Early-onset osteoarthritis: Why the “old age” disease is striking the young

Osteoarthritis (OA), once considered a condition of the elderly, is increasingly being diagnosed in younger adults, even those in their 20s and 30s. Traditionally linked with “wear and tear” of joints over time, OA is now emerging as a lifestyle-linked, injury-triggered, and metabolic disorder that can affect anyone. This shift is worrying, as early-onset OA not only limits mobility but also impacts long-term quality of life, productivity, and mental well-being.


Osteoarthritis is a degenerative joint disease that affects the cartilage, the smooth, cushioning tissue covering the ends of bones in a joint. When cartilage breaks down, bones rub against each other, leading to pain, stiffness, swelling, and reduced movement. The knees, hips, hands, and spine are most commonly affected.


While age remains a key risk factor, OA is not simply a by-product of aging. The disease involves complex biochemical processes influenced by genetics, inflammation, hormones, and mechanical stress. This means that younger people, especially those exposed to certain risks, are far from immune.


Why are younger adults at risk?

1. Post-COVID steroid therapy and AVN (avascular necrosis):
One of the most concerning post-pandemic trends is the rise in severe hip arthritis among individuals who recovered from COVID-19. Many of these patients required prolonged or high-dose steroid therapy to control inflammation during their illness. Such steroid exposure, in some cases, can cause reduced blood supply to the hip bone, leading to bone cell death — a condition known as avascular necrosis (AVN). Over time, AVN can progress to hip joint collapse and severe arthritis, often necessitating total hip replacement at a young age.

2. Sports and overuse injuries:
Young athletes and fitness enthusiasts often suffer repetitive stress or acute injuries to joints, particularly the knees, shoulders, and ankles. A torn ligament or meniscus, if not treated properly, can disrupt the biomechanics of the joint and accelerate cartilage wear, eventually leading to early OA.

3. Sedentary lifestyle and obesity:
The modern lifestyle, with long hours of sitting, minimal physical activity, and rising obesity, has created the perfect storm. Excess weight places additional stress on weight-bearing joints such as the knees and hips. Meanwhile, lack of movement weakens the muscles that support joints, increasing strain on cartilage.

4. Occupational stress:
Jobs requiring repetitive movements, squatting, heavy lifting, or prolonged standing (such as in construction, manufacturing, or healthcare) can increase the risk of early joint degeneration.

5. Genetic and metabolic factors:
Some individuals inherit genes that make them more susceptible to cartilage breakdown. Additionally, metabolic conditions such as diabetes and hormonal imbalances may alter joint health by promoting inflammation.

6. Postural imbalance and poor biomechanics:
Inappropriate footwear, poor posture, or muscle imbalances (common in people with desk jobs or gym beginners using incorrect techniques) can cause uneven pressure on joints, leading to gradual damage.


Symptoms to watch out for

• Persistent joint pain or stiffness, especially after physical activity or long periods of rest
• Mild swelling or warmth around the joint
• Clicking or cracking sounds during movement
• Reduced flexibility or difficulty performing routine activities like climbing stairs or squatting

Early symptoms are often mistaken for “gym soreness” or temporary fatigue, delaying diagnosis and allowing further cartilage deterioration.


Diagnosis and management

Diagnosing OA in younger patients requires a combination of clinical evaluation, imaging (like X-rays or MRI), and assessment of joint function. Once diagnosed, the focus is on slowing disease progression and managing symptoms through lifestyle modification, physiotherapy, and medical management.


Key treatment strategies include:

• Weight management: Even modest weight loss can significantly reduce pressure on the joints.
• Low-impact exercise: Activities such as swimming, cycling, or yoga improve joint flexibility without causing further stress.
• Physiotherapy: Targeted exercises strengthen surrounding muscles and improve alignment.
• Medications: Pain relievers and anti-inflammatory drugs can help manage discomfort, while newer injectable therapies (like hyaluronic acid) may support joint lubrication.
• Surgical options: In severe cases, procedures such as arthroscopy or joint replacement may be considered.
• Prevention and Early Intervention

Preventing OA begins with awareness. Maintaining an active lifestyle, using correct exercise techniques, wearing supportive footwear, and managing body weight are essential. Addressing injuries promptly, rather than ignoring persistent pain, can prevent long-term complications.


The Takeaway

Osteoarthritis is no longer confined to the elderly. The rise in early-onset cases reflects changing lifestyles and increased physical strain in younger populations. Recognizing symptoms early, seeking timely medical advice, and adopting joint-friendly habits can make a significant difference in preserving mobility and quality of life for decades to come.


(Dr Narayan Hulse, Principal Director, Orthopaedics & Joint Replacement Surgeon, Fortis Hospital, Bannerghatta Road, Bengaluru)