Some individuals have a genetic predisposition to early-onset joint alterations and inflammation.

“I see patients come in that'll maybe be you know only 50 very young they'll come in and they'll already have a lot of the visible alterations not terrible functionally but they're getting the knobbiness they're getting a little bit of inflammation in the the joints out here maybe down at the thumb base and they'll say hey so what can you do my hands look exactly like my moms did or my my dads did and there's there's there's real evidence to support that some people are more predisposed than others”