Pain

Question

Hello,
My daughter with cystic fibrosis (26 years old) has pain in all joints, she suffers a lot.
The doctor of the CF centre gives her ibuprofen, but it does not relieve her a lot. Can you tell me if there is anything else to do?
Thank you for your reply.

Answer

Hello,
Joint pain are relatively common in adults with cystic fibrosis and occurs in 5-10% of patients. Arthritis in cystic fibrosis can cause joints to become very painful and during an episode, joints may feel warm to the touch and appear red and swollen. There are 2 main types of arthritis which are related to cystic fibrosis: “cystic fibrosis associated arthritis” and “hyertrophic pulmonary osteoarthropathy”.

Cystic fibrosis associated arthritis can start at a young age and is defined as having episodes which usually last less than a week, involve the large joints (such as knees, ankles, wrists and shoulders) and respond to treatment with anti-inflammatory medication such as ibuprofen. Sometimes flu-like symptoms, rashes and fever may occur during an episode. In between episodes, symptoms tend to disappear. This type of arthritis is not related to the severity of lung disease.

Hypertrophic pulmonary osteoarthropathy usually starts in young adults with a gradual and constant ache which gets worse over time. This type of arthritis also tends to affect the large joints such as the knee, ankle and wrist and is usually symmetrical (affects the joints on both sides of the body). Symptoms associated with this type of arthritis usually respond to non steroidal anti-inflammatory drugs such as ibuprofen as well and help to relieve pain and swelling.. This type of arthritis tends to get worse during a lung infection. Therefore, in this case, treating the lung infection can reduce symptoms associated with arthritis.

There may be other reasons for joint pain in cystic fibrosis. Occasionally arthritis can be a side effect of medication often taken by people with cystic fibrosis such as some antibiotics (particularly ciprofloxacine). Sometimes people with cystic fibrosis may get arthritis due to a family history of arthritis or the normal aging process (although this is unlikely in your 26 year old daughter).
So in conclusion, the usual treatment involves "non steroidal anti-inflammatory" drugs which include ibuprofen. Indeed, it is not advisable to use steroids systemically immediately but, if symptoms are not relieved, they may be used for treatment.
I do not know which doses were prescribed to your daughter. It may be that another anti-inflammatory drug at larger doses is indicated. Your daughter could discuss with her CF doctor to take advice from a rheumatologist. In some cases, for example when knees are very inflammed, he could decide for a local infiltration of cortisone into the joint.
Finally, I do not know if your daughter is also suffering from back pain or neck and trapezius muscles pain; in these cases, manual therapies such as massage by a physiotherapist or osteopathy can provide relief.
Sincerely.
Dr Dominique Hubert

20.01.2011