Arthritis in the Young: Debunking the Myth that it is just an Elderly Disease

More than 10.5 million people in the UK have arthritis, equating to one in six people. Arthritis, a disease long associated with the elderly, can have severe, life-impacting symptoms. However, contrary to popular belief, arthritis does not only affect older people. In reality, two-thirds of people with arthritis and other musculoskeletal conditions are under the age of 65 and more than 12,000 young people are affected by juvenile idiopathic arthritis (JIA).   

The misconception that arthritis only affects elderly people ignores the millions of young people affected by arthritis and the significant impact arthritis can have on younger adults and even children. Arthritis is a major cause of disability, with many people with arthritis experiencing severe pain every day and finding their ability to work, socialise and function in their day-to-day lives significantly compromised. Today, we will look at debunking the myth that arthritis is a disease that only affects the elderly.

Understanding arthritis

Arthritis is a commonly occurring condition that causes pain and inflammation in one or more of the joints, most frequently in the knees, hips, hands and spine. Arthritis is characterised by symptoms such as:

• Joint pain and tenderness.
• Swelling.
• Stiffness of the joints.
• Decreased joint mobility and restricted movement.
• Inflammation of the joints or around the joints.
• Muscle weakness or wastage.

Symptoms can range from mild to severe and the severity may change over time and may fluctuate day to day depending on other factors, such as the weather. Arthritis can cause severe pain and can make it difficult to walk, sit down or perform your usual activities. Long-term arthritis can cause permanent changes in your joints. 

There are more than 100 different types of arthritis, with the most common types being osteoarthritis and rheumatoid arthritis. Osteoarthritis is the most common type of arthritis and affects the cartilage lining in the joint. As the cartilage lining becomes rough and thin, the tendons and ligaments surrounding the joint have to work harder, which can cause swelling, pain, stiffness and the formation of bony spurs. As the cartilage degenerates further, bones can begin rubbing together, which can alter their shape permanently or force them out of position. Although it can affect people of any age, it most commonly affects those in their mid-40s and older. Younger people can experience osteoarthritis following an injury or another joint-related condition. 

Rheumatoid arthritis occurs when the immune system begins to target the joint, leading to pain and swelling. The outer covering is initially affected, followed by the rest of the joint. This can cause the joint to change shape and the bone and cartilage to break down. Symptoms most commonly begin between 30 and 50 years of age.

Although both osteoarthritis and rheumatoid arthritis affect younger and middle-aged adults, arthritis can also affect children. Juvenile idiopathic arthritis (JIA) is a condition that causes pain and inflammation in one or multiple joints for a minimum of six weeks. Symptoms first begin before the age of 16. It usually occurs when the child or young person’s immune system creates inflammation in their joints. The symptoms of JIA often improve as the child ages – some children enter remission or the disease may go away permanently. For other children, the disease may become a long-term health condition. 

The main types of JIA are:

• • Oligoarticular JIA: Also known as oligoarthritis, this can affect up to four joints at one time, usually the knees, ankles and wrists. The most common symptom is stiffness after rest. For many children with this type of arthritis, their symptoms will go away for a long time or permanently, with no long-term damage. However, in some children, more joints develop pain over time and they can experience additional problems, such as issues with their eyes and bone growth.
  • Polyarticular JIA: Also known as polyarthritis, this affects five or more joints, usually on both sides of the body. It can affect both small and large joints. Polyarticular JIA can also cause other problems, such as joint damage, inflammation in the lining of the heart or lungs, anaemia and an enlarged liver, spleen or lymph nodes. It typically develops between the ages of 1-3 and 10-14.
  • Systemic onset JIA: This type of juvenile arthritis begins with symptoms including a fever, a rash, low energy levels and enlarged glands. Following this, joints swell and become inflamed. Children with systemic onset JIA may also have problems with their heart, lungs and blood.
  • Enthesitis-related JIA: This type of arthritis most commonly affects the joints of the leg and the spine. It causes inflammation in the areas where the tendons are attached to the bone. Teenagers and young adults with this type of arthritis often develop stiffness in their neck and lower back. It is also associated with acute uveitis, a painful eye condition.

Another form of arthritis, ankylosing spondylitis (AS), most commonly develops in the teenage years and young adulthood. AS is a long-term condition that occurs when the spine and joints become inflamed. It is characterised by back pain and stiffness, swelling and extreme tiredness.

