What is the most common cause of fused joints in a 76-year-old male?

From the Guidelines

The most common cause of fused joints in a 76-year-old male is osteoarthritis that has progressed to end-stage disease, particularly in weight-bearing joints like the knees, hips, and spine. This condition occurs when the protective cartilage that cushions the ends of bones wears down completely over time, leading to bone-on-bone contact, inflammation, and eventually ankylosis (joint fusion) 1. Age is a significant risk factor, with most people over 65 showing radiographic evidence of osteoarthritis. Other potential causes include rheumatoid arthritis, ankylosing spondylitis (more common in males), and post-traumatic arthritis from previous injuries.

Key Considerations

• Ankylosing spondylitis, a form of chronic inflammatory arthritis, can also lead to sacroiliac joint and spinal fusion, particularly in males 1.
• The Assessment of SpondyloArthritis international Society (ASAS) criteria include MRI in the diagnostic algorithm for axial spondyloarthritis, allowing for earlier diagnosis and treatment 1.
• Management of fused joints typically involves pain control with acetaminophen or NSAIDs, physical therapy, and assistive devices, with surgical interventions considered for severely painful joints that limit function.

Treatment Options

• Pain control with acetaminophen (up to 3000mg daily in divided doses) or NSAIDs like naproxen (250-500mg twice daily) if not contraindicated by kidney disease or bleeding risk.
• Physical therapy to maintain mobility in unaffected joints and assistive devices like canes or walkers may help with mobility.
• For severely painful fused joints that limit function, surgical interventions such as joint replacement might be considered if the patient is otherwise healthy enough for surgery.

From the Research

Fused Joints in a 76-Year-Old Male

The most common cause of fused joints in a 76-year-old male is likely related to ankylosing spondylitis (AS), a chronic inflammatory disease that can lead to the fusion of joints, particularly in the axial skeleton.

• Key characteristics of AS include:
  • Inflammatory back pain with sacroiliitis and arthritis of peripheral joints 2
  • Deformities of the vertebral column, joints, and extra-spinal structures 2
  • Fusion of sacroiliac joints and ankylosis of the vertebrae, resulting in the iconic "bamboo spine" on imaging 3
• AS can lead to joint fusion or ankylosis, especially if left undiagnosed or untreated 3
• The disease often presents in young males, but its effects can be seen in older adults, such as a 76-year-old male, due to the progressive nature of the condition 4, 5
• Total hip arthroplasty (THA) can be an effective treatment option for fused hips with spine stiffness in AS, resulting in considerable improvement of mobility and function 6

Relevant Studies

Studies have shown that AS is a common cause of fused joints, particularly in the axial skeleton 2, 3, 4, 5. The disease can lead to significant functional impairment, especially if left untreated or undiagnosed 4, 5. Effective treatment options, such as THA, can improve mobility and function in individuals with fused hips and spine stiffness due to AS 6.