What is Juvenile Arthritis?
Any type of arthritis that develops before the age of 16 is
considered juvenile arthritis. Within this broad category are many different
types of arthritis. The most common type is juvenile rheumatoid arthritis (JRA).
Other types known to affect children are: Still's disease, lupus,
dermatomyositis, vasculitis, scleroderma, and the spondyloarthropathies.
JRA is then divided into 3 types:
Systemic JRA: occurs in 10-20% of affected children;
usually characterized by a febrile onset and evanescent rash with multiple
physical and laboratory abnormalities. It is strikes boys and girls equally.
Polyarticular JRA: occurs in 30-40% of affected children;
characterized by multiple (more than 4) joint involvement and minimal systemic
features. Girls are affected by polyarticular JRA more frequently than boys.
Pauciarticular JRA: occurs in 40-50% of affected children;
characterized by fewer than four joints involved, usually larger joints; a risk
for chronic uveitis in young girls and axial skeletal involvement in older boys.
What causes it?
The cause is unknown, though abnormal immune response,
genetic predisposition and environmental triggers, and infectious agents are all
being considered.
Although symptoms vary between each type of juvenile
arthritis and each individual child, the most common symptoms are: pain redness
and swelling in the joints, fatigue, rash, fever, morning stiffness, flu like
feeling, weight loss, and nausea. Nodules or lumps under the skin may form with
juvenile rheumatoid arthritis.
Juvenile arthritis is usually difficult to diagnose due to
the wide range of possible symptoms and severity of symptoms. JA may be
suspected when a child presents with joint pain and swelling, fever and
unexplained rashes. A diagnosis of JA is also considered in children with an
unexplained limp or excessive clumsiness.
No one test can definitively diagnose JA. Diagnosis is
carefully based on physical exam, medical history, blood tests and x-rays. It is
important to note that many blood tests that are positive in adults with
rheumatic diseases may be negative in children with the same diseases.
The treatment of JA focuses on relieving pain, reducing
inflammation, slowing or stopping joint damage, and improving the child's sense
of well-being and ability to function. A combination of treatments is almost
always used.
Medications:
NSAIDS (Nonsteroidal anti-inflammatory drugs) are commonly
the first type of drug used to treat the joint pain associated with JA.
Available over the counter or by prescription, they fight inflammation or
swelling and relieve pain. Aspirin is avoided if possible due to the risk of
Reye's syndrome.
DMARDS (disease modifying anti-rheumatic drugs) are also
known as SAARDS (slow acting anti rheumatic drugs. As their name might suggest
these medications take some time to be effective, up to several months. Most of
them were originally invented to treat other diseases but were noted to have a
positive effect on rheumatic diseases. Most of them do not have any common
properties other than their ability to slow down the progression of the disease.
They are usually given in combination with a NSAID.
In
children with very severe JRA, stronger medicines may be needed to stop serious
symptoms such as inflammation of the sac around the heart (pericarditis).
Corticosteroids like prednisone may be added to the treatment plan to control
severe symptoms. The risk of serious side effects in children is fairly high.
Once the disease is brought under control the corticosteroid is likely to be
reduced or discontinued. Reduction of corticosteroids should always be done
under the supervision of a doctor. Never stop a steroid suddenly without a
doctor's approval.
Physical Therapy & Exercise:
Physical therapy is an important part of a child's
treatment plan. Exercise can help to maintain muscle tone and preserve and
recover the range of motion of the joints. A physical therapist can design an
appropriate exercise program for a child with JA.
Joint protection:
Splints, braces and supports can protect the joints and
help prevent further damage. A doctor or a physical or occupational therapist
can help get a splint and ensure that it fits properly. Other ways to reduce
stress on joints include self-help devices, devices to help with getting on and
off chairs, toilet seats, and beds; and changes in the ways that a child carries
out daily activities.
Surgery:
Although many children with arthritis may never need a
surgical procedure, some will. Several types of surgery are available to
patients with severe joint damage. These procedures can help reduce pain,
improve the affected joint's function and appearance, and improve the patient's
ability to perform daily activities. Surgical procedures include joint
replacement, tendon reconstruction, and synovectomy.
Scientists are investigating the possible causes of JRA.
Researchers suspect that both genetic and environmental factors are involved in
development of the disease and they are studying these factors in detail. To
help explore the role of genetics, the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS) has established a research registry
for families in which two or more siblings have JRA. NIAMS also funds a
Multipurpose Arthritis and Musculoskeletal Diseases Center (MAMDC) that
specializes in research on pediatric rheumatic diseases including JRA.
Researchers are continuing to try to improve existing
treatments and find new medicines that will work better with fewer side effects.