As seen above, arthritis can impact people of all ages, not just the elderly. The exact cause of arthritis varies depending on the specific type, but factors such as genetics, age, gender and environmental factors may contribute to the development of arthritis and the severity of symptoms.

Prevalence in younger age groups

Arthritis in younger age groups is significantly underestimated. It is estimated that 2% of children aged under 16 have a long-term musculoskeletal condition, with 12,000 children in the UK diagnosed with juvenile idiopathic arthritis in the UK alone. 

There are multiple reasons why arthritis is becoming increasingly prevalent in younger people, including:

• Genetic factors
  There is some evidence that arthritis runs in families. Although genes are not the only factor that causes arthritis, they can predispose some people to develop arthritis. Having a family history of arthritis can make some young people more likely to develop arthritis, compared to others.
• Autoimmune factors
  Some forms of arthritis develop when the immune system starts to attack the body’s own tissue. This can happen in response to an infection, an autoimmune disease or another factor.
• Environmental factors
  Multiple lifestyle and environmental factors can contribute to someone developing arthritis. These factors can include diet, physical activity, previous injury, smoking or exposure to tobacco smoke, and environmental pollutants, for example living in an urban area with high traffic.
• Obesity
  A rise in obesity rates and the more sedentary lifestyles many young people follow can contribute to the prevalence of arthritis. Being overweight and a lack of physical activity can contribute to an increased risk of arthritis. Being overweight puts extra stress on the joints and excess fat in the body can cause increased damage to the cartilage.
• Impact sports
  Regularly playing impact sports, such as rugby, football or hockey, can increase the risk of arthritis. Impact sports can cause increased stress on the joints and serious injuries to the joints can increase the risk of an individual developing arthritis earlier.
• Hormones
  Many types of arthritis are more common in females compared to males, suggesting hormonal factors could play a part in the development of arthritis, particularly the hormone oestrogen. This could mean that teenage girls may be more likely to develop arthritis than teenage boys.
• Increased awareness and improved diagnostics
  Advances in medical diagnostics and increased awareness among healthcare professionals can contribute to the increased identification of arthritis in younger age groups and an increase in diagnoses.

Symptoms and early signs

Different types of arthritis have different symptoms. Being able to recognise the symptoms early allows you to get earlier treatment and can improve the long-term outcomes.

The most common symptoms and early signs of arthritis in young people are:

• Joint pain: This could be persistent or recurring pain in one or more of the joints. The pain can vary in intensity and may be a throbbing, aching or sharp pain.
• Joint stiffness: Stiffness in the joints, particularly in the morning or after a period of inactivity, is one of the most common symptoms of arthritis. The joints may feel stiff and difficult to move.
• Swelling: Inflammation of the joints can lead to swelling, tenderness and warmth or redness around the affected joint. The swelling may be visible or can be recognised by touch.
• Reduced range of motion: Arthritis can limit the range of motion in the affected joint. It may be difficult to bend, flex, move, extend or put weight on the joint.
• Fatigue: Chronic inflammation and pain associated with arthritis can lead to persistent fatigue. This fatigue may be disproportionate to the level of physical activity.
• Difficulties with grasping or holding: Arthritis in the hands or fingers can lead to difficulties in gripping objects, making simple tasks challenging.
• Grinding sound or sensation: Hearing or feeling a grinding or grating noise when you move your joints could indicate that the cartilage in your joint has worn down and the bones are rubbing together.
• Pain in a previously injured joint: Many people with arthritis previously experienced an injury or trauma to a joint, for example a knee injury during a football game. If the same joint experiences repeated pain at a later time, it could be a sign of arthritis.
• Joint deformities: In more advanced cases or aggressive forms of arthritis, joint deformities may develop, affecting the normal alignment of the joint.
• Eye inflammation: This could be indicative of enthesitis-related JIA.
• High fever and rash: This could be indicative of systemic juvenile idiopathic arthritis.

Early diagnosis equals early treatment, which can prevent irreversible joint erosion. Early treatment can stop the disease from progressing and stop the joint and the bone from becoming irreversibly damaged. Effective management of arthritis can slow the progression of the disease and prevent the loss of range of motion and deformities. Early treatment can also help with symptom management and can offer an improved quality of life for individuals with arthritis, particularly because arthritis treatment is most effective the earlier it starts. Early diagnosis enables healthcare professionals to tailor treatment plans for optimal results.

