We often associate arthritis with older people with swollen knuckles and weak hips – not with children or young adults. But arthritis is now recognized as a complication of cystic fibrosis. Arthritis can start in childhood and occurs in 5-10% of people with cystic fibrosis.
Two types of arthritis seem to be directly related to cystic fibrosis:
Arthritis can result from the use of drugs such as ciprofloxacin and cimetidine – frequently taken by people with cystic fibrosis. Often a part of the normal aging process, it can also occur when there is a family history of arthritis.
Arthritis is an immune disorder. CF arthritis and HPOA tend to worsen when the immune system is highly active and can flare up when a person with CF acquires a lung infection.
CF arthritis, which can start when a person is young, generally occurs in episodes lasting less than a week at a time. These episodes may be accompanied by flu-like symptoms, rash and fever, which are likely to disappear between attacks.
HPOA in young adults begins with a gradual, constant ache that worsens over time. X-rays usually show some new bone formation. Tissue covering the bone may have ‘lifted’ from the bone surface. These bone formations can cause joint pain and ‘finger clubbing’ (a rounded, broad appearance of the fingertips and toes sometimes seen in people with cystic fibrosis). HPOA seems to occur when there is a chronic low oxygen level. It often worsens if lungs become infected or damaged. HPOA has been associated with cystic fibrosis, and several heart and lung disorders.
CF arthritis can be treated satisfactorily with non-steroidal anti-inflammatory drugs (NSAIDs) – over-the-counter or prescription pain relievers. Generally, HPOA is treated with NSAIDs, physiotherapy and, occasionally, corticosteroids. The damage caused by HPOA and even finger clubbing can be reversed when a person receives a lung transplant.
There is still no cure for arthritis pain. The recent controversy over the safety of some arthritis medications is another example of how challenging the management of arthritis can be.