Causes for Joint Pain in Elderly

A study on pain prevalence among older adults in Singapore found that about 25% experience chronic pain. While joint pain is often dismissed as a normal part of ageing, untreated pain can become persistent and significantly reduce quality of life.

Chronic pain is generally defined as pain lasting more than three months and may be caused by underlying conditions such as arthritis or, less commonly, cancer. Below are some common causes of joint pain in the elderly, along with their symptoms and management options.

Osteoarthritis

What is Osteoarthritis?

Singapore’s Ministry of Health estimates that around 40% of older adults have knee osteoarthritis. It is a degenerative joint disease and one of the most common causes of chronic knee pain in the elderly.

Osteoarthritis occurs due to gradual wear and tear of cartilage, the protective tissue between bones, leading to pain, stiffness, and reduced mobility. It affects women more than men, particularly in their 60s and beyond.

There are two types of osteoarthritis:

• Primary Osteoarthritis: Occurs when the cartilage between bones gradually degenerates with age.
• Secondary Osteoarthritis: Not directly related to ageing and may be caused by injury, disease, or genetic factors.

Some risk factors for osteoarthritis include:

• Age: As we grow older, cartilage gradually wears away and has a reduced ability to repair itself, leading to changes in underlying bone and tissues.
• Obesity: Excess body weight places additional stress on joints, especially the knees, accelerating cartilage breakdown.
• Joint injuries: Previous trauma such as ligament tears or fractures may increase the risk later in life.
• Genetics: A family history of osteoarthritis increases susceptibility.

What are the symptoms of Osteoarthritis?

Common symptoms of osteoarthritis include:

• Pain and stiffness in affected joints during or after movement
• Tenderness and swelling in the affected joints
• A loss of range of motion and joint function

What worsens Osteoarthritis?

• Not seeking treatment promptly: Delayed care may lead to further cartilage degeneration. Other joints may also become strained as the body compensates.
• Weak muscles: Insufficient muscle support can increase joint stress and discomfort.
• Dehydration: Since cartilage is about 70–80% water, poor hydration may contribute to joint discomfort and reduced overall physical function.
• Being overweight: Additional body weight increases joint load and accelerates disease progression. Maintaining a healthy weight helps reduce risk.

How is Osteoarthritis treated?

Although there is no cure for osteoarthritis, there are ways to control the symptoms and manage the condition to prevent it from worsening.

Non-Surgical Options: This includes physiotherapy to strengthen muscles and improve joint flexibility, along with the use of painkillers and anti-inflammatory drugs.

Surgical Options: If your condition is severe and you do not respond well to non-surgical treatments, your orthopedic specialist may recommend procedures such as arthroplasty, which is the replacement of damaged joints with artificial ones.

Rheumatoid Arthritis

What is Rheumatoid Arthritis?

Rheumatoid Arthritis (RA) is an autoimmune disease that most commonly affects people between 40 and 60 years old, and women are more likely to develop it. In Singapore, it is the most common chronic inflammatory arthritis.

It occurs when the immune system mistakenly attacks joint tissues and may also affect organs and other body tissues.

What are the symptoms of Rheumatoid Arthritis?

RA typically affects small joints such as the wrists, hands, ankles, and feet. In advanced cases, larger joints like the shoulders, elbows, hips, and knees may be involved.

Symptoms include:

• Painful, swollen joints, along with joint stiffness that is typically worse in the mornings and after periods of rest
• Fatigue
• Fever
• Lack of appetite

What worsens Rheumatoid Arthritis?

Some factors that worsen RA include:

• Smoking: Smoking is a major trigger as it increases whole-body inflammation. Over time, this can worsen immune activity and accelerate joint damage.
• Living a sedentary lifestyle: Regular exercise improves muscle strength and joint health. While rest is important, prolonged inactivity may worsen stiffness and symptoms.
• Becoming dehydrated: Poor hydration may contribute to fatigue and overall discomfort.
• Delaying or not following your RA treatment: Skipping medication or appointments may lead to disease progression and increased joint damage.

How is Rheumatoid Arthritis treated?

There is no definitive cure for RA, but treatment options are available to alleviate the symptoms of RA and prevent further joint damage.

Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate or leflunomide are usually prescribed for RA treatment. Low-dose steroids may also be used during the early stages of treatment to help control inflammation and symptoms. Other treatment options include nonsteroidal anti-inflammatory drugs (NSAIDs) and injectable biologic drugs.

In selected cases, surgical procedures such as arthroplasty, knee arthroscopy and synovectomy may also be recommended by your doctor to help restore the use of your affected joints, reduce pain, and correct deformities.

Degenerative Disc Disease

What is Degenerative Disc Disease?

The spine provides structural support and protects vital organs. It is made up of vertebrae (bones) and intervertebral discs, which act as shock absorbers.

As we age, discs lose water content and develop small cracks. This process is known as degeneration. Degenerative disc disease occurs when these discs break down, leading to pain and reduced function, most commonly in the neck and lower back.

What are the symptoms of Degenerative Disc Disease?

DDD is often characterised by discomfort and dysfunction associated with disc degeneration. Symptoms of DDD include:

• Lower back or neck pain: Symptoms may include a dull, constant ache, sharp stabbing pain, or a burning or tingling sensation.
• Lower back pain with prolonged sitting and standing: Sitting or standing for long periods of time can put a strain on your lower back, increasing the pressure inside the discs and leading to discomfort and stiffness over time.
• Lower back pain when bending forward or heavy lifting: Frequent forward bending of the neck, including prolonged smartphone use (‘text neck’), may also worsen symptoms.

What makes Degenerative Disc Disease worse?

Some factors that can cause DDD to worsen include:

• Repeated heavy lifting or improper lifting techniques: Strains discs and may cause bulging or nerve compression.
• Smoking: Reduces blood flow and oxygen delivery, accelerating disc degeneration.
• Overexercising: Excess strain may worsen symptoms.
• Poor posture: Slouching increases pressure on the spine, accelerating wear and tear.

How is Degenerative Disc Disease treated?

Although there is no cure for DDD, there are treatment options available to relieve your pain and other symptoms of DDD as well as slow the disease’s progression. You can do your part by adopting proper posture and practicing proper lifting techniques. Your treatment may include physical therapy, medications or steroid injections.

In serious cases where nonsurgical treatments do not seem to be working and you are persistently experiencing pain and/or weakness, surgery may be a good option. Some surgeries your surgeon may recommend include:

• Diskectomy: Removing part of a spinal disc to relieve pressure on your nerves
• Foraminotomy: A surgery to expand the opening for your nerve roots by removing tissue and bones.
• Laminectomy: Removing a small portion of bone in your lower spine
• Osteophyte Removal: Removing bone spurs (osteophytes) from your spine
• Spinal Fusion: A surgery to connect two or more vertebrae to improve the stability of your spine.

Don’t Ignore Joint Pains

Joint pain in older adults may be common, but it should not be dismissed as an inevitable part of ageing. Conditions such as osteoarthritis, rheumatoid arthritis, and degenerative disc disease each have distinct causes, symptoms, and treatment approaches, yet for all these conditions, early recognition and appropriate management can significantly improve quality of life.

With timely medical care, lifestyle modifications, and adherence to treatment plans, many individuals will be able to effectively manage pain, maintain mobility, and continue leading active, fulfilling lives. If persistent joint or back pain interferes with daily activities, seeking professional medical advice is an important first step toward preventing further joint damage and preserving long-term function.