Earlier diagnosis and treatment can also help to improve mental health by addressing the pain, fatigue and physical limitations associated with arthritis. It allows healthcare professionals to monitor for potential complications, such as inflammation affecting other organs. Early diagnosis by healthcare professionals can lead to appropriate treatment and an improved prognosis for those living with arthritis.

Impact on daily life

Arthritis can affect many areas of an individual’s life. It is the leading cause of disability in the UK and the effects of arthritis can be life-changing. The pain, stiffness, inflammation and fatigue commonly experienced by people with arthritis can make simple tasks difficult or impossible to do. Someone with arthritis may need to make significant changes to their day-to-day life or may find they are unable to do things they usually can. The effects of arthritis on a young person can be particularly significant. Although the symptoms of arthritis are very similar in younger and older people, the day-to-day impact may be more significant for young people, particularly if they find they cannot keep up with their peers, engage in the sports and activities they usually enjoy or attend school or work.

Some ways arthritis can affect the daily life of a young person are:

• An inability to work or study.
• Difficulties walking, standing or sitting for extended periods of time.
• Reduced mobility, making it difficult to perform normal activities.
• Difficulties with daily tasks, such as tying shoelaces, climbing stairs or writing.
• Inability to engage in physical activity.
• Chronic fatigue.
• Impact on mental health, including increased risk of stress, anxiety and depression. Young people with arthritis may also experience a decrease in self-esteem and confidence and reduced emotional well-being.
• Withdrawal from social activities and social isolation.
• Sleep disturbances.
• Impacted relationships with family and friends.
• Higher risk of comorbid conditions, such as cardiovascular disease.
• Reduced life expectancy.

Diagnosis and treatment

If you think you or your child may be experiencing arthritis, your first step is to visit your GP. Your GP will ask about your symptoms and may perform a physical examination. Because the symptoms of arthritis can be similar to other physical health conditions or injuries, your GP may request you undergo further tests, such as an X-ray, an MRI scan or a CT scan. 

Although arthritis has no cure, there are treatment options that can help to slow the progression of the disease. Treatment can also help to reduce the severity of your symptoms. Once you are diagnosed with arthritis, the type of treatment you are prescribed will depend on the type of arthritis you are diagnosed with. You may receive treatment from your GP and several other specialists, such as a physiotherapist, rheumatologist, occupational therapist and orthopaedic surgeon. 

Your treatment programme may include:

Medication 

Different types of medication are available to stop the progression of certain types of arthritis and to treat the symptoms of the disease. Some medication options include:

• Disease-modifying anti-rheumatic drugs (DMARDs): DMARD medication can be used to slow down the progression and treat the symptoms of rheumatoid arthritis. They work by blocking the effects of the chemicals released by your immune system when they attack your joints.
• Biological treatments: Biological treatments, such as adalimumab and infliximab may be used in combination with other treatments. The medication is injected into your system and stops specific chemicals in your blood from triggering your immune system to attack your joints.
• Pain relievers: Pain relievers may be prescribed to treat the pain associated with your arthritis. This can include paracetamol and codeine.
• Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs can reduce inflammation in your joints and act as a pain relief.
• Steroids: Steroids can be used to treat pain, stiffness and inflammation.
• Corticosteroids: These may be prescribed for short-term relief of severe symptoms or as injections directly into affected joints.

Physiotherapy 

Physiotherapists design tailored exercise programmes to improve joint flexibility, strengthen muscles around affected joints and enhance overall physical function. Physiotherapy will include in-person sessions with a trained physiotherapist and exercises you can do yourself at home. A physiotherapist may also use a transcutaneous electrical nerve stimulation (TENS) machine to send small pulses of electricity into the affected joint. This is designed to numb the nerve endings and reduce the pain associated with arthritis.

Occupational therapy 

Occupational therapists (OTs) help individuals manage daily activities by suggesting adaptive devices, ergonomic modifications and teaching techniques to conserve energy. If your arthritis causes difficulties in your day-to-day life, an OT can offer training and advice to protect your joints and make everyday tasks more manageable.

Assistive devices 

Braces, splints and other assistive devices can help support joints and improve overall mobility.

