‘Old people disease’ that’s now ravaging the youth

It’s 8am on a Monday morning.

As we walk into the Nairobi Spine and Orthopaedic Centre, a sea of humanity has braved the morning cold and is already waiting to be served.

We meet Margaret Gatimu, 69, who is suffering from a form of arthritis.

She narrates how an incident that happened 27 years ago as she babysat her children later subjected her to endless bouts of pain.

“One Friday morning in 1989, I was at home taking care of my children. My house has a flight of stairs and so with children being children, one of them was up there almost falling,” narrates the farmer from Uthiru in Kiambu County.

Fearing for the worst, she frantically rushed to get hold of the little girl but unfortunately in the process, Margaret tripped; falling down with a thud and injuring her right knee.

She was rushed to hospital, where her leg was plastered. A few months later the leg injury healed.

“But in 2013, bouts of pain in my knee that kept me wreathing and turning in bed all day and night showed up.

“I ignored the pain for a while because I thought it would just go away and then started taking painkillers after which I graduated to downing more and more pain medicines, but nothing seemed to work,” she tells Healthy Nation.

After trying to deal with the numbing pain on her own in vain, she decided to go to Kikuyu Hospital for check-up in 2017.

A series of tests would confirm that things were not really looking good for her.

“Doctors revealed that my knee had been attacked by osteoarthritis, which is why I was feeling the pain, and that the only way out was to immediately go for surgery.”

According to the World Health Organization (WHO), osteoarthritis is a degenerative joint condition. It causes pain, swelling and stiffness, affecting a person’s ability to move freely. It is most common in the knees, hips, spine and hands. Many factors can contribute to developing osteoarthritis such as history of joint injury, older age and being overweight. It affects women more than men.

Margaret was then referred to three different hospitals in Nairobi.

“The hospitals were charging at least Sh 750,000 to perform the surgery, which I could not afford.”

“It was Dr Michael Maru, the orthopaedic surgeon who operated on me, who took me to a more affordable facility that also accepts the National Hospital Insurance (NHIF) card,” says Margaret while noting that NHIF paid Sh250,000. She topped up Sh200,000 for the Sh450,000 surgery to be performed.

In an interview with Healthy Nation, Dr Maru, who now works at the Nairobi Spine and Orthopaedic Centre, reveals that the country has been increasingly grappling with devastating orthopaedic and trauma injuries.

“We receive a minimum of 40 patients per week,” he notes.

The top five orthopaedic conditions on the rise in Kenya are osteoarthritis, gout, back pain, rheumatoid arthritis (RA) and injuries as a result of sports and traffic accidents, especially boda boda accidents that result in dislocations and fractures.” 

The consultant orthopaedic surgeon explains that osteoarthritis or wear and tear inside the joint is a condition that comes with age and is different from RA.

According to WHO, RA is a chronic disease that causes inflammation around the body and commonly presents with pain in the joints.

Untreated, RA can cause severe damage to the joints and their surrounding tissue. It can also lead to heart, lung or nervous system problems.

The global health regulator explains that common symptoms include chronic pain, stiffness, tenderness, heat and swelling in the joints. RA can make it hard to move and perform daily activities.

“The causes of rheumatoid arthritis are unknown. Risk factors include smoking, obesity and exposure to air pollution. Women and older people have a higher risk of developing RA,” WHO states on its official website.

Dr Maru says there are some conditions that can predispose a person to osteoarthritis, the main one being injuries. “A huge population is getting involved in  (boda boda) accidents that end up damaging their joints, especially the knee and the elbow.  Such an injury damages the lining of the knee, which starts wearing off. Within 10 years, they will have developed osteoarthritis.” 

This is why he urges the country to embark on a multifaceted approach in efforts to nip osteoarthritis in the bud.

“As long as we have ever-rising cases of road accidents, the cases of osteoarthritis will continue to go up,” he warns.

“The rising cases of motorbike accidents are immensely affecting 25 and above year-olds and by the time they reach 35, osteoarthritis shows up,” he says.

Longer life is also predisposing Kenyans to osteoarthritis.

“People are living longer than expected. The longer they live, the higher the likelihood of getting osteoarthritis. We have observed that this is particularly higher in women than men.”

According to the United Nations, the current life expectancy for Kenya is 67.47 years, a 0.38 per cent increase from 67.21 years in 2022.

Kenya is also grappling with an increasing middle-class population that is battling gout.

“The rapidly growing middle class has an insatiable appetite for red meat and alcohol, which can result in increased uric acid production.”

Increased uric acid production can cause gout when the body is unable to effectively eliminate the excess acid that is usually stored in the knee, elbow, big toe and sometimes in the ankle. Uric acid is a waste product that forms when the body breaks down purines found in certain foods and tissues. Under normal circumstances, the kidneys filter and remove uric acid from the blood, and it is excreted through urine. 

However, if there is an overproduction of uric acid or if the kidneys are unable to eliminate it efficiently, uric acid levels in the blood can rise, leading to the formation of urate crystals in the joints. These urate crystals can trigger an inflammatory response, causing painful and swollen joints characteristic of gout.

According to Dr Maru, various factors can contribute to increased uric acid production such as a diet high in purine-rich foods (red meat, seafood especially ‘red meat fish’ like salmon, pork, mutton and alcohol), certain medical conditions (kidney disease, metabolic syndrome), or certain medications. Managing gout often involves lifestyle changes, medication and reducing purine intake to control uric acid levels and prevent flare-ups.

This is why he encourages people to consume more white meat such as chicken and fish like tilapia.

