Before lockdown in 2020, Elizabeth Takyi had a thriving social life, a busy job and enjoyed regular sessions at the gym. “My life used to be great,” he says.
But these days, the mother of three rarely leaves the house and needs a cane when she does.
At 54, she is one of around ten million people in the UK with osteoarthritis, a disease in which cartilage (the tough fibrous material that acts as a “cushion” for our joints) wears down to the point that it the bones rub. often causing extreme and paralyzing pain.
For years, this “wear and tear” form of arthritis was primarily associated with the long-term effects of sports-related injuries or simply aging.
There may also be a familial link: there are thought to be several hundred genetic variations associated with the condition, and the more you have, the greater the risk.
Elizabeth Takyi is one of the estimated ten million people in the UK with osteoarthritis.
Now experts are warning of a “tsunami” of osteoarthritis cases driven not only by Britain’s aging population but also by rising obesity rates which mean younger and younger people are being diagnosed with the disease.
“Obesity is a straight line to osteoarthritis – the heavier we get, the more our joints suffer,” says Dr Wendy Holden, consultant rheumatologist at North Hampshire Hospitals NHS Foundation Trust and medical adviser to the charity Arthritis Action.
‘Knees are not designed to support excess weight. It’s very simple: like driving a heavy truck over a bridge and causing it to collapse.’
And you don’t have to be morbidly obese to increase stress on your joints. In fact, any degree of overweight “puts the body in an inflammatory state,” which increases the risk of osteoarthritis, says Dr. Holden. «The more overweight you are, the greater the risk, and the longer it lasts, the worse the effects will be.
“But for every kilogram we carry above a healthy body weight, it has the impact of another 4 or 5 kg passing directly through our weight-bearing joints.”
This is because the force exerted by the additional weight is amplified as it travels through the joints, a sort of funnel effect. So for someone who is 20kg overweight, for example, the stress on their joints each time they take a step is roughly equivalent to 80-100kg, says Dr Holden.
A 2022 analysis of data from the National Joint Registry in England, Wales, Northern Ireland and the Isle of Man found that by 2060, demand for hip and knee replacements will increase by around 40 percent due to the effects of increasing rates of osteoarthritis.
The NHS already performs around 100,000 knee replacement operations a year, in addition to 95,000 hip procedures. But some experts fear the real burden could be much higher.
“The figures we have on osteoarthritis cases in the UK are probably the tip of the iceberg,” says Dr Fiona Watt, a rheumatologist and researcher at Imperial College London.
‘We are probably underestimating because we rely on healthcare data that counts those who receive a specific diagnosis code for osteoarthritis. Therefore, if it is simply recorded as joint pain, or if people do not seek help and mistakenly think that the condition is an inevitable part of aging, then not all cases will be counted.’
In some parts of the UK, he says, patients are waiting two years or more for joint replacement surgery as the NHS struggles to clear the backlog caused by the pandemic.
One of the most effective ways to compensate for the pain and discomfort caused by osteoarthritis is regular exercise. It combats weight gain and increases muscle strength capable of relieving some of the stress on damaged joints.
But many patients, like Elizabeth, who already suffer from pain and lack mobility due to this condition, struggle to move and do the exercise that could help.
It occurs when cartilage (the tough fibrous material that acts as a “cushion” for our joints) wears down to the point where bones rub, often causing pain.
“If you have joint pain, you should exercise more, not less, to strengthen the muscles around the joint and improve joint stability,” says Dr. Holden. ‘You are never too old to start exercising. “Doing less leads to more weight gain and, in turn, more joint damage, so it becomes a vicious cycle.”
Additionally, being overweight is also believed to increase inflammation in the body, which can lead to osteoarthritis in non-weight-bearing joints, such as the hands as well.
“We currently have no treatments to slow the progression of osteoarthritis, so this is a priority for researchers,” says Dr Watt, adviser to the charity Versus Arthritis.
‘Joint replacements are very effective in some people, but they are extremely expensive and since Covid there are long waiting times for surgery. As cases increase, demand will continue to increase.”
Elizabeth was told that her weight was at least partly to blame for her condition. Before his diagnosis, he had suffered years of mild back pain, then his right hip and knee were affected.
As her pain worsened throughout 2019 and 2020, she attributed it to sitting in one place for too long while working from home during the Covid lockdown.
“When I bent over, I got sharp pains in my hip, so I couldn’t put on my socks or tie my shoelaces,” Elizabeth recalls. She also couldn’t walk to the park with her youngest daughter, but had to drive the short distance.
One morning in June 2021, he woke up unable to get out of bed, much less walk, with a “severe, spasm-like pain in his lower back.” A scan revealed severe osteoarthritis in Elizabeth’s hip.
“I was shocked because I always assumed it only affected older people,” he says.
At the time she was a size 14 and her BMI was in the overweight category. In addition, his mother also suffers from the disease. ‘They told me that
Lose weight to reduce pressure on your joints and back,” says Elizabeth, a neurodiversity consultant from south-west London, who has two older sons, aged 29 and 27, and a 14-year-old daughter.
“I lost a few pounds after the diagnosis, but now I’m a size 20 because even though I changed my diet, I had a hard time exercising or moving much due to the chronic pain I had.”
He was also diagnosed with osteoarthritis in his right knee in 2022 and in his spine earlier this year.
“It was a dead end: the more I exercised, the worse the pain became and sometimes my leg would stiffen,” says Elizabeth. “I tried going to the gym and walking 30 minutes every morning, but the next day working out left me in great pain.” He adds that it is distressing to find himself so overweight, as it has never been a problem before.
Experts say that although the outlook for the number of osteoarthritis cases is bleak, there are emerging treatments that can help and, above all, get patients moving again, so they can stop the vicious cycle of weight gain and more joint problems.
Healthy eating is essential: Dr. Holden advises eliminating sugar and ultra-processed foods and switching to a Mediterranean-style diet (rich in fruits, vegetables, fish and olive oil).
Among the new treatments being investigated is hormone replacement therapy (HRT): researchers at the University of Oxford are planning a trial in postmenopausal women with osteoarthritis, based on the theory that lower levels of estrogen lead to poorer cartilage. weaker. Lower estrogen levels are also associated with increased inflammation in the body, which can worsen joint pain.
After a year of waiting, Elizabeth underwent a hip replacement a few weeks ago. “My social life is non-existent and my mental health has been affected by everything I’ve been through,” he says. ‘I used to love making an effort to look and feel good, but I don’t feel like myself anymore.
‘But now that I’ve had surgery I can try to rebuild my life. The pain from osteoarthritis has already improved; I can finally have hope again.’
- For more information, visit: versusarthritis.org; arthritisaction.org.uk