Surgery 

In severe cases where other treatments are not effective, surgical interventions may be considered. Joint replacement surgery, such as knee or hip replacement, may be recommended for arthritis affecting large joints.

Complementary and alternative therapies 

Some people with arthritis seek alternative therapy to help treat their symptoms, for example:

• Acupuncture: Fine needles are inserted into the skin and may be able to divert or change painful sensations. Some people find acupuncture to be an effective pain relief for arthritis.
• Massage therapy: Massage can help to reduce muscle tension and improve joint flexibility.
• Herbal supplements: Certain supplements, such as fish oil, glucosamine and chondroitin are sometimes utilised by people with arthritis.

Coping strategies

Living with arthritis can be difficult for young people and can present unique challenges. Coping strategies are essential for managing pain, maintaining good mental health and helping you to maintain a good quality of life. Below are some coping strategies you can implement in your everyday life:

Educate yourself 

Being knowledgeable about your condition can be empowering. Learning about your specific type of arthritis, its symptoms and treatment options and ensuring you understand your condition can help you make informed decisions and communicate effectively with healthcare professionals.

Pain management techniques 

As well as the treatment options listed above, there are some pain management techniques you can implement at home, including:

• Hot and cold therapies: Applying heat pads or cold packs to the affected joints can help relieve pain. Heat helps to relax your muscles and reduce joint stiffness and cold helps to reduce pain, inflammation and swelling. 
• Topical creams and gels: Over-the-counter or prescribed creams and gels can provide localised pain relief.
  

Mind-body techniques 

Relaxation techniques can help to improve the connection between your mind and body, relax your body and help you manage pain and any negative thoughts or emotions you may experience in relation to your arthritis. Some techniques you can incorporate into your daily routine include:

• • Yoga: Yoga can help to ease the pain and stiffness associated with arthritis. It can improve your strength and flexibility and reduce joint tension. Yoga can also help you enter a more relaxed state and decrease your stress levels, control your breathing and manage any negative thoughts and feelings.
  • Mindfulness meditation: Meditation is a mind-body practice that can help to improve your relaxation and improve your mental well-being. Mindfulness meditation allows you to focus solely on the moment, accept your pain and overcome any negative thoughts, emotions or sensations surrounding your pain. Mindfulness can help you to break the patterns of negative thinking, which can worsen your pain.
  • Deep breathing: Deep breathing techniques can reduce stress levels and decrease body tension. Integrating deep breathing into your nightly routine can promote relaxation and improve your well-being and sleep. Slow, even, deep breathing can help to relax the tension in your muscles and relax your body.

Managing fatigue 

Fatigue is a major issue for many young people with arthritis. Prioritising your sleep and establishing a consistent sleep routine can help to reduce fatigue. It can also be beneficial to plan rest breaks throughout the day and listen to your body when rest is needed. Opening up to your friends and family about your arthritis can help them understand why you may need to rest and can help remove the embarrassment you may have previously felt when needing to stop an activity to sit down and rest.

Emotional well-being 

Being a young person with arthritis can feel very isolating. It is likely that none of your friends or peers have arthritis, so finding someone to talk to can be difficult. However, focusing on your emotional well-being is essential. Joining a support group, either in person or online, allows you to connect with other young people who share a similar experience with you. This offers you access to support, understanding and knowledge. Some young people with arthritis also find counselling or therapy to be beneficial. Speaking to a mental health professional can help you address the emotional challenges and mental health difficulties that may arise from living with arthritis.

Medication management 

Take medications as prescribed and communicate openly with your healthcare team about any concerns or side effects. It can also be helpful to be aware of how medications may interact with your lifestyle.

Set realistic goals 

Break down tasks into manageable goals and celebrate your achievements. This can help you stay positive and focused on your progress. Remember, although arthritis may change the way you perform everyday tasks, compared to your peers, many of these tasks are still achievable. However, it is important that you don’t push yourself too hard.

Advocate for yourself 

Be an active participant in your healthcare. Communicate openly with your healthcare team, express your needs and ask questions. Advocate for the treatments and support that will help you manage your condition effectively. Regularly communicating with healthcare professionals can help them monitor your symptoms and adjust the treatment plan as needed.

