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"There are broadly two forms of arthritis: osteoarthritis that is linked to ageing, and secondary arthritis, which arises from conditions like rheumatoid disease, fractures, or major ligament injuries. Of these, osteoarthritis is the most common -- and long regarded as a disorder of old age. Increasingly, patients as young as their mid-40s are being diagnosed, suggesting the disease may be arriving earlier than ever," says Dr Ashok S. Gavaskar, clinical lead at the Institute of Orthopaedics and Trauma, Rela Hospital in Chennai.
Osteoarthritis cases in India nearly tripled from 23 million in 1990 to 62 million in 2019, a study in the Osteoarthritis and Cartilage journal reports. The disease now ranks as the country's 20th leading cause of disability, with Goa and Punjab seeing the steepest increases.
India's rapid urbanization has brought with it new patterns of risk. Gavaskar points to five drivers: rising obesity and inactivity; sports injuries from India's new athletic push; road accidents on unsafe streets; punishing industrial work; and environmental shifts that may be rewriting genetic risk.
Diet and lifestyle play an outsized role. Refined carbohydrates, sugary products, and sedentary routines create a fertile ground for joint deterioration. The paradox of widespread vitamin D deficiency in a sun-rich country has further weakened bone and muscle health. "High-carb diets create chronic inflammation," notes Dr Paneendra Sudarshan, an orthopedic surgeon specializing in knee and shoulder care at Sammprada Multispecialty Hospitals, Bengaluru. "Vitamin D deficiency weakens bones and muscles. Combine this with poor posture and inactivity, and we are seeing joints wear out much earlier."
Sports physiotherapists are observing the same trends. "The primary contributing factors are lifestyle-related -- low physical activity, weight gain, muscle de-conditioning, and poor movement habits -- further compounded by sports injuries and metabolic factors such as vitamin D deficiency," says Dr Karishma Sanghavi, a musculoskeletal and sports physiotherapist. "We're seeing more young adults presenting with knee pain or even requiring knee replacements, driven not just by inactivity but also by unstructured participation in leisure sports and marathons."
Gavaskar observes how many patients with knee osteoarthritis arrive late, often after months of self-managing with painkillers or cutting back on activity. Because early stages cause little disruption, sedentary patients especially delay care. Some push through with over-the-counter drugs, sometimes landing in kidney or bowel failure. More often, people quietly give up movement to avoid pain, but it comes at the cost of long-term mobility and, eventually, drastic interventions like knee replacement.
A 2016 study in the Indian Journal of Orthopaedics found nearly one in three Indians over 40 has knee osteoarthritis. Surveying 5,000 people nationwide, it reported higher rates among women, the obese, older adults, and the sedentary -- with big cities and villages showing the greatest burden.
THE COST OF DELAYING TREATMENT
If the causes are complex, the consequences of delay are stark. Sudarshan says, "Instead of early medical intervention, symptoms are ignored or self-treated. By the time patients arrive, joint replacement surgery becomes the only viable option." Studies show that 8 to 12 percent of joint replacements in India today are performed on patients under 50 -- a figure, Sudarshan stresses, reflects not over-treatment but missed opportunities for early care.
Physiotherapists echo this frustration. "The biggest loss in arthritis care is time," says Sanghavi. "Every year of delayed physiotherapy often means a year of preventable joint deterioration. Without proper guidance, patients cut activity because of pain, leading to muscle weakness, stiffness, and joint decline. By the time they reach us, moderate-to-advanced arthritis is often already present."
A 2014 review published in Clinical Medicine Insights, Arthritis and Musculoskeletal Disorders, emphasizes that young, active, and athletic individuals are increasingly vulnerable to OA, often due to joint injuries, obesity, and high-impact occupational or recreational activities.
Athletes' toughness can delay diagnosis, while repeated impact and injuries hasten joint damage. Studies show over 80 percent of ex-football players with knee injuries develop osteoarthritis, with former soccer players also facing far higher knee and hip rates.
EARLY DIAGNOSIS IS CRITICAL TO HEAL JUVENILE ARTHRITIS
For children, the stakes are even higher. India has one of the highest burdens of juvenile idiopathic arthritis (JIA) in Asia, yet diagnosis often comes months or even years later. "The inability to diagnose JIA in time amounts to poor awareness, misrepresentation of symptoms and inaccessibility to special channels," says Dr Aneesa Kapadia, rheumatologist at Saifee Hospital, Mumbai. "It is often assumed that joint pains in children are a normal part of growing up, even when there is no visible inflammation early on."
Juvenile arthritis can strike much earlier than most parents imagine. "It can start in kids as young as 6 months old, though the average age of onset is around 6 years," says Dr Sanju Sidaraddi, consultant - pediatrician and neonatologist at Motherhood Hospitals, Kharghar, Navi Mumbai. Unlike osteoarthritis, which is associated with ageing, JIA is an autoimmune disease that inflames the joints of children under 16, leading to pain, swelling, and stiffness. Children may even develop fevers and rashes uncommon in adults with rheumatoid arthritis. "Both conditions share inflammation as their hallmark, but JIA may resolve in childhood, whereas rheumatoid arthritis usually persists into adulthood," he explains.
The consequences of delay, however, are lifelong. "The window of diagnosis is extremely vital," Kapadia warns. "Once a joint is damaged due to long-time inflammation there is no reversal of damage. Without treatment, JIA may lead to disability and deformities, by which the child will have to live until the end of his or her life." She adds that juvenile arthritis can extend beyond joints, slowing growth, causing anemia, and in rare cases inflaming the eyes. Warning signs -- persistent swelling, stiffness in the morning, unexplained fatigue, or sudden changes in gait -- should never be overlooked.
Still, a diagnosis need not mean a childhood defined by limitation. "With the right medications, physical therapy, and timely lifestyle adjustments, children with juvenile arthritis can lead active, full lives," Sidaraddi notes. Some young patients may see their disease go into remission, while others will carry it into adulthood. The outcome, he stresses, depends on the type of JIA, how early it is detected, and how effectively it is managed. "Early recognition and treatment are critical -- not only to control symptoms but to prevent long-term joint damage."
HOW TO MINIMISE ARTHRITIS RISK THROUGH NUTRITION
Primary care remains the weak link and experts call for trained GPs, early referrals, and a team-based approach. Poor nutrition -- low vitamin D and calcium -- exacerbates damage, while rising joint replacements spark debate over surgery offered too soon versus restoring mobility.
From a nutritional perspective, the story is much the same. "Reducing arthritis risk in India starts with balancing the plate," says Nicole Linhares Kedia, sports nutritionist and integrated health coach. "That means cutting back on polished rice and refined wheat, and replacing them with whole grains like millets, and high-quality proteins like pulses, eggs, dairy, chicken, or fish. We should include a daily diet of vegetables, whole fruits, and anti-inflammatory fats such as omega-3-rich fish, flaxseeds, chia seeds, walnuts. Fixing vitamin D gaps -- through diet, fortified foods, safe sun exposure, and supplementation -- is also critical." Even modest weight loss, she adds, can significantly reduce joint strain and inflammation.