For back pain, the expert notes that it’s very broad and it affects the entire population. “In your lifetime you must experience some back pain before you die.” 

For those below the age of 30, the cause is usually poor posture.

“During the Covid-19 pandemic, I received many patients who were dealing with back pains because many people in this age group spend so many hours on their laptops and other gadgets while seated in abnormal postures. This made them get muscle spasms.” 

Apart from poor posture, he observes that back spasms can be caused by various factors including muscle strain or injury, poor posture, overuse of muscles, sudden movements, lifting heavy objects improperly and muscle imbalances.

Other possible triggers are dehydration, electrolyte imbalances, and underlying medical conditions such as herniated discs (a condition, which refers to a problem with a rubbery disc between the spinal bones) or arthritis.

 “For those between 30 and 50 years of age, posture comes into play, but more commonly is a disc issue that generates pain down your neck through to the nerves of the back. For those above 50, it is due to wear and tear (spondylosis).” Dr Maru explains that spondylosis is a medical term used to describe age-related changes in the spine. It typically involves degeneration and wear-and-tear of the intervertebral discs, which are the cushions between the vertebrae.

“As a result, the spine may develop bone spurs and other structural changes, leading to symptoms like pain, stiffness, and reduced flexibility. Spondylosis is a common condition that often occurs with aging, but it can also be caused by injuries or repetitive stress on the spine,” he says while adding that treatment usually focuses on managing symptoms and improving mobility as one can get pain going down their legs or arms.

Like Margaret, Kelly Odhiambo, 25, a footballer who lives in Donholm, Nairobi, has gone to the surgeon’s table twice as the pain in both his knee joints knew no bounds.

“I have been operated on twice,” he says.

“The first time was in October 2021 in my right knee while the second one happened last year in December on the left and in both instances the issue was chondromalacia,” he discloses to Healthy Nation.

Chondromalacia is a condition that affects the cartilage on the underside of the kneecap (patella) and the groove in the thighbone (femur) it slides in. This cartilage is responsible for smooth movement of the knee joint during bending and straightening.

“When someone develops chondromalacia, the cartilage in the knee may become soft, damaged or worn out, leading to pain and discomfort. This condition arises from factors like overuse, injury, muscle imbalances or poor alignment of the patella,”  explains Dr Maru.

“As a result, the knee may experience grinding, popping, or pain with movements, especially during activities that involve bending the knee such as walking, running, or going up and down stairs.”

For Kelly, it all started as a mild pain two years ago.

“At a football match during training, someone gave me a hard tackle on the right knee in March 2021 and as time went by, the pain got worse.

“I at first ignored the pain and then started taking pain killers. I skipped certain training days and also embarked on exercises that I thought would strengthen my quad muscles (muscles on the front of your thigh, above your knee and below your hip) hoping that the pain would go away but it did not,” he says.

“After consulting a doctor, a magnetic resonance imaging (MRI) scan was done, which showed that I had ‘grade four’ chondromalacia —  the most severe stage.”

Last year the footballer underwent an arthroscopic knee surgery.

This is a minimally invasive procedure used to diagnose and treat problems in the knee joint.

“For my right knee, the surgery cost Sh450,000 while the left one cost Sh490,000,” he says while urging anyone experiencing any pain not to ignore. “Being ignorant is very expensive, it almost cost me my legs but now I am well and back in the field playing football.”

Mr Justus Terer, an  orthopaedic technologist( prosthetist and orthotist) at Kikuyu Hospital, discloses that in 2020 alone, more than 1.8 million cases of arthritis were recorded in Kenya. “There are  different types of arthritis (over 100 identified). Osteoarthritis, ankylosing spondylities, juvenile athrities, gouty athrities, psoriatic athrities and rheumatic athrities are the most common types. 

“According to the WHO data published in 2020, rheumatoid deaths in Kenya reached 84 or 0.03 per cent of the total deaths. Though there is no research on the actual numbers, there are all indications pointing to an increase in the number cases of arthritis recorded in both orthopaedics and trauma centres across the country,” he tells Healthy Nation. 

He says the reason osteoarthritis is rapidly emerging even among the young people is due to  injuries, occupational activities and obesity in young and athletic population.

“Boda boda accidents have contributed to huge number of orthopaedic cases seen on both outpatient and  inpatient orthopaedic centres. These accidents end up in orthopaedic centres either for conservative management, surgical or orthopaedic rehabilitation,” he says while noting that boda boda accidents are increasingly  resulting in huge number of amputations  among  young people. 

“The few prosthetics and orthotics centres meant for rehabilitation of these amputees get overwhelming numbers hence delayed and compromised rehabilitation process.”

“Hospital morbidity statistics in Kenya show that injuries from motorcycle crashes account for  two per cent to three per cent of all hospital visits, 22-64 per cent of trauma admissions and 50-52 per cent of surgical intervention.” 

He notes that 30 per cent  of approximately 300 patients seen every month in both in-patient and out-patient clinics in their facility show up because of  fractures and dislocations affecting their  joints and this  directly  results in osteoarthritis in the long run. “Amputations  caused by accidents indirectly contribute to osteoarthritis due to weight bearing pressure on the  sound limbs.

“In my view, proper regulations  on boda boda sector should be introduced with the requirement of training  and licensing before the riders are allowed to operate,” he says while urging the government to allocate more funds towards  the  establishment of orthopaedic centres with surgical and rehabilitation components so that they are able to deal with surging numbers.

“More training facilities for health care workers should also be provided to ensure early identification, treatment and rehabilitation to reduce the disease impact.”   

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