You don’t need to be a doctor to be familiar with arthritis and its effects. The condition is such a common one that most of us, even if we haven’t experienced symptoms ourselves, will know someone that has.
Characterised by swollen joints, pain, stiffness and in more severe cases, immobility, arthritis is a condition more commonly associated with later life, and with good reason; osteoarthritis, which is the most common form, is caused by the weathering away of connective tissue (or cartilage) between the joints, and it’s only logical that this occurs after years of activity and use.
What many people don’t realise, however, is that there are other types of arthritis which aren’t exclusive to the older generation. There are thousands of young people in the UK living with arthritis too, and these instances may not always be caused by the same factors as those which cause adult cases.
To discuss this further, we got in touch with Dr. Ian Scott from King’s College London, who is also the specialist registrar and medical spokesperson for Arthritis Research UK, to get his take on those varieties which do affect younger people, and what measures someone can take to effectively manage symptoms.
How prevalent is arthritis in younger people?
As mentioned above, osteoarthritis (or OA) is the most common form of arthritis; the NHS estimates that there are currently around 8 million cases in the UK. ‘OA occurs when cartilage at the ends of bones wears away and the joint tries to repair itself,’ explains Dr Scott, ‘leading to pain and stiffness. It tends to affect people in their 40s and upwards.’
However, Dr Scott goes on to say that: ‘In people aged 16 years and over there are many different types of arthritis.’
‘Rheumatoid arthritis, or RA, can develop at any age from 16 onwards, although people most commonly first develop symptoms of it in their 40s. It is caused by changes in the body’s immune system, leading to inflammation in the joints.’ This type of arthritis is the second most common in the UK behind osteoarthritis, and is thought to affect approximately 400,000 people.
‘Other less common types of arthritis in people aged 16 and over include psoriatic arthritis (where joint inflammation happens in a person with skin psoriasis) and ankylosing spondylitis (where joint inflammation affects the spine). Psoriatic arthritis most commonly develops in your 30s to 50s. Ankylosing spondylitis symptoms are most likely to begin in your 20s.’
There is, however, a category of arthritis which can affect people as early as their adolescent years.
‘This is called juvenile idiopathic arthritis (JIA),’ explains Dr Scott, ‘and is the main type of arthritis affecting younger people, usually occurring before the age of 16. Like RA, it involves inflammation of the joints. Around 15,000 young people aged 16 and under have JIA in the UK.’
Juvenile Idiopathic Arthritis
As you might expect with a condition that affects so many, JIA can take on numerous forms.
‘Several different types of JIA exist.’ Dr Scott tells us. ‘The commonest type is called oligoarthritis, in which only a few joints are affected.’ In most cases, one or both of the knee joints will be likely to exhibit symptoms. ‘This type is often mild and most likely to go away without joint damage.’
‘There are other types that are very similar to RA, psoriatic arthritis, and ankylosing spondylitis in adults, with similar symptoms and areas of the body being affected.’ Ankylosing spondylitis mainly affects the spine, while psoriatic arthritis is more likely to occur in the fingers and toes.
However, the effects of JIA aren’t just limited to joint inflammation, as Dr Scott goes on to illustrate:
‘One main difference between JIA and adult arthritis is that the eye can become inflamed more often in JIA. This is a problem called uveitis. In some types of JIA young people need to see an eye specialist on a regular basis to make sure uveitis isn’t developing. Some young people with severe JIA may find that puberty is delayed, and occasionally drugs such as steroids can slow growth.’
The Role of Exercise
For many living with arthritis, particularly those with more painful manifestations, prescription medication is unfortunately a necessity. But making changes to certain aspects of your lifestyle can help to ease symptoms too, and make a flare-up less likely.
One activity many experts point to is exercise. It is perhaps not the first or most obvious solution someone might consider when trying to tackle arthritis; after all, physical exertion involves the movement of joints, and these are the problem areas for those with the condition.
In truth, however, exercise is vital in helping to reduce stiffness, improve mobility, and in some cases, reduce pain.
‘There’s no evidence to suggest that exercise makes arthritis worse.’ Dr Scott tells us. ‘In fact, we know that gentle exercise can help inflamed joints. Swimming, cycling, yoga and pilates are all good forms of exercise that improve cardiovascular fitness, strengthen the muscles that support the joints and improve flexibility.’
