2011 Issues   /   Rheumatology

Osteoarthritis More Common in Servicemembers, Presents Challenge for Military

By US Medicine

Though most servicemembers are relatively young, osteoarthritis is a serious problem for the U.S. military.

A recent study in journal Arthritis & Rheumatism found that military troops are more likely to develop osteoarthritis than civilians, and that arthritis is especially an issue for enlisted personnel and those serving in the Army.

Between 1999 and 2008,  a total of 108,266 incident cases of OA were identified by physicians in the military population, according to Kenneth Cameron, PhD, MPH, director of orthopedic research at Keller Army Hospital in West Point, NY, and lead author of the recent study, “Incidence of Physician Diagnosed Osteoarthritis among Active Duty United States Military Service Members.” The study identified one cause as the regular occupational activities of servicemembers, which often include repetitive joint motions.

In addition to the problem of increased repetitive and load bearing activities on the joint, osteoarthritis can have a genetic component or even an “environmental” cause, said Lt. Col. Jonathan Roebuck, Office of the Surgeon General rheumatology consultant.

“Obesity is linked to knee and hand OA and likely other joints as well,” he noted. Misalignment of joints such as valgus and varus deformities of the hip and knee can play a role, he added, as can prior joint injury such as torn ligament or meniscus. In addition, prior inflammation in a joint such as with infection or rheumatoid arthritis will also predispose to OA, Roebuck said. 

On the positive side, the incidence of joint injury, which is a key factor in the development of OA, can be reduced through targeted prevention strategies, according to Cameron.

A problem, however, is the number of uncontrolled factors in a deployment-type setting, even in servicemembers who are not deployed, that exacerbate the problem among active-duty troops. For example, he said, military personnel are 10 times more likely to get injuries to the ankle or knee, adding that non-battle joint injuries are a leading cause of medical evacuation from deployment to Iraq and Afghanistan.

Risk prevention possible

Preventive measures include weight loss, increased muscle tone and strength, and avoidance of injuries that predispose to developing OA, said Roebuck, noting, “Unfortunately, absolute avoidance is not possible for those genetically predisposed.”

Training of servicemembers also can go a long way toward staving off OA, according to Cameron. “If they are going to carry a large rucksack or a heavy backpack over a number of miles, they should not just pick it up and do it that first time,” he recommended. “There should be practice, progressively increasing the distance, so they are trained to do that.”

In addition, Cameron says, there are a number of common risks that can be mitigated – many of which occur during leisure-time activities such as “pick-up” football or basketball games. “Make sure the area of play is flat and as smooth as possible – that there aren’t any holes people can step on and twist their knee,” he said.

The Army has focused on joint health, providing safety and prevention information through military physical fitness schools, Cameron said, adding, ”The U.S. Army Public Health Command has made great efforts to reduce the burden of injuries; they’ve put a lot into injury reduction.”  

One recent change was revising the Army’s fitness test, but more focused efforts are required to prevent injuries and subsequent OA, he said.

“Having the strength and ability to do what we need to do is important. And doing push-ups and sit-ups are good for general fitness, but they do not necessarily help soldiers prepare for mission-essential tasks,” according to Cameron. “The intent of the revised test is to make it more mission-specific; otherwise, you could have poor mechanics.”


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