Osteoarthritis (OA), long considered a wear-and-tear disease of old age, is increasingly being diagnosed in patients as young as 30 years, according to a review by researchers published in the journal International Orthopaedics.
The review, published on May 15, reframes osteoarthritis as a heterogeneous syndrome rather than a single disease, driven by diverse biological, biomechanical, metabolic, genetic and molecular mechanisms.
The findings suggest that the traditional “one-size-fits-all” approach to treatment often fails because patients present with different underlying disease drivers.
More than 500 million people worldwide live with OA, accounting for 7.6 per cent of the global population. Prevalence has surged 132 per cent in the past 30 years and is projected to rise by another 60 per cent by 2050, according to Global Burden of Disease estimates. Women, individuals with obesity, and those with joint injuries are disproportionately affected.
“Osteoarthritis is no longer confined to the elderly. We are now seeing patients as young as 30, often driven by obesity and sedentary lifestyles.
“This research makes clear that osteoarthritis is not a single disease but a spectrum of conditions, and recognising the specific phenotype in each patient allows us to deliver far more effective, personalised treatment than a one-size-fits-all approach,” said Dr Raju Vaishya, senior consultant Orthopaedic and Joint Replacement Surgeon at Indraprastha Apollo Hospitals.
The review identifies six disease subtypes, including inflammatory, metabolic and pain-sensitisation variants, and recommends MRI-based tools alongside biomarker panels to guide treatment decisions.
Researchers cited examples illustrating the need for personalised care. A 33-year-old IT professional with persistent knee pain was found to have vitamin D deficiency, elevated body mass index and early joint degeneration.
Treated as a case of metabolic osteoarthritis with weight management, supplementation and structured exercise, the patient showed significant improvement.
In another case, a 60-year-old woman with severe burning knee pain and disrupted sleep experienced little relief from standard medication.
Further assessment revealed a pain-sensitisation phenotype, and treatment with neuromodulators targeting nerve pain pathways brought substantial relief.
The study also highlighted that MRI-based structural phenotypes, including inflammatory, meniscus-cartilage, subchondral bone, atrophic and hypertrophic forms, along with molecular endotypes such as low tissue turnover, structural damage and systemic inflammation.
These tools, combined with biomarkers, including COMP, CTX-II and hsCRP, are expected to help clinicians make more precise treatment decisions, the authors said.
Emerging technologies such as AI-assisted MRI scoring and PET-MRI with 18F-NaF are enabling earlier detection and patient clustering, though wider clinical adoption will require standardised protocols, validation across joints and large-scale clinical trials, the review noted.
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