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. Even children with cerebral palsy may develop osteoarthritis, which can be painful and limiting.
Preventing and treating arthritis are important for helping both children and adults with cerebral palsy have a better quality of life. Good treatment to correct musculoskeletal abnormalities can minimize damage to 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 may take one of multiple forms and that can affect a wide range of people. There are, in fact, more than 100 types of arthritis. In general, arthritis refers to disease and pain in the joints, typically causing swelling, pain, stiffness, redness, and difficulty moving the joint. Arthritis can affect any joint in the body, including the knuckles, shoulders, hips, and knees.
The most common type of arthritis, and the type that most often affects adults or even children with cerebral palsy, is osteoarthritis, also known as degenerative arthritis. This is most common in older adults because it is caused by deterioration in the cartilage in joints over time and with overuse of joints. The cartilage is what provides cushioning in a joint, so when that wears down the result is pain, swelling, and stiffness.
Various factors cause osteoarthritis, but risk factors include being overweight, a family history of arthritis, being older, 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 treatments are needed to relieve 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, joints affected, and age of onset all vary by individual. People with cerebral palsy have varying degrees of abnormalities in the musculoskeletal system, and these abnormalities may cause unusual movements in the joints, overuse of joints, excessive wear on joint cartilage, and compression in joints that ultimately lead to osteoarthritis. Arthritis often begins earlier in someone with cerebral palsy than is typical in the general population, and is sometimes even seen in children.
The joint or joints affected depends on the type of disabilities that a person with cerebral palsy has. For instance, a child who struggles to walk and has an abnormal gate that makes the knees move in a way that isn’t normal can lead to arthritis in the knees. Hip arthritis is also 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 a shoulder or elbow joint that leads to premature wearing of the cartilage.
Symptoms and Signs of Arthritis
While many people with cerebral palsy will not experience arthritis until they become adults, it is possible in 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 another long period of not mobbing.
- Tenderness when the joint is touched.
- Being unable 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 around a joint, under the skin, called bone
Treatment for Arthritis
How arthritis is treated in a child or adult with cerebral palsy depends on the individual, but there are some typical treatments that can be used. The least invasive types of treatment don’t really treat the disease, but help with pain and mobility. These include painkillers, like over-the-counter nonsteroidal anti-inflammatory drugs or acetaminophen. They also include physical therapy and gentle exercise that help to strengthen specific muscles that 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. This may include surgery. Depending on what is causing the abnormal movements or overuse of the joint may 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 system may help relieve pain and restore mobility. Hip replacement surgery has been found to be a generally safe way to treat adults with cerebral palsy severe osteoarthritis in the hip joint.
Prevention of Arthritis
Many people with cerebral palsy will develop arthritis and completely preventing it may not be possible. However, it is possible to prevent it to some degree, delay its onset, or minimize the damage and symptoms. The most important thing is to diagnose and begin treating cerebral palsy early in childhood. The better, more comprehensive treatment a child gets, the better his or her 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 arthritis development. 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 learn how to perform daily tasks in ways that are best for the joints. Lifestyle habits can also help minimize and prevent arthritis. Maintaining a healthy weight, for instance, can take pressure off 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 excessive than for other people. With good overall treatment, watching for early signs of arthritis, and treatment for pain and other symptoms, a young person with arthritis can continue to enjoy life with mobility and minimal pain.
- http://www.cdss.ca.gov/agedblinddisabled/res/VPTC2/12 Working With Consumers with Disabilities/Cerebral_Palsy.pdf