Arthritis Among Younger Veterans

Arthritis is usually thought of as a disease of the elderly. However, anyone can develop arthritis at any time. For example, a surprising number of military members and veterans who served in Iraq and Afghanistan have arthritis. A study published in Arthritis and Rheumatism (July 2011) found that members of the military developed arthritis at higher rates and younger ages than the civilian population.

Just what is arthritis? There are numerous types of the disease, but generally it is characterized by the breakdown of cartilage at the ends of bones. When the unprotected bones rub together, the result can be intense pain that makes it difficult to move or perform simple physical tasks. Once arthritis develops, bones can become misshapen. They can develop bony spurs and become thicker, contributing to pain and lack of function.

Everyone knows that active military service is physically taxing. Heavy body armor often weighs 50 to 60 pounds and weighed even more in the early days of the Afghan war. Soldiers and Marines often lift and carry heavy weights for years through multiple deployments. Motorized transport often is not just a rough ride - it's spine-shattering. Soldiers on the lookout for roadside bombs often ride for miles in the same position, leaning out the window to prevent catastrophe.

The study found that between 1998 and 2008, military doctors diagnosed 108,266 cases of mechanical degenerative arthritis, also known as osteoarthritis. The rate of osteoarthritis in solders and veterans age 20 to 24 was 26 percent higher. Individuals over age 40 were twice as likely to develop the disease after returning to civilian life.

In addition to the strenuous work they are expected to perform, members of the military are often very active and train hard to pass fitness exams. Intense training can cause injuries such as torn ligaments that make one more susceptible to developing arthritis.

Of the 450 soldiers in the 2011 study, 29 percent of them had arthritis to the extent that they were discharged from the service. Soldiers who had been injured by roadside bombs and other blasts were frequently diagnosed with the condition within two years of being injured. In contrast, those who develop arthritis as a result of civilian injury usually develop the disease after 10 years or more.

The reason is that shock waves from bomb blasts affect cartilage cells, causing damage that the body cannot repair. For these soldiers, the breakdown in cartilage is not gradual, as is the case in civilian populations. Rather, it can happen suddenly, within a year or two after being injured.

Veterans who suffer from arthritis are eligible to apply for veterans disability benefits. In fact, vets with arthritis who were diagnosed within a year of discharge are presumed to have a service-connected impairment. In short, the VA presumes that the arthritis was caused by being in the military and benefit applicants are not required to prove that the arthritis is connected to their service.

Although the number of veterans with arthritis is surprising (68,000 in 2008, for example), it allows the Department of Veteran Affairs to conduct studies into treatment options for veterans, including participating in drug trials for those with rheumatoid arthritis (RA).

Because so many younger veterans have arthritis, the VA is trying to develop effective ways of treating the condition. Joint replacements are not usually indicated for younger patients, because the mechanism usually lasts only 10 or 15 years, requiring more surgeries to replace it. Researchers are looking into drug treatments that can slow the progression of the disease or eliminate it entirely.

One of these studies involved the evaluation of methotrexate, a widely prescribed disease-modifying drug, in combination with biologic agents that block of inflammation at specific steps in the progression of the disease. Another study investigated whether more expensive medications were more effective than standard, less costly drug treatments.

One thing that has become clear from these and other studies into RA treatment options is that the earlier treatment begins, the better the prognosis will be. Veterans with RA or other forms of arthritis should seek help from a Veterans Health Administration hospital or clinic to get started on treatment that can limit the impact of the disease.