But Dr Scott also says that choosing the right exercise is important too: ‘Regular, careful and safe exercise is one of the best things that young people can do to manage their condition and improve their health. There are many different ways to exercise, so it’s important for young people to pick an activity they enjoy, so that they remain motivated to stick at it.’
Can Making Diet Changes Help?
In some illnesses, diet plays an integral role. In fact, one of the first areas of research someone might consult upon learning that they have a certain condition will be how it is affected by food and drink; and whether eating or drinking more or less of one particular thing may help to improve symptoms.
So what’s the case with arthritis? Is there a specific kind of diet which can help to reduce its effects?
‘Although there are no diets or dietary supplements that will cure arthritis, some people do find that their symptoms improve as a result of changing what they eat.’ Dr Scott explains. ‘However, there is no scientific evidence to prove that this works, and in fact cutting out certain foods may mean you lose some of the important nutrients from these foods.’
Unsurprisingly and as is the case with so many other conditions, Dr Scott goes on to illustrate that no one particular diet programme fits all when it comes to arthritis, be it JIA or osteoarthritis:
‘Because people are all different and there are many different types of arthritis, what works for one person and one type of arthritis may not work for another. A balance of exercise and a good diet, alongside medications, is a very important part of managing arthritis. People with all types of arthritis should eat a balanced and varied diet to get all the vitamins, minerals, antioxidants and other nutrients needed.’
Sticking with the common sense choices, which can contribute towards healthy bone and tissue structure, is a wise choice.
‘Try a more Mediterranean-style diet which includes fish, pulses, nuts, olive oil and plenty of fruit and vegetables.’ advises Dr Scott. ‘Also try foods rich in omega-3 fatty acids, for example from oily fish, which has been shown to reduce inflammation in certain settings.’
Some supplements have been shown to be beneficial in reducing osteoarthritis symptoms. But are these a viable option for someone with JIA?
‘Popular supplements on the market for osteoarthritis, such as glucosamine, will have no effect on JIA or other forms of inflammatory arthritis.’ Dr Scott tells us, but maintains that there are several other strategies that can make a difference:
‘As alluded to earlier, exercise is one of the best ways of coping with arthritis. Acupuncture has also been shown to help some people cope with pain and massage can relieve anxiety, stress and muscle tension.’
He also explains that keeping a sensible balance between work, study and life can make a big impact as well: ‘As many young people with arthritis also find that fatigue is a symptom of their condition, it’s important to think about pacing. That means managing time and working within your limits, and setting small weekly goals. Occupational therapists and rheumatology nurses specialist can help with this.’
Help Staying Positive
Something which many people don’t always like to speak about when it comes to arthritis is the psychological effect the condition can have. ‘Being in pain and having a long-term health condition like arthritis can sometimes lead to low mood and frustration.’ says Dr Scott. ‘These feelings are natural, common and understandable.’
I know from experience that emotional distress is an accompanying factor which both young and old people living with arthritis might be hesitant to approach their doctor about. Nevertheless, this is something which your GP or your specialist can help you with. As Dr Scott explains:
‘Some paediatric and adolescent rheumatology departments have a psychological service. Some of the issues these services help young people with include coping with difficulties around procedures like blood tests, injections and scans; adjusting to a new diagnosis or treatment; coping with symptoms which interfere with life, such as reduced mobility and pain; helping others to understand your condition and its impact; and dealing with worries of any kind, such as keeping up with your peers, concerns about the future and fears about not making the most of life.’
Stress is thought by many experts to play a contributory factor in the severity of osteoarthritis pain and flare-ups. But, especially when you take into account the many pressures study, exams, and applying to college or university bring for teenagers, can stress exacerbate JIA as well?
Dr Scott tells us that it’s a subject which Arthritis Research are actively looking into:
‘Researchers at our Arthritis Research UK Centre for Adolescent Rheumatology in London are investigating whether psychological stress can lead to JIA flares. JIA can flare during times of stress, for example around exams and we’re investigating why this happens. More than 100 young people will take part in this study.’
Perhaps the most important fact for young people living with JIA to know, is that help is at hand. Talking to your doctor about how best to manage symptoms can make a huge difference, as can speaking about the condition with family and friends.
For more information please go to the young people’s section of the Arthritis Research UK website: www.arthritisresearchuk.org