Before the 2020 lockdown, Elizabeth Takyi had a thriving social life, a busy job and enjoyed regular gym sessions. “My life was great,” she says.
But today, the mother of three rarely leaves the house and needs a walking stick when she does.
At the age of 54, she is one of an estimated 10 million people in Britain with osteoarthritis, a disease in which cartilage – the tough fibrous material that acts as a ‘shock absorber’ for our joints – becomes worn to the point where bones collide with each other. to rub. often causing extreme and crippling pain.
For years, this ‘wear and tear’ form of arthritis was mainly associated with the long-term effects of sports injuries, or simply growing older.
There may also be a family bond; there are thought to be hundreds of gene variations linked to the condition, and the more of these you have, the greater your risk.
Elizabeth Takyi is one of an estimated 10 million people in Britain with osteoarthritis
Now experts are warning of a ‘tsunami’ of osteoarthritis cases, caused not only by the UK’s aging population, but also by rising rates of obesity, which is seeing younger and younger people being diagnosed with the disease.
‘Obesity is a straight line to osteoarthritis – as we gain weight, our joints suffer more,’ 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 carry excess weight. It’s simple: like driving a heavy truck over a bridge and causing it to collapse.’
And you don’t have to be morbidly obese to put even more strain on the joints. Any excess weight “puts your 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 that lasts, the worse the consequences.
‘But for every kilogram we carry above a healthy body weight, it has the impact of another 4-5kg passing directly through our weight-bearing joints.’
That’s because the force exerted by extra weight is amplified as it moves through the joints – a kind of funnel effect. So for someone who is, for example, 20kg overweight, the stress on their joints every 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 shows that demand for hip and knee replacements will increase by around 40 percent by 2060 due to the effects of rising numbers osteoarthritis.
The NHS already carries out an estimated 100,000 knee replacement operations a year, plus 95,000 hip procedures. But the true burden could actually be much greater, some experts fear.
‘The figures we have on osteoarthritis cases in Britain are probably the tip of the iceberg,’ says Dr Fiona Watt, a rheumatologist and researcher at Imperial College London.
“We are likely undercounting because we rely on health care data that counts those assigned a specific diagnostic code for osteoarthritis. So if it’s just recorded as joint pain, or if people don’t seek help and mistakenly think the condition is an inevitable part of aging, then not all cases are counted.”
In parts of Britain, she 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 offset the pain and discomfort caused by osteoarthritis is regular exercise. It counteracts both weight gain and muscle strength, which can relieve some of the burden on damaged joints.
But many patients – like Elizabeth – who already have pain and lack of mobility due to the condition, struggle to get moving and do the exercises that could help.
It happens when cartilage – the tough fibrous material that acts as a ‘shock absorber’ for our joints – becomes worn to the point where bones rub against each other, often causing pain
“If you have joint pain, you need to exercise more, not less, to strengthen the muscles around the joint and improve stability in the joint,” says Dr. Holden. ‘You are never too old to start exercising. Doing less leads to more weight gain and therefore more joint damage, making it a vicious circle.’
Additionally, being overweight is also thought to increase inflammation in the body, which can lead to osteoarthritis in non-weight-bearing joints, such as the hands.
‘We currently have no treatments that slow the progression of osteoarthritis, so that is a priority for researchers,’ says Dr Watt, consultant to the charity Versus Arthritis.
‘Joint replacements are very effective in some people, but they are extremely expensive and since Covid there have been long waiting times for surgery. As cases increase, demand will continue to rise.”
Elizabeth was told that her weight was at least partially to blame for her condition. Before her diagnosis, she had had mild back pain for years, then her right hip and knee were affected.
As her pain worsened in 2019 and into 2020, she blamed sitting in one place for too long while working from home during the Covid lockdown.
“When I bent over, I would get sharp hip pain that would prevent me from putting on socks or tying shoelaces,” Elizabeth recalls. She also couldn’t walk to the park with her youngest daughter, but had to drive a short distance.
One morning in June 2021, she woke up, barely able to get out of bed, let alone walk, with “intense, cramp-like pain in my lower back.” A scan revealed severe osteoarthritis in Elizabeth’s hip.
“I was in shock because I always thought it only affected the elderly,” she says.
She was a size 44 at the time and her BMI fell into the overweight category. Moreover, her mother also has the condition. ‘I was told
losing weight to reduce pressure on my joints and back,” says Elizabeth, a neurodiversity consultant from South West London, who has two adult children aged 29 and 27, and a 14-year-old daughter.
‘I lost a few kilos after the diagnosis, but now I am a size 20 because although I changed my diet, I had difficulty exercising or exercising due to the chronic pain I had.’
She was also diagnosed with osteoarthritis in her right knee in 2022 and in her spine earlier this year.
“It was a Catch-22: the more I did, the worse the pain got and sometimes my leg would lock up,” says Elizabeth. ‘I tried going to the gym and walking for 30 minutes every morning, but exercising left me in a lot of pain the next day.’ She adds that it’s disturbing to find her weight is so bad because it’s never been a problem before.
Experts say that while the outlook for osteoarthritis rates is bleak, there are emerging treatments that can help and – crucially – get patients moving again so they can break the vicious cycle of weight gain and more joint problems.
Healthy eating is essential – Dr. Holden recommends cutting out sugar and ultra-processed foods and switching to a Mediterranean diet (rich in fruits, vegetables, fish and olive oil).
One of the new treatments being investigated is hormone replacement therapy (HRT). Researchers from the University of Oxford are planning a trial in postmenopausal women with osteoarthritis, based on the theory that lower levels of estrogen lead to weaker cartilage. Lower levels of estrogen are also linked to increased inflammation in the body, which can worsen joint pain.
After a year of waiting, Elizabeth had her hip replacement a few weeks ago. “My social life is zero and my mental health has suffered from everything I’ve been through,” she says. ‘I used to love doing my best to look and feel good, but I don’t feel like myself anymore.
‘But now that I’ve had the operation, I can try to get my life back on track. The pain from osteoarthritis has already improved – I can finally be hopeful again.’
- For more information, visit: versusarthritis.org; arthritisaction.org.uk