Arthritis sufferers are becoming younger, thanks to obesity and over-exercise

Arthritis, a joint disease in itsmany painful and debilitating forms, does not just affect the elderly,writes Elaine Yau

PUBLISHED : Tuesday, 15 January, 2013, 12:00am
UPDATED : Tuesday, 15 January, 2013, 10:57am

Scott Taylor has always been a passionate athlete, playing rugby, football, tennis and squash. But four years ago, his love for sport was dealt a crippling blow. It all began with groin pain.

"It was like I pulled a muscle in my groin," says Taylor, 31, the managing director of executive search firm Webbe International. "The niggling pain I felt got worse and worse. On some days, I couldn't take any pressure on it and I limped when I walked." He was eventually diagnosed with hip osteoarthritis.

Osteoarthritis, a disease usually seen in the elderly whose joints and cartilage are damaged by wear and tear, is showing up increasingly in young people. Also known as degenerative joint disease, the condition is the most common form of arthritis, of which there are more than 100 types.

Gout, another form of arthritis, is also striking younger people in greater numbers. The most common form of inflammatory arthritis, it's characterised by painful and swollen joints, usually the big toe joint. It's caused by high levels of uric acid in the blood, which leads to the formation of small crystals in joints and tissues.

Dr Daniel Ng Kam-hung, rheumatologist and executive committee member of Hong Kong Arthritis & Rheumatism Foundation (HKARF), says the rising incidence of gout is caused by excessive consumption of meat, seafood and alcohol, which increases uric acid levels in the body.

Lifestyle factors - the rise of the weekend warrior and of obesity - are also the key culprits for more cases of osteoarthritis in young people, according to Benjamin Chow Kai-pun, a specialist in orthopaedics and traumatology. Ironically, both reasons are at opposite ends of the healthy lifestyle spectrum.

"Those weekend warriors whose muscle and tendon lack training on weekdays put themselves at high risk of injury when they engage in excessive sports on weekends. For obese people, their weight weighs on the joints and speeds up wear and tear," says Chow. The most frequently affected joints, he says, are the wrist, knee and hip joint, and the spine.

More cases of rheumatoid arthritis, a debilitating genetic disease and the second most common arthritic condition, are detected - but mainly because of better awareness and advances in diagnostic technology. In the past, rheumatoid arthritis patients were often wrongly diagnosed as having joint wear-and-tear, Ng says.

Rheumatoid arthritis is, in fact, a chronic autoimmune disorder characterised by persistent inflammation around the joints, predominantly in the wrist and fingers. The disease causes pain, swelling, stiffness and loss of function and can result in tissue destruction. About 1 per cent of the world's adult population has the condition, with women being three times more likely to suffer from it.

But there is new hope for relief for the growing number of arthritis sufferers. The Hong Kong Arthritis & Rheumatism Foundation Jockey Club Patient Resource and Training Centre - the first of its kind in the city - was recently opened in Sham Shui Po, with a HK$1.65 million donation from the Jockey Club.

The centre houses the offices of HKARF and three self-help organisations: the Rheumatoid Arthritis Association, Ankylosing Spondylitis Association and Psoriatic Arthritis Association. It also provides pain management workshops, programmes for physiotherapy and occupational therapy training and exercise classes.

"While there is currently no cure for arthritis and rheumatism, we believe the centre can make a huge difference to the well-being of these patients by providing physical and psychological support," says Douglas So, Jockey Club executive director of charities.

Taxi driver John Sin Man-wai, 40, who has ankylosing spondylitis, a form of rheumatoid arthritis that causes inflammation in the joints between the bones of the spine, suffered with severe back pain for a decade before getting the correct diagnosis at age 30.

The doctor told him the disease was very rare and incurable. "I thought my life was over. I spent much money doing all types of therapy, including acupuncture, Chinese massage, physiotherapy - all to no avail," says Sin. "With severe back and waist pain, I needed crutches and I walked slower than an elderly man."

Then in 2005, a passenger who learned of Sin's condition told him about the Ankylosing Spondylitis Association. The self-help group has provided great support.

"Quite a lot of young to middle-aged adults suffer from [the condition]. There's also treatment for it, such as stretching exercises and water therapy," says Sin. "My condition improved a lot and I can walk like a normal person now."

But avid athlete Taylor hasn't seen much improvement in his condition, despite having arthroscopy in 2009. The surgery is a minimally invasive procedure where an endoscope and a special drill are inserted into the hip joint through tiny incisions. He will have hip replacement surgery this month.

Health Department figures show that osteoarthritis affects nearly half of elderly people, 80 per cent of whom experience it in the knee. In young adults, however, the problem spot is the hips. Many have early onset hip arthritis because they played a lot of sport during childhood, says Jason Brockwell, medical director with Asia Medical Specialists and an orthopaedic hip surgeon specialising in young adult hip problems.

"In the bones of children, there's a growth plate at the top of the thigh bone. We think the growth plate gets slowly pushed in the wrong direction by playing lots of sport."

Femoro acetabular impingement (FAI) is the cause of most hip arthritis cases, says Brockwell. It is caused by too much friction between the ball (femoral head, or highest part of the thigh bone) and socket (acetabulum, or the part of the pelvis that meets the thigh bone) of the hip joint.

"As the growth plate is affected by sport, the ball becomes slightly elliptical, instead of round," he says. The wear starts to appear at about 12 years of age. "Then every time the hip is moved, it is like pushing a square peg into a round hole, damaging the cartilage and eventually causing arthritis."

Brockwell says the condition was only recognised about 15 years ago, and not all doctors are aware of it. Instead, he says, patients with typical vague groin or buttock pain are often diagnosed with a "groin strain" or "sports hernia". "I don't think [they] exist," he says. "The hip joint is usually the problem."

The prognosis for athletes doesn't look good. Brockwell's youngest patients are athletes.

Patients who do intense sports - those that involve repeatedly bending and twisting the hip, such as racquet sports and fencing - get symptoms at a very young age, and might need an operation at age 15 or 16. Those who take part in less intense sports might get problems in their 20s and 30s.

The best treatment for FAI is arthroscopy, but Brockwell says the surgery is only for people who still have some cartilage left. Severe cases require a hip replacement. Still others, he says, have "silent FAI": the young adult feels no pain but arthritis quietly develops, and when pain does strike, it's too late and a hip replacement is needed.

Hip arthritis is very common in the West but less so in Asia. But this might not be the case for long.

"We might see more of this problem as Asia gets richer, and more young people play sport instead of just study," says Brockwell.