Early-Onset Arthritis: Types, Symptoms, and Treatment

Early-onset arthritis is joint disease that strikes earlier in life than is typical. What that age is depends on the type of arthritis. For example, those who develop osteoarthritis (OA) before age 50 are considered to have an early-onset case. The same is also true for those diagnosed with rheumatoid arthritis (RA) before age 30 or lupus before age 15.

Only 7% of diagnosed arthritis cases start between the ages of 18 and 44, connect the disease to older age. But early-onset arthritis can sometimes affect even very young children. All forms of juvenile arthritis are considered early-onset. They are typically due to an autoimmune condition, rather than wear and tear of the joints, like with OA.

The symptoms of early-onset arthritis are the same as for any case of arthritis. A notable difference, however, is that people early-onset must live with them longer.

This article discusses early-onset arthritis, including types, age of onset, and common symptoms. It also details how different types of early-onset arthritis are diagnosed and treated.

Types of Early-Onset Arthritis

Like arthritis, early-onset arthritis comes in many forms. Of these, one (osteoarthritis) is associated with wear and tear of joints while the others are autoimmune diseases (in which the immune system attacks healthy tissues.)

What's considered "early" depends on the specific type of arthritis. Some typically develop earlier than others.

Rheumatoid Arthritis

Rheumatoid arthritis (RA), an autoimmune and inflammatory disease, can occur at any age, so children can also be diagnosed with this condition. The typical age range for RA diagnosis is between 30 and 50. Before 30, it's considered early onset.

In RA, your immune system attacks healthy cells in your body by mistake. Symptoms can present in a subtle way and worsen slowly over weeks or months, or they can occur very quickly. Onset can be categorized in several ways, with two being:

• Explosive polyarticular onset: Occurs over one or two days
• Palindromic presentation: When joint swelling occurs in one or two joints that lasts for a few days or weeks and then disappears and returns in the same or a different joint

Most often, symptoms come on slowly, starting with stiffness, pain, and swelling in a few joints, then becoming polyarticular in nature (more joints become involved). The explosive polyarticular onset and palindromic rheumatism are less common than this.

The first signs of early-onset RA include:

• Stiffness in one or more joints
• Pain on movement
• Tenderness in the joint
• Pain spreading to other joints over time

Also, weeks or even months before other symptoms arise, you can experience other symptoms that come and go:

• A general feeling of discomfort, illness, or uneasiness without an identifiable cause (malaise)
• Fatigue
• Depression
• Sometimes a low-grade fever

Osteoarthritis

Osteoarthritis (OA) is the most common form of arthritis. It can happen at any age but usually starts in the 50s, so before age 50 is considered early onset.

Symptoms tend to occur gradually and get worse over time. Some common early symptoms are:

• Aching joints
• Joint stiffness in the morning or after resting
• Limited range of motion that may go away after moving around
• Clicking or cracking sound when a joint bends
• Swelling around a joint
• Muscle weakness around a joint
• Unstable joint (like if your knee gives out)

Psoriatic Arthritis

Those who suffer from psoriasis, a skin disorder that causes red, scaly patches, can develop psoriatic arthritis about 10 to 20 years after the skin disorder appears. A small percentage of those with psoriatic arthritis develop joint symptoms before the skin lesions. People typically develop psoriatic arthritis between 30 and 40 years old. Early-onset is before age 30.

Early symptoms of psoriatic arthritis include:

• Pain and swelling in the joints
• A small patch of psoriasis or patches covering many areas of the body
• Joint stiffness
• Fatigue
• Worse episodes of psoriatic arthritis followed by improvement

Ankylosing Spondylitis

Symptoms of ankylosing spondylitis most often appear between the ages of 17 to 45. Before 17 would officially be early onset, but it may still be considered early in young adults. Early symptoms of this inflammatory disease include:

• Frequent pain and stiffness in the lower back and buttocks that start gradually over the course of a few weeks or months
• Discomfort on one side, or alternate sides
• Dull and spread out pain, rather than focused in one place
• Pain and stiffness that is usually worse in the mornings and during the night, but may be improved by a warm shower or light exercise
• Mild fever
• Loss of appetite
• Mild to moderate anemia
• Bowel inflammation
• Uveitis (inflammations of the uvea)

As time passes, the pain typically lasts longer and is felt on both sides, usually lasting for at least three months. Over the years, the stiffness and pain can travel up the spine and into the neck area, as well as the ribs, shoulder blades, hips, thighs, and heels.

Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is an autoimmune condition that can affect all systems of the body. Lupus arthritis presents in a similar way to the early stages of rheumatoid arthritis. Arthritis is one of the most common ways for lupus to show itself.

The signs of lupus include:

• A butterfly-shaped skin rash
• Mouth sores
• Hair loss
• Chest pain

Lupus is most often diagnosed in people between 15 and 45. Before 15 would be early onset.

Juvenile Arthritis

The first signs of juvenile arthritis can appear between the ages of 6 months and 16 years old. All juvenile arthritis is early onset.

