World Arthritis Day: Why Is Arthritis More Common In Women?

Not a lot of people are aware of the challenges women face regarding arthritis. Not only are more women diagnosed with arthritis than men, but women also often experience worse pain –ache in different joints. And they are far more vulnerable to rheumatoid arthritis, one of the most debilitating forms of the condition. World Arthritis Day is a global awareness day held every year on 12th October. So, learn more about this condition and ways to stop it from progressing.

TC46 connected Director of Orthopaedics & Joint Replacement Surgery Dr Kaushal Malhan, Fortis Hospital, Mumbai to shed some light on this condition. Here he talks about the kind of arthritis problems women face, along with treatment options and lifestyle changes that can help.

1. Arthritis is inflammation in the joints

Simply put, arthritis is inflammation in the joints. This can happen due to injury, infection, wear and tear from ageing, as is commonly seen in Osteoarthritis (OA) in older people. Factors such as abnormal biomechanical stresses cause damage like Osteoarthritis at a younger age and autoimmune conditions causing inflammatory joint damage, for example, Rheumatoid Arthritis (RA). Arthritis can therefore occur in all age groups depending on what causes it. Common risk factors of getting arthritis include family history, age, sex (women are more prone to the disease, especially in old age), previous injuries in the joint, and obesity. 

2. Common causes of female arthritis

Some physical factors may contribute to women suffering more Osteoarthritis than men. This may be partly due to a difference in the biomechanical forces on the eroded joints in women. Women’s ligaments and tendons are more elastic, leading to asymmetric joint reaction forces. Women also have wider hips, which affect the alignment of the knees in a way that leaves them more vulnerable to certain types of pressure wear, translating to more damage and pain.  Women who go through menopause often gain weight and increased stress on the joints.

3. Osteoarthritis and Rheumatoid Arthritis are most common in women

The two common types of arthritis are – Osteoarthritis and Rheumatoid Arthritis (RA). Women get more Arthritis than men, making them more vulnerable to the disease and often experience worse pain. Rheumatoid Arthritis can strike anyone irrespective of age and gender. Rheumatoid Arthritis is an autoimmune disorder that occurs when your immune system mistakenly attacks the body’s tissues. It damages the lining of joints and causes painful swelling that can eventually cause bone erosion, destruction, and joint deformity. 

4. Symptoms of arthritis in women

Symptoms of Arthritis will vary depending on which type it is. 

1. For Osteoarthritis, which commonly affects the knees, patients present painful swollen joints, deformities, inability to walk and often instability. 
2. Rheumatoid Arthritis presents with tender, warm, swollen joints, and severe morning stiffness, usually affects multiple joints symmetrically, with gradual destruction, deformities and instability. Many patients with Rheumatoid Arthritis also experience symptoms that don’t involve the joints. It can affect non-joint structures as well.

5. Osteoarthritis is the most common type of arthritis in women

Overall, Osteoarthritis is the most common type of Arthritis in women—three times as many women as men get Rheumatoid arthritis. Also, women tend to be younger when they get Rheumatoid arthritis.

It is probably more common in women because:

• It is thought that the female immune system is more robust and more reactive. Hence, women get autoimmune diseases in far greater numbers than men
• It appears that hormones affect RA risks and flares. Estrogen and Progesterone levels frequently change due to menstruation, pregnancy, and even menopause. These changes may affect the level of some proteins in the blood, raising the risk of inflammation. This, in turn, increases the possibility of the disease in women. 
• Many women with RA who get pregnant experience fewer or no symptoms, only to find that they reappear after the baby is born. And breastfeeding lowers the risk of developing RA; a woman who has breastfed for two years reduces the chance of ever getting the condition by half  
• Genetic risk factors could also lead to more prevalence of the disease in women. Genes specific to the X chromosome are among newly identified genes linked to RA. Women have two X chromosomes, while men have one X and one Y chromosome. This could help explain why women are more likely than men to develop the disease
• Environmental factors like diet and smoking are shown to impact the prevalence of RA

6. Treatment depends on the stage of the disease, the age and functional status of the patient

Treatment options will depend on the nature of Arthritis, the stage of the disease, the age and functional status of the patient. Early diagnosis is essential and appropriate medications with lifestyle changes can arrest the progress of the disease. 

• Corrective braces and gel injections can be used to prevent the progress of the disease in the early stages
• Minor operations like Arthroscopic Keyhole procedures can help in the Synovitis stage when the joint is swollen, but the cartilage cushion is intact in Rheumatoid Arthritis. Corrective surgery for bone deformities (Osteotomy) done before the joint gets severely damaged can give respite from pain and slow down the progress in Osteoarthritis
• For an end-stage disease with cartilage loss, advanced joint replacement surgery options are available
• Total Knee Replacements done minimally invasively allow much faster recovery with the long-lasting natural function 
• The tissue preserving technique allows much faster recovery with muscle preservation. Hip replacements that allow complete flexibility with low dislocation risk can be done through a minimal surgical incision 
• Shoulder resurfacing preserves bone as compared to replacements. Unicompartmental knee resurfacings are ideal for the active young arthritic knee when there is isolated involvement of a single compartment, a technique pioneered by our team at Fortis with the first minimally invasive Oxford partial knee

7. Regular exercises help to maintain flexibility, keep weight down and muscles strong

1. Stretching Exercises: Stretch when you get started to warm up. Stretch when you’re done to cool down
2. Low-Impact Aerobic Exercise: These are exercises that keep your heart strong without hurting your joints. Riding a bike and swimming are good choices. You may also try a machine like a stationary bike
3. Strengthening: These exercises help keep your muscles strong. You might use resistance bands that gently strengthen your muscles. You can also use lightweights
4. Pilates: It is a low-impact activity that can increase flexibility for enhanced joint health
5. Swimming, Water Aerobics, And Other Gentle Water Exercises: They increase flexibility, range of motion, strength, and aerobic conditioning. Water minimises gravity, which means that water exercises do not impact heavily on the joints

8. Ways to stop arthritis from progressing and reverse it naturally

• Rest your joints
• Meditation diminishes stress, fear, and depression in response to pain
• Yoga like meditation, yoga can be an essential Arthritis treatment. 
• Yoga combines stretching and balance exercises with psychological harmony, improving joint function as it elevates the mood

9. Changes in one’s diet to help with arthritis pain

In Arthritis, eat fewer calories and more fruits and vegetables (containing antioxidants that reduce inflammation). Add Omega-three fatty acids (fish like Salmon, Sardines are rich in Omega 3) to the diet, and take olive oil (which has anti-inflammatory properties). Adding vitamin C to your diet is crucial as it helps build collagen and connective tissue. Avoid eating meat cooked at high temperatures as that makes compounds that cause inflammation. Stop smoking, drinking alcohol and consuming junk food. 

10. Changes in lifestyle can help with arthritis pain

There are many changes one can make outside of mind and body for a more accessible, pain-free life

• Medical Devices: A cane or a walker may significantly improve your ability to move around.  This may not only help your mobility in the home and outside, but it may also help prevent any additional injuries that could come with other pain symptoms
• Adaptive Equipment: Many arthritis sufferers find life much more manageable with equipment like grabbers and dressing aids. There is no reason to endure unnecessary pain or stress stiff joints if there is a pain-free alternative
• Electric Devices: If you find yourself having difficulty performing tasks around your home with traditional tools like brooms or knives, then you may want to replace them with electric versions. You often get comparable results with less invested time and aggravation
• Comfortable Clothing: One of the biggest challenges for many Arthritis patients is donning clothes. If you find it troublesome to lace-up shoes or button shirts, you may substitute more comfortable alternatives like Velcro binders