Lifestyle changes can play an important role in managing the symptoms of arthritis in young adults, particularly if your symptoms are not severe. Some lifestyle changes you can make include:

Prioritise your social life 

Maintaining social connections and staying active socially can help to support your mental health. Engage in activities you enjoy and don’t hesitate to communicate your needs to friends and family. Social support is important for your emotional well-being and for helping you to manage your condition.

Lifestyle modifications

Lifestyle changes can play an important role in managing the symptoms of arthritis in young adults, particularly if your symptoms are not severe. Some lifestyle changes you can make include:

Regular exercise 

Exercising regularly can help to keep your joints mobile, prevent stiffening and strengthen the muscles and ligaments that support your joints. Exercise within your limits and ensure you find the right balance between rest and exercise. Low-impact activity, such as swimming, walking or yoga, that is recommended or approved by healthcare professionals or physiotherapists can help to improve the symptoms of arthritis. If exercise causes you pain or your joints become warm or swollen, ensure you stop exercising and rest.

A healthy diet 

Dietary changes, such as incorporating more anti-inflammatory foods into your diet, including fruits, vegetables and omega-3 fatty acids and avoiding potential trigger foods, can also be beneficial. Exercise and a healthy diet can also help if you are overweight, as reducing your weight will reduce the pressure on your joints. Consult a healthcare professional or a dietitian for personalised dietary advice.

Hydration 

Ensuring you are hydrated is essential for joint health. Water helps in lubricating the joints, supporting overall bodily functions and reducing inflammation. This can help to reduce arthritic flare-ups and prevent attacks of gout.

Stop smoking and drinking excessive alcohol 

Smoking and excessive alcohol consumption can contribute to inflammation and may worsen arthritis symptoms. Quitting smoking and moderating alcohol intake can have positive effects on your overall health.

Joint protection techniques 

Incorporating joint protection techniques into your daily life and using adaptive equipment to minimise the stress on your joints during daily activities can be beneficial. Joint protection techniques can include:

• Avoiding repetitive activities.
• Avoiding weight bearing on the affected joint.
• Using rubber grips on pens, pencils, toothbrushes and utensils.
• Using a button hook.
• Installing lever attachments on doorknobs.
• Using a shoulder strap bag, rather than carrying it with your hands.
• Avoiding staying in the same position for too long.
• Avoiding prolonged inactivity.
• Wearing braces and splints if necessary.
• Using a cane or walker if needed.
• Respecting your pain and listening to your body.

Dispelling myths

Dispelling myths and misconceptions about arthritis in young people is essential to raising awareness and promoting early intervention. Here are some common myths about arthritis in young individuals and explanations to counter these misconceptions:

Myth: Arthritis only affects the elderly.

Reality: Arthritis can affect individuals of all ages, including children, teenagers and young adults. Conditions like juvenile idiopathic arthritis and rheumatoid arthritis are frequently diagnosed in younger people. While the risk of arthritis does increase as you age, arthritis is not exclusively an elderly disease and, in fact, two-thirds of people diagnosed with arthritis in the UK are under 65.

Myth: Joint pain in young people is due to overuse or injury.

Reality: While overuse or injury can cause joint pain, persistent or chronic joint pain in young individuals may be a sign of arthritis or other rheumatic conditions. It is important not to dismiss ongoing symptoms and to seek medical evaluation. It is also important to be aware that young people who have previously injured a joint, such as their knee, are at higher risk of developing arthritis at a young age. This means you shouldn’t dismiss joint pain in a young person, regardless of whether a previous injury has occurred or not.

Myth: Arthritis is not a serious health condition, it is only aches and pains.

Reality: Arthritis can be a serious and chronic condition that significantly impacts daily life. It may lead to joint damage and disability and even affect internal organs in certain autoimmune forms. Early intervention and proper management are essential for preventing long-term complications. The pain some people experience from arthritis can be debilitating and should not be dismissed.

Myth: Young people can’t have inflammatory arthritis. They can only develop certain types of arthritis. 

Reality: Inflammatory arthritis, such as rheumatoid arthritis, can affect people of any age. These conditions involve the immune system attacking the joints and can lead to significant joint damage if not treated early. Inflammatory arthritis can affect children, adolescents and young adults.

Myth: Arthritis in young people isn’t visible or obvious so it mustn’t affect them as much as older people. 

