Cerebral Palsy and Arthritis
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Cerebral palsy is not a degenerative condition, but it can cause secondary conditions, some of which do get worse with time. One of these is osteoarthritis, the pain and stiffness in joints that results from wear and tear on the cartilage over time. Children with cerebral palsy can have increasing difficulty when they suffer from osteoarthritis, because it can be painful and limiting.
Both preventing and treating arthritis are essential for helping children and adults with cerebral palsy have a better quality of life. Treatment to correct musculoskeletal abnormalities can minimize damage to the joints, while good pain management, and in some cases surgery, can treat arthritis and its symptoms after its onset.
What is Arthritis?
Arthritis is a common joint disease that has many forms and can affect a wide range of people. There are, in fact, more than 100 types of arthritis. In general, the term arthritis refers to inflammation and pain in the joints, which causes swelling, pain, stiffness, redness, and difficulty moving the joint. It can affect any joint in the body, including the knuckles, elbows, shoulders, hips, and knees.
The most common type of arthritis, and the type that most often affects people with cerebral palsy, is osteoarthritis, also known as degenerative arthritis. This is more frequently seen in older adults because it is caused by deterioration in the joint cartilage with time and overuse of joints. The cartilage is what provides cushioning within the joint, so when that wears down, the result is pain, swelling, and stiffness.
Risk factors for the development of arthritis include a family history of arthritis, being older, being overweight, having injured a joint, and having a condition that causes unusual or excessive wear on joints, like cerebral palsy. The symptoms of arthritis are generally chronic and progressive, and treatment is needed to relieve the pain and swelling and to improve movement in the joints.
How Does Cerebral Palsy Cause Arthritis?
Having cerebral palsy is a risk factor for osteoarthritis, but the degree of risk, which joints are affected, and age of onset all vary by individual. People with cerebral palsy have different degrees of abnormalities of the neuromuscular system, and these abnormalities may cause unusual movements in the joints, overuse of joints, excessive wear on joint cartilage, and compression of the joints that ultimately lead to osteoarthritis. Arthritis often begins earlier in someone with cerebral palsy than in the general population, and it is sometimes even seen in children.
The joint or joints affected depend on the type of disability that a person with cerebral palsy has. For instance, a child who struggles to walk, having a gait that makes the hips or knees move in an abnormal way can lead to arthritis in those joints. Hip arthritis is fairly common for this reason in people with cerebral palsy. Even joints not involved in walking can be affected. Muscle imbalance across a joint is common in cerebral palsy. This can cause unusual movements of a shoulder or elbow joint that leads to premature wear on the cartilage.
Symptoms and Signs of Arthritis
While many people with cerebral palsy will not experience arthritis until they become adults, it is possible to develop it as children. Parents should be aware of the signs of arthritis because earlier intervention will produce better outcomes. The symptoms of osteoarthritis in any joint include:
- Pain that occurs during or after movement in the joint
- Stiffness in the joint, often after sleeping or a long period of little movement
- Tenderness when the joint is touched
- Inability to move or flex the joint through a full range
- A feeling of grating inside a joint when it is moved
- Hard lumps that can be felt under the skin around a joint
Treatment for Arthritis
The treatment of arthritis in people of any age with cerebral palsy depends on the individual, but there are some typical treatments that are used for many.
The least invasive types of treatment don’t really treat the inflammation, but do help with pain and mobility. These include painkillers, like over-the-counter acetaminophen, or nonsteroidal anti-inflammatory drugs such as ibuprofen. They also include physical therapy and gentle exercises that help to strengthen specific muscles and make moving a joint easier and less painful.
When arthritis becomes more severe or debilitating, and these non-invasive treatments provide little relief, more invasive strategies can be used, such as surgery. It is sometimes possible for a problem causing the abnormal movements or overuse of the joint to be improved with surgery. This is highly variable by individual. For advanced cases of arthritis in a joint, a replacement of the entire joint with an artificial one may relieve pain and restore mobility. Hip replacement surgery has been found to be a safe way to treat adults with cerebral palsy who suffer from severe osteoarthritis in the hip joint.
Prevention of Arthritis
Many people with cerebral palsy will develop some form of arthritis, and preventing it completely may not be possible. However, there are ways to prevent it to some degree, delay its onset, or minimize the damage and symptoms. The critical step is to diagnose and begin treatment for cerebral palsy early in childhood. The more comprehensive and consistent treatment a child gets, the better the chances of reducing joint damage over time.
Any early and ongoing treatment that can help children and adults with cerebral palsy move in healthier ways will minimize the development of arthritis. This may mean surgery to correct bone or joint deformities, physical therapy and exercise to develop muscle strength and balance around joints, and the use of mobility aids. Also helpful is occupational therapy to promote the performance of daily tasks in a manner best for the joints. Lifestyle habits can also minimize and prevent arthritis. Maintaining a healthy weight, for instance, can take pressure off of the joints.
Arthritis is a painful condition and one that most people don’t expect to experience until they are elderly. Unfortunately for people with cerebral palsy, the deterioration of joints that causes osteoarthritis begins early in life and is more significant than for other people. With good overall treatment, watching for early signs of arthritis, and treating pain and other symptoms, a young person with arthritis can continue to enjoy life with improved mobility and minimal pain.
- http://www.cdss.ca.gov/agedblinddisabled/res/VPTC2/12 Working With Consumers with Disabilities/Cerebral_Palsy.pdf