis and the shocks begin to wear, repeat the same thing with the joints, the heavier, the person, the more pressure on the joints.

Q: What is the prevalence rate using UCH as a case study?

A: Let’s focus on osteoarthritis because it’s the commonest form.

Osteoarthritis rarely occurs in people under twenty, unless they have had severe injuries that have damaged the joints much earlier in life and are now suffering the consequences.
Apart from that, I haven’t seen anyone younger than 20years of age with idiopathic osteoarthritis, (meaning it doesn’t have any other directly identifiable cause other than hereditary). For people who have a significant family history or who have other conditions that affect the quality of the cartilage, they tend to have to develop osteoarthritis earlier in life.

So, in those people who have one form of risk factor or the other, we may start seeing signs of osteoarthritis in as early as 40 years of age.

However, most people, by the time the average person is 60 to 65 years, there will be some mild features of osteoarthritis even in people who haven’t developed severe clinical arthritis. In the first instance, I mentioned that idiopathic arthritis is rare in young people. There are some other things that predisposes younger people to arthritis. One of the most common in this environment is arthritis of the hip in people who have sickle cell disease. They have degeneration of the head of the femur called avascular necrosis, hence, the head of the femur is no longer smooth. The roughened edge collapses and is now damaging the hip joint. They then go on to develop secondary arthritis very early. I’ve seen that in teenagers, but that is because there’s an underlying problem. Otherwise, it’s not common in young people.

Q: Is there a relationship between Rheumatism and Arthritis?

A: Well, rheumatism is a broad term that is used to refer to anything that causes pain in the bone or around the joints. Medically, rheumatoid arthritis is what I described earlier. Rheumatic fever on the other hand is a condition that affects not just the joints, but the heart as well, there’s an underlying infection and then the response of the body affects the heart and the joints. So, rheumatism is a term that is used rather loosely to refer to pain in and around the joints.

Q: Is arthritis more common among women or men?

A: That’s a rather difficult question. We tend to see it more in females.

The risk factors are more or less the same, But, if you remember, I said well-toned muscles help to protect the joints. Men have an advantage in that area. So, men tend to have increased level of activity, increased muscle bulk, and better balancing of the joints which tends to give some degree of protection. However, men are also more prone to trauma.

Q: What is the relationship between Arthritis and Post-delivery syndrome

A: None. The only relationship between arthritis and childbearing would be that the increased weight during pregnancy is now putting more pressure on the joints. But that’s a temporary weight gain which is lost as soon as the baby is delivered and the water comes out and the woman loses the extra fluid accumulated during pregnancy. So, there’s no direct relationship between pregnancy and arthritis.

Q: Is Arthritis Curable?

A: No, Arthritis is not curable. Treatment is essentially management, because once those degenerative changes start, they cannot be reversed. The cartilage does not regenerate itself once it is damaged. What we do in treatment is aimed at slowing down the progression, limiting the symptoms, preserving function, and when the damage is severe, reconstruction (joint replacement) can be done

Q: There’s this saying, “Prevention is better than cure”. How can we prevent Arthritis?

A: Don’t overload your joints. If you are obese or overweight, then lose weight. It’s important to know your Body Mass Index (BMI) and to keep it within the normal range.

People who are physically active, who have good muscle bulk, well-toned muscles tend to help to balance the joints better, (and the more well-balanced the joints is, the more it is protected from degeneration) much better than somebody who doesn’t have that advantage of well-toned muscles helping to balance the joints.

Technically that means exercise can help and is one of the things we recommend for prevention and treatment of arthritis.

Another thing is sports. While exercise and sport have huge benefits, on the other hand, contact sports, while it gives the opportunity for well-balanced, well-toned muscles, the repeated impact and injuries that athletes accumulate from a long career in contact sports is actually damaging to the joints.

For somebody who has injured his or her knee or who already has arthritis, he or she should see an Orthopaedic Surgeon as soon as possible. It’s also important at this point to emphasize that not all joint pain is arthritis. It’s important to have proper evaluation from a specialist to determine the cause of the pain and the appropriate treatment.

Adebukola Aluko