Symptoms may include:

• High fevers that tend to spike in the evening and then suddenly disappear
• Limping or a sore wrist, finger, or knee
• Rashes that suddenly appear and disappear in one or more areas
• Stiffness in the neck, hips, or other joints
• Joint stiffness that is worse after rest
• Sudden swelling of the joints, which stay enlarged
• Joints may appear red and feel warm

Although there is no cure, some children with arthritis achieve permanent remission, which means the disease is no longer active. However, any physical damage to the joint will remain.

Early-Onset Arthritis Symptoms

Early-onset arthritis symptoms include:

• Pain that comes and goes
• Pain in one or many joints
• Redness, swelling, and warmth in the joints that last for three days or longer or occur more than three times per month
• Difficulty moving a joint

Causes of Early-Onset Arthritis

There are many risk factors for early-onset arthritis: 

• Being overweight: Excess weight can put strain on weight-bearing joints like the hips and knees.
• Infections: Bacteria and viruses can infect joints and potentially cause the development of some types of arthritis.
• Joint injuries: Sports injuries and repetitive movements that put stress on the joints can contribute to the development of osteoarthritis.
• Certain jobs: If your job requires frequent knee bending or squatting, that can result in osteoarthritis.
• Smoking: Smoking can increase the risk of rheumatoid arthritis.
• Gender: Some forms of arthritis are more prevalent in women than men, such as rheumatoid arthritis.
• Genes: Some types of arthritis are inherited or in the genes, such as rheumatoid arthritis, systemic lupus erythematosus, and ankylosing spondylitis. People with human leukocyte antigen (HLA) gene class II are at higher risk for developing arthritis.

Diagnosis

It is important to have a healthcare provider diagnose your arthritis because you can have more than one type at the same time. Diagnosis of early onset arthritis is similar for each type of arthritis.

To rule out other conditions that may mimic the symptoms of arthritis, your healthcare provider will need the following to determine the cause of your symptoms:

• Medical history
• Physical examination
• X-rays
• Blood tests for inflammatory forms of arthritis like RA

The earlier you understand your arthritis, the earlier you can start managing your disease, reducing pain, and making healthy lifestyle changes. 

Treatment

For all forms of arthritis, early diagnosis and proper treatment are important, as they can help prevent or minimize further damage joint damage. People who are diagnosed with any form of arthritis earlier can prevent their condition from worsening over the years.

Treatments for early-onset arthritis include:

• Physical therapy or occupational therapy: These types of therapy focus on pain relief, strengthening and flexibility exercises, ambulation training (improving the ability to walk from place to place independently), and using assistive devices.
• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) can reduce pain, some forms of corticosteroids can reduce symptoms during flare-ups, and DMARDs (disease-modifying antirheumatic drugs) can suppress the body’s overactive immune system.
• Surgery: Repair of tendons that ruptured because of the inflammatory process can restore function.
• Lifestyle changes: Losing weight or maintaining a healthy weight can lessen the pressure placed on joints.

Prognosis

For inflammatory arthritis like RA, psoriatic arthritis, ankylosing spondylitis, and SLE, early treatment can greatly reduce the symptoms and slow disease progression. Stopping inflammation has been shown to not only stop joint swelling and pain, but also to decrease risk of heart complications.

Early diagnosis of osteoarthritis can be helpful if there are preventable causes (e.g., your body is accumulating too much iron-hemochromatosis, or lifestyle factors such as obesity, can be modifies. Research is being done to look at treatment to modify the long term course of osteoarthritis, but disease modifying therapy approved by the FDA is not currently available. Surgery to replace damaged joints is a common treatment option and sometimes doing the procedure sooner, depending on the situation, may provide a better outcome.

With osteoarthritis, for early treatment to be successful, it needs to be identified before the development of joint damage, substantial cartilage loss, or malalignment. Waiting for damaged joints to show up on an X-ray is too late, since many of the issues that can be found on an X-ray would not be reversible.

Medications can help alleviate the discomfort caused by the symptoms, and lifestyle changes can reduce the strain placed on joints, which can slow cartilage breakdown.

Coping

Experiencing the symptoms of arthritis at an earlier age can be challenging, but there are ways to cope and maintain a positive outlook. Putting together a team of professionals like your primary care provider, a rheumatologist (a doctor who treats joint diseases), and a physical or occupational therapist can help you slow disease progression.

Tips for coping with early-onset arthritis include:

• Work with your healthcare provider to get your disease under control and minimize medication side effects.
• Keep negative emotions under control through physical and emotional self-care, such as mind–body practices, music and art therapy, exercise, a healthful diet, massage, and activity pacing.
• Stay social with activities that prevent feelings of isolation, and find opportunities for joy and play.
• Seek out professional counseling or an arthritis-specific support group so that you can talk about your emotions and build coping mechanisms.

A Word From Verywell

It can be scary to experience the symptoms of arthritis early in life. It’s important to remember that while it cannot be cured, there are many things you can do to stay healthy and prevent it from getting worse.

Listening to your body and having your joint pain checked out early can avoid the complications of a more advanced version of the many forms of arthritis. In many cases, early diagnosis and treatment can delay disease progression and minimize the impact your condition has on your daily life.