Arthritis in Adults and Children and what to do about it

Arthritis in Adults and Children and what to do about itArthritis is extremely common, around 10 million people in the UK will seek help from their GP every year for it and related problems. While it is more common in adults, some types can and do affect children. This post will first outline the main types and subtypes of arthritis, then discuss management from a physiotherapy view point and then finally discuss arthritis in children and younger adults,

Arthritis can effectively be separated into two broad types non inflammatory and inflammatory. It is helpful to diagnosis which type of arthritis is present as their medical management is quite different and early diagnosis, while not usually leading to a “cure” can ensure that management is optimal.

Our clinicians based in our clinic in Eskbank near Edinburgh, have extensive experience treating patients with arthritis both children and adults. Rehabilitation and exercise are essential for the optimal long term management of arthritis, both in children and adults and inflammatory and non inflammatory. For more information regarding arthritis and its overall management please follow this link to the UK’s leading arthritis charity Arthritis Research UK.

Non inflammatory arthritis or Osteoarthritis

By far the more common type of arthritis is non-inflammatory, often referred to as degenerative arthritis or osteoarthritis and when referring to the spine it is often termed spondylosis. Therefore it is important to realise that health care practitioners will often use these terms interchangeably which can cause confusion. The clinicians at Midlothian Physiotherapy LLP most commonly see patients with osteoarthritis affecting the neck, the lower back, the knee, the elbow and the shoulder. However osteoarthritis will affect any joint both spinal and non spinal.

Osteoarthritis often referred to as OA affects around 8 million people, it can affect those of any age however it usually affects those over the age of 50. OA can be divided into 2 categories, primary or secondary.

Primary OA refers to OA which does not appear to have an underlying cause. This normally has a gradual onset with the patient initially noticing occasional joint stiffness. This then progressively worsens over time until it affects joint mobility and the ability to carry out normal activities.

Secondary OA refers to OA which occurs secondary to some previous disturbance to the joint. For example previous significant joint injury such as ACL rupture in the knee, or bony injury such as a fracture which affected the joint surface, or more rarely joint infection.

However the nature of the initiation of joint degeneration does not really affect the pathophysiology or the progression of OA. The symptoms affecting those with secondary OA are similar to that affecting primary OA.

A healthy joint has a layer of articular cartilage covering the underlying bone, in OA there is a thinning of or damage to the articular cartilage which progressively worsens over time. As a reaction to the breakdown of the articular cartilage, bone spurs or osteophytes form. The result is that there is a progressive onset of joint stiffness, a loss of joint range of movement, pain and loss of function or disability.

Therefore it would seem common sense that the best thing to do would be to minimise the use of the joints that are affected. Indeed in the past this was in fact the advice that was often given. However more recent evidence would suggest that this is not the case.

Firstly there are multiple studies showing that findings on X rays, MRI and CT scans do not correlate strongly with the degree of symptoms that patients complain of. Therefore if you have been told that a scan or X ray shows “degenerative change” don’t assume that there is nothing that can be done.

Secondly there are multiple studies showing that rehabilitation can successfully increase strength, flexibility, balance and overall function, whilst reducing the level of pain that is reported.

Therefore the role of physiotherapy in the management of non inflammatory arthritis is to help in making the initial diagnosis, managing any flare up of symptoms and establishing a management plan to optimise the state of the affected joint or joints and the surrounding soft tissues.

 

Inflammatory Arthritis and related disorders

Inflammatory arthritis of which the most common is rheumatoid arthritis, affects more than 400,000 people. It is an autoimmune condition, this is where the body’s own immune system mistakenly attacks itself. It commonly presents between the ages of 40-50 and is three times as common in women.

There are a number of other types of inflammatory arthritis and related conditions such as Psoriatic arthritis, Systemic Lupus Erythematosus often referred to as SLE or lupus and Reactive arthritis previously referred to as Reiter’s syndrome. However there are many other forms of inflammatory joint problems so this list is by no means exhaustive.

Patients with inflammatory joint problems or disorders will often have problems with other tissues or organs. SLE or lupus in particular will often result in multiple systems and tissues being affected.

As with non inflammatory arthritis or OA, the role of physiotherapy in the management of inflammatory arthritis is to help in making the initial diagnosis, managing any flare up of symptoms and establishing a management plan to help optimise the state of the affected joint or joints and the surrounding soft tissues. In the case of the various different types of inflammatory arthritis the diagnosis can be delayed, as the symptoms can be very similar to other causes of musculoskeletal pain.

It is not uncommon for a diagnosis of inflammatory arthritis to made following referral back to the patient’s GP, because a physio has felt that something about the patient’s presentation, history or lack of response to treatment made him or her suspicious that there was an underlying inflammatory component to the problem.

 

Arthritis and children

Although arthritis is commonly thought to be a problem affecting adults and older adults at that. It is important not to ignore the possibility of arthritis being an issue when presented with a child or young adult who has problems with musculoskeletal pain. In particular if the child has persistent problems that are not settling as would be expected.

In the UK arthritis affects around 15,000 young people. Generally the various types of childhood arthritis are referred to as juvenile idiopathic arthritis or JIA. As with arthritis in adults the exact cause of JIA is unknown, however it often seems to settle as the child reaches adulthood.

JIA often affects multiple joints. If it affects five or more joints it is termed Polyarticular JIA. If it affects less than five joints then it is referred to as Oligo-articular JIA, which is the most common form. As with inflammatory joint problems in adults there can be systemic symptoms such as lethargy, fever etc.

As with adults the role of physio in the management of JIA may involve aiding in the initial diagnosis if the patient hasn’t been diagnosed when they initially present to the clinic. Once the diagnosis has been made then the role of physiotherapy will be manage symptom flare ups and establish a management programme that optimises the child or young persons joints.

 

Can we help?

If you or your child are struggling with pain or other problems due to arthritis or indeed any other problem and you would like us to assess, treat and establish a management plan for you. Then please contact us to arrange an appointment or if you have any queries. Our clinic is in Eskbank within easy reach of Edinburgh, Penicuik and the surrounding area. We are open from 8 am to 8 pm Monday to Thursday and 8 am to 6 pm on Friday and have no waiting list, therefore we can see you quickly at a time that is convenient to you.

Our clinicians have over 15 years of clinical experience across a wide range of specialities including working in a elective orthopaedic unit which specialised in joint replacement surgery and the Sick Children’s Hospital in Edinburgh. Therefore we have extensive experience in the assessment, treatment and overall management of patients, both children and adults with a wide range of different types of arthritis and related disorders.

 

 

 

 

 

 

 

 

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