Today, at 47 years old, Celena Adams-Locke knows the reason behind the pain and stiffness in her joints. But when she was 23 and a married mother of two stationed with the Army at Fort Drum in New York, she didn’t know what to think about the worsening discomfort she experienced.
After all, she was in great shape, running multiple miles daily and participating in routine mandatory hikes and marches while carrying pounds of heavy equipment.
Even so, “my knee was stiff, and it was causing me a lot of pain,” Adams-Locke says. “I started having trouble completing all the mandatory activities, and then it even started hurting when I got out of bed in the morning.”
Adams-Locke went to see military physicians, who referred her to physical therapy and recommended that she not stress the joint to help it recover. Arthritis was never mentioned as a possible cause of the pain, and she wasn’t diagnosed with it until years later, after she left the military.
Rethinking a Disease
Arthritis—specifically osteoarthritis, the disease’s most common form—has typically been thought of as an age-related problem. Years of wear and tear on joints can cause inflammation, and in turn stiffness and pain. But researchers are now learning that age isn’t the determining factor in osteoarthritis, or OA.
“Joint injuries, which can happen in multiple ways, are a risk factor for OA,” says Kelli Allen, PhD, researcher in UNC’s Thurston Arthritis Research Center and the Durham Veterans Affairs Medical Center.
Major injuries like a torn ACL increase the risk of OA in the knee joint. At the same time, lots of smaller injuries or excessive joint loading over time can increase risk of OA in joints. All of these instances are common in the military because of the physical demands and responsibilities of service members.
While nearly 1 in 4 Americans have OA, it affects more than 1 in 3 who have served in the military. Military members older than 40 are twice as likely to develop arthritis after returning to civilian life, and OA rates in active-duty personnel younger than 20 are 26 percent higher than those of their nonmilitary peers. About half of veterans with arthritis report limitations in their daily activities because of joint symptoms. OA is a leading cause of activity limitations among veterans and a major barrier to managing other common health conditions they may have, including cardiovascular disease and diabetes.
That’s because “OA, weight management and cardiovascular health are all connected,” Dr. Allen says. “If your joints hurt, you don’t feel like exercising, which is an important part of weight management and preventing type 2 diabetes. Gaining weight puts more pressure on your joints, which causes more pain and decreases activity even more, affecting cardiovascular health as well.”
For the most part, that cycle occurs in life after the military. But for active-duty members, arthritis is one of the major reasons personnel are discharged from service.
Coping with Change
About a year after first seeing a military physician, Adams-Locke was no better. Because of her knee pain, she couldn’t do mandatory training exercises. A military panel reassigned her to a less physically demanding position. Adams-Locke stayed in that position until 2000, when she left active duty.
She served in the National Guard as a supply noncommissioned officer for five years while she studied to become a nurse. Throughout that time, the pain and stiffness in her knee grew worse, and other joints started feeling the impact. Adams-Locke practiced as a nurse for several years but eventually chose work that required less activity.
“I consider the OA I suffer from to be a disability,” she says. “I try to keep active, but I’m limited in what I can do.”
She now works as a public health associate for the Centers for Disease Control and Prevention as part of the Osteoarthritis Action Alliance, a national coalition based at UNC that focuses on raising awareness and promoting research centered on arthritis.
Changing the Future
Dr. Allen conducts such research, studying interventions that can improve care and treatment outcomes in veterans with arthritis. She says people with arthritis, particularly in the knees, should start with lifestyle changes.
“The first recommendation is always that patients try to lose weight and increase activity to help prevent arthritis from getting worse,” Dr. Allen says. “We are trying to figure out ways to support people in their efforts to adopt healthier lifestyles.”
If more aggressive treatment is needed, pain medications and joint injections are common options. Physical therapy can help as well.
Dr. Allen’s most recent trial studied how teaching pain-coping skills to veterans with arthritis can help them achieve a better quality of life. Researchers coached participants on how to use different skills to help manage arthritis and the pain and limitations that accompany it.
Both Dr. Allen and Adams-Locke say it is important to identify arthritis early so that people don’t inadvertently worsen the condition with overuse. Additionally, members of the military should monitor and report injuries or new symptoms to a health care professional right away.
If you are worried about the symptoms of arthritis, talk to your doctor. If you need a doctor, find one near you.