Injuries and arthritis

I’ve heard it a lot:”Oh, you injured x, you’ll get arthritis there for sure.” So, are injuries truly connected with arthritis? are some injuries more likely to be related? and is there anything that can be done?

It seems like this is such a common sense relationship that it isn’t worth asking the question about whether or not injuries are actually related to osteoarthritis but given what I found regarding running and knee health I wanted to start here. It turns out that arthritis that develops after an injury even has its own label, not a good sign. Post-traumatic osteoarthritis (PTOA) is a real thing, and is “especially debilitating due to its earlier onset than traditional OA, and its predisposition to affect a younger and more active population” (Carbone & Rodeo, 2016). Cry! In the US, around 12% of cases are PTOA.

The reasons why injuries lead to PTOA are not entirely clear. Damage to the cells that produce/maintain cartilage (acts as a cushion between bones in your joints) appears to be a feature of most of the relevant injuries, but the PTOA doesn’t always occur in exactly the same place so there have to be other mechanisms. The way the cells work (gene expression) also appears to be changed by injury in a way that appears to reinforce itself. They change how the work, which changes the functioning, which changes how they work, until you have progressive cartilage loss and PTOA develops.

Inflammation affects how different pathways work which can also affect how a joint functions.

Mechanical changes either through the body adjusting to the new way it functions after injury (shifting how weight is distributed through the joint) and psychological impacts such as pain or fear of re-injury will also affect the body mechanics. All of this can also impact how the cartilage making/maintaining cells work.

Type of injury does appear to have an impact with ACL rupture (boo) (50% develop PTOA within 5-15 years) (phew), meniscus tear (double boo) (24-71% depending within 21 years depending on how much of the meniscus was affected/removed), shoulder instability (26% – no timeline given), patellar (knee cap) instability (with full acute dislocation (happened all of a sudden) 52% were affected – no timeline given), and ankle instability (13% within 20 years) making up the top five.

Now here’s the real challenge: typically you don’t get symptoms until there is already damage. Once you have a reason to look, it’s potentially too late. Diagnostic tools may include MRI and biomarkers measured in different body fluids but research has not yet determined exactly what changes count as hard evidence. And again, you still generally need a reason to be tested.

Oh, and then there’s the worst part of all of this. Even if we figure out exactly how to diagnose it early there are currently no known treatments that are successful over the long term in preventing any form of OA. Woot!

Well, I should be on the low end of the knee (hopefully) and wrists aren’t mentioned so I’m going to think positive. The think method will totally work right?

Carbone, A. & Rodeo, S. (2016). Review of current understanding of post-traumatic osteoarthritis resulting from sports injuries. Journal of Orthopaedic Research. doi:10.1002/jor.23341