Joint problems

What are joint problems?

Joint problems can be broken down into conditions that involve inflammation of the joints (inflammatory joint conditions, arthritis) and conditions that do not involve inflammation. The most common inflammatory joint conditions are rheumatoid arthritis and gouty arthritis. The most common non-inflammatory joint condition is osteoarthritis (alongside the common transient joint conditions in which no specific diagnosis is made).

 

  • Rheumatoid arthritis is an auto-immune condition involving the chronic inflammation of several joints. The inflammation occurs mainly in the small joints of hands and the forefoot but it may be found in almost all joints.
  • Gouty arthritis (or gout) is an inflammation of a joint caused by uric acid crystals. It usually resolves within one to three weeks but it may return in time during what are known as 'gout episodes'.
  • Osteoarthritis is another name for 'wear and tear' of the joints and it is particularly prevalent in older people.

 

What are the complaints associated with joint problems?

  • Rheumatoid arthritis results in stiffness, joint distortion and the degradation of cartilage, bone and the joint capsule. Although there is a strong focus on the joint abnormalities associated with rheumatoid arthritis, it is in fact a condition that affects the entire body. It can result in symptoms such as fatigue, weight loss, fever and problems with organs such as the heart, blood vessels, lungs, nerves and kidneys.
  • Gouty arthritis causes joint pain, usually at the base of the big toe, sometimes in the middle foot, ankle, knee or wrist. The inflammation is associated with the thickening of the joint (swelling), which also becomes red and warm. People with gout sometimes have small nodules under the skin (tophi), which are accumulations of uric acid crystals. The tophi are found, for example, on the fingers, toes, knee and elbow, or on the ear or the heel. Uric acid crystals may also form kidney stones. 337
  • Osteoarthritis leads to pain, stiffness in the morning and after rest, and limitations in movement. 581

 

People with intellectual disabilities sometimes find it impossible to communicate these symptoms. The people around them may then notice only a change in behaviour.

 

How common are joint problems in the general population?

Arthritis is found in 2.3% of the general population; the prevalence rate is 1.7% for gouty arthritis and 0.5% for rheumatoid arthritis. 337
Osteoarthritis occurs in 4.0%. 338

 

How common are joint problems in people with intellectual disabilities?

Joint conditions would seem to be more common in people with intellectual disabilities than in the general population.


An Irish study found that 20.9% of 753 participants aged 40 years and older with intellectual disabilities suffered from joint conditions (inflammatory and non-inflammatory joint conditions combined). 582


An English study found a one-year prevalence of 23.9% for arthritis in 134 people with an intellectual debility aged between 65 and 94 years and a one-year prevalence of 5.5% in 73 people with an intellectual debility aged between 20 to 64 years . 339


A European questionnaire survey of a random sample of 1269 adults with intellectual disabilities found a combined prevalence rate for arthritis and osteoarthritis of 7.9%. 340

 

A large Australian survey of 2540 people with intellectual disabilities (in which questionnaires were answered by carers and parents) found that 15% of the study sample had arthritis. 341


By contrast, a Canadian study found a lower prevalence of arthritis than in the general population. Because this was a questionnaire survey, it may have underestimated the prevalence of joint conditions because they were not known to be present in part of the sample (when people were unable to communicate their symptoms, for example). 583

 

It is not known how often rheumatoid arthritis alone occurs in people with intellectual disabilities. However, another type of arthritis – juvenile idiopathic arthritis – is found more often in children with Down syndrome. 342


Another study has shown that levels of auto-antibodies (rheumatoid factors) may be elevated in people with Down syndrome without any clinical symptoms being evident. This could be an early indicator of rheumatic conditions. 343

 

It is not known how common gout is in people with intellectual disabilities. However, it is known to be associated with certain syndromes, such as Lesch-Nyhan's syndrome. 344 , 346


Increased levels of uric acid are often seen in Down syndrome but it is not clear whether this also results in more gouty arthritis. 345 , 346



It is also unknown how often osteoarthritis occurs in people with intellectual disabilities.

6.30% General population
7.9% to 15% People with intellectual disabilities

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