Osteoarthritis in the UK Armed Forces: a review of its impact, treatment and future research

O'Sullivan, Oliver; Behan, Fearghal P.; Coppack, Russell J.; Stocks, Joanne; Kluzek, Stefan; Valdes, Ana M.; Bennett, Alexander N.

Abstract

Within the UK Armed Forces, musculoskeletal injuries account for over half of all medical downgrades and discharges. Data from other Armed Forces show that osteoarthritis (OA), more common in military personnel, is likely to contribute to this, both in its primary form and following injury (post-traumatic OA, PTOA), which typically presents in the third or fourth decade. OA is not a progressive ‘wear and tear’ disease, as previously thought, but a heterogenous condition with multiple aetiologies and modulators, including joint damage, abnormal morphology, altered biomechanics, genetics, low-grade inflammation and dysregulated metabolism. Currently, clinical diagnosis, based on symptomatic or radiological criteria, is followed by supportive measures, including education, exercise, analgesia, potentially surgical intervention, with a particular focus on exercise rehabilitation within the UK military. Developments in OA have led to a new paradigm of organ failure, with an emphasis on early diagnosis and risk stratification, prevention strategies (primary, secondary and tertiary) and improved aetiological classification using genotypes and phenotypes to guide management, with the introduction of biological markers (biomarkers) potentially having a role in all these areas. In the UK Armed Forces, there are multiple research studies focused on OA risk factors, epidemiology, biomarkers and effectiveness of different interventions. This review aims to highlight OA, especially PTOA, as an important diagnosis to consider in serving personnel, outline current and future management options, and detail current research trends within the Defence Medical Services.

Citation

O'Sullivan, O., Behan, F. P., Coppack, R. J., Stocks, J., Kluzek, S., Valdes, A. M., & Bennett, A. N. (2023). Osteoarthritis in the UK Armed Forces: a review of its impact, treatment and future research. BMJ Military Health, https://doi.org/10.1136/military-2023-002390

• Journal Article Type: Review
• Acceptance Date: May 31, 2023
• Online Publication Date: Jul 25, 2023
• Publication Date: Jul 25, 2023
• Deposit Date: Jun 7, 2023
• Publicly Available Date: Jul 25, 2023
• Journal: BMJ Military Health
• Print ISSN: 2633-3767
• Electronic ISSN: 2633-3775
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1136/military-2023-002390
• Public URL: https://nottingham-repository.worktribe.com/output/21637786
• Publisher URL: https://militaryhealth.bmj.com/content/early/2023/07/24/military-2023-002390
• Additional Information: Invited review