Reality: Many forms of arthritis are not visible and individuals may appear healthy despite experiencing pain and other adverse symptoms. It’s important to recognise that arthritis is an invisible condition that can impact various aspects of a person’s life. Arthritis can be even less noticeable in young people, who are generally fit and healthy in other ways. However, this does not mean that arthritis doesn’t have a significant impact on their lives.

Myth: Nothing can be done for arthritis, you just have to learn to live with it. 

Reality: While there is often no cure for arthritis, various treatments and lifestyle modifications can help you to effectively manage symptoms, improve joint function and enhance quality of life. Early intervention is key to preventing irreversible joint damage. It is also important to bear in mind that many types of juvenile idiopathic arthritis can go into remission or the disease can disappear altogether. If you or your child developed arthritis before the age of 16, symptoms may improve or stop completely.

Myth: Young people with arthritis should avoid physical activity to protect their joints.

Reality: Physical activity is an effective way of managing arthritis. Low-impact activities, done on the advice of healthcare professionals, can help maintain joint flexibility and strengthen supporting muscles, contributing to overall joint health. Exercise can also help to improve mental well-being.

Myth: Arthritis is not a serious health concern, it is just a normal part of ageing. 

Reality: Arthritis is not an inevitable part of ageing and it can have a substantial impact on health and well-being. Arthritis is a medical condition that requires attention and early diagnosis and intervention are important for long-term outcomes. Additionally, with more and more younger people being diagnosed with arthritis, increased awareness of juvenile arthritis is required.

Myth: Joint pain is the only symptom young people with arthritis deal with.

Reality: Juvenile idiopathic arthritis has many different symptoms, including joint pain. Other symptoms can include joint stiffness, swelling, inflammation, fatigue, a fever, a rash, swollen lymph nodes and eye pain. Many children and young people with arthritis also experience stress, anxiety and embarrassment about their condition. They may be unable to attend school, may miss out on social activities or may not be able to play sports. This can have a significant impact on their mental well-being.

Raising awareness

Delays in diagnosis of arthritis in young people often occur because of a lack of awareness and knowledge. Early intervention and treatment can significantly affect long-term outcomes and can change the lives of people living with arthritis at a young age. By increasing awareness, we can work towards a future where arthritis is recognised and addressed across all age groups.

Raising awareness of juvenile arthritis can lead to earlier recognition of arthritis symptoms in young individuals. Early diagnosis allows for prompt medical intervention, reducing the risk of long-term joint damage and improving outcomes. By understanding the impact of arthritis on young people, society can better support those affected. This support can lead to improved quality of life through effective management strategies, including access to medical treatment, lifestyle modifications and improved emotional well-being support.

As part of raising awareness, educating healthcare professionals is an important factor. Improving awareness among healthcare professionals ensures that they consider arthritis as a potential diagnosis when young individuals present with joint symptoms. This can lead to quicker referrals to specialists and appropriate management plans.

Raising awareness can also help to reduce the stigma of arthritis and help to dispel myths and misconceptions about arthritis in young people. This can positively impact the mental and emotional well-being of individuals living with arthritis. Increased awareness can also encourage more research into the condition. Funding and resources can be directed towards understanding the causes, improving treatments and finding potential cures. 

Awareness also empowers individuals to become advocates for themselves and others affected by arthritis. Advocacy efforts can drive policy changes, improve access to healthcare services and promote inclusivity for those with arthritis in various aspects of life.

There are many ways you can raise awareness of arthritis in young people. Social media platforms, blogs and other online resources can be useful for sharing accurate and reliable information about arthritis in young people. It can also be helpful for young people with arthritis to share their experiences, to help raise awareness of living with arthritis. Arthritis awareness campaigns can also help to provide educational materials, organise events and create opportunities for community engagement. 

Supporting research initiatives, for example contributing to fundraising efforts, can help to support arthritis research to help advance knowledge and find better treatments for arthritis. Encouraging inclusive practices in schools, workplaces and recreational settings for individuals living with arthritis can also be beneficial as it helps to create understanding environments to help those affected feel supported and included and more comfortable being open about their arthritis. 

By collectively raising awareness and promoting understanding, we can create a more informed and compassionate society that empowers young people living with arthritis. Encouraging open conversation, sharing information and supporting arthritis initiatives can contribute to a better future for those affected by this condition.