Arthritis

Question

At about 11 years, my daughter developed a mild form of arthritis in her knee for the first time, which was ignored by doctors initially. It became more and more severe over time, and by now it is particularly bad and occurs in all joints after each i.v. therapy. When she took strong pain killers, her intestine became paralyzed. What would be your advice to my daughter? Also, are there a lot of CF patients with this complication, and how do they deal with it?

Answer

Hello,

joint pain in the form of arthritis, which can be limited to a single joint at first, is not an uncommon problem with CF. This phenomenon is explained as an accessory symptom with acute infections due to so-called immune complexes, which can provoke a sterile inflammation in the joints. Usually, the condition regresses after successful treatment of the infection that causes it. With your daughter, apparently several joints are affected by the problem. Therefore, one the problem should be tackled systematically.

The following three things usually need to be clarified:

1. Has your child been treated repeatedly with so-called chinolon compounds (ciprofloxacin, ofloxacin, etc.)?

2. Does the pain really occur only after the beginning of the i.v. therapy, or does your daughter primarily show signs of an acute infection and is given antibiotics because of that? It is also particularly important whether the pain occurs during a so-called interval therapy, that is, in the absence of an infection. Should there be a causal connection between the drug administration and the ailment, the question of changing the drug has to be addressed.

3. The CF doctor should be consulted about whether a comprehensive diagnostic investigation for rheumatism has to be carried out in order to clarify whether a classic (CF-independent) case of rheumatism is on hand.

Eventually, the therapy will conform to the results obtained. Sometimes a time-limited dosage of so-called non-steroidal antiphlogistics will be sufficient. In individual cases, however, long-term treatments are necessary. This should then happen in cooperation with a pediatric rheumatologist.

We hope your daughter’s pain can be relieved.

Kind regards,
Dr. H.-G. Posselt

12.01.2009