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Harvard Commentaries
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Reviewed by the Faculty of Harvard Medical School


Medical Myths Medical Myths
 

Age and Arthritis -- Facts and Fiction


February 27, 2013

By Robert H. Shmerling M.D.

Beth Israel Deaconess Medical Center


Last reviewed and revised February 27, 2013

If you think that arthritis is something only older people get, you're not alone. Many people picture a person with arthritis as an elderly relative with bony, knobby fingers or a hip replacement.

It's true that the most common type of arthritis, osteoarthritis, is a disease that mainly affects people over the age of 50. And it's true that at least half of adults over the age of 64 report having been told by a doctor that they have arthritis.

But there are more than 100 types of arthritis and some of them affect younger adults and children.

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Arthritis Is More Than Aches and Pains

The term "arthritis" is often used to describe aches and pains in or around a joint. However, the word actually means joint inflammation. The joint is painful and swollen, and has limited motion. The joint may also appear red when the inflammation is severe, although it may be more difficult to see in people with dark skin.

Some types of joint disease have more inflammation than others. For example, rheumatoid arthritis generally causes noticeable inflammation, while osteoarthritis (also called "degenerative joint disease") usually causes mild inflammation.

People with joint pain could have problems unrelated to arthritis. For example, tendon inflammation (tendonitis) can cause joint pain, but the joint itself isn't the problem. To make it even more complicated, people with certain types of arthritis may also have tendonitis. One example is psoriatic arthritis, a type of joint disease that occurs in 10% to 20% of people with the skin condition psoriasis.

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Who Gets Arthritis?

Different types of arthritis tend to affect people in different age groups. For example:

    • Osteoarthritis (OA) - Although primarily a disease in older adults, younger adults and even kids sometimes develop OA. For example, OA may develop years after an injury, such as a fracture near a joint.
    • Polymyalgia rheumatica (PMR) - This is a type of arthritis affecting the shoulders and hips. It only affects adults ages 50 and older; the typical patient is at least in his or her late 60s.
    • Rheumatoid Arthritis (RA) - The onset of this disease peaks among adults ages 25 to 50.
    • Lupus - In this condition, the body's immune system mistakenly attacks its own tissues. This causes inflammation in the joints and other organs. Lupus is most commonly diagnosed in women ages 20 to 40.

 

    • Gout - This condition commonly causes sudden onset of arthritis in one joint at a time (especially the big toe); it affects men of any age and post-menopausal women.

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Arthritis That Is (Almost) Unique to Children

Some types of arthritis primarily affect children. Their names may sound similar — juvenile rheumatoid arthritis (JRA), juvenile lupus or, more recently, juvenile idiopathic arthritis (JIA). But they are distinct diseases with important differences from the adults versions.

For example, it's rare that an adult with rheumatoid arthritis has eye inflammation — especially without symptoms — but that's a relatively common problem for kids with JIA. Also, arthritis can cause as much — or even more — trouble for young children as the more common versions do for adults. Recent data suggest that nearly 300,000 kids under age 18 have arthritis or a related condition in this country. This translates to about 4 per 1,000 children and accounts for more than 800,000 visits to doctors each year. Because children's bones and joints are still developing, and because fitting in is so important to kids, the challenges faced by kids with arthritis are quite different from those of adults.

As odd as it may seem, arthritis that is nearly unique to children can affect adults. One example is a condition called Still's Disease. It is named for George F. Still, a British pediatrician who described it about 110 years ago. Still's Disease is one of the major types of JIA. Typical symptoms include a rash and fever, which are not common features of adult RA. However, so-called "Adult Onset Still's Disease" affects 1 in 100,000 adults. It can be a severe illness that requires hospitalization and powerful immunosuppressive drugs to control.

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Other Aches and Pains

Young people not only get arthritis, but also the aches and pains from non-arthritic conditions, such as tendonitis and bursitis. These problems may be even more common among young athletes than they are among older adults. Stress fractures, growing pains (a poorly understood phenomenon among kids) and infections (including the flu or mononucleosis) are other causes of joint discomfort among young people.

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The Bottom Line

It's a myth that arthritis and other aches and pains are conditions that only affect the elderly. In fact, there are important and relatively common forms of arthritis and other joint pains that affect a younger crowd.

So, the next time you hear someone refer to creaky joints or aches and pains as something only old people get, maybe they have a short memory, or were fortunate enough never to have had arthritis as a child. Either way, they are mistaken. Now you can set them straight.

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Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.

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