Posted on July 09 2018
Over 40 million people in the United States are affected by arthritis, including over a quarter of a million children. July is the month to bring awareness to a very complicated medical condition, called Juvenile Arthritis, or JA for short.
Juvenile Arthritis is not a disease in itself, but rather, it is an umbrella term used to describe various autoimmune and inflammatory conditions, or pediatric rheumatic diseases that can develop in children 16 years old and under. Juvenile Arthritis is where there is inflammation of the tissue that lines the inside of one's joints. This is considered an autoimmune disease, meaning that the immune system, which normally protects the body from foreign substances, attacks the body instead.
There are six different types of Juvenile Arthritis, and although each type share many similar symptoms - such as pain, joint swelling, redness, and warmth - each type of Juvenile Arthritis is distinct and has its own unique symptoms and special concerns. Some types of JA affect the musculoskeletal system, with joint symptoms being minor or non-existent, while other types of JA can affect the eyes, skin, muscles, and/or gastrointestinal tract.
The most common type of Juvenile Arthritis is called Juvenile Idiopathic Arthritis, or JIA, which means that no exact cause is known. From this umbrella, there are six subtypes of JIA, though none are contagious. Currently, researchers believe that Juvenile Arthritis may be related to genetics, certain infections, and environmental triggers, and are continuing to study the multiple types of each.
Types of Juvenile Arthritis
- Systemic Arthritis: also called Still's Disease, causes inflammation in one or more joints, and is often accompanied by a high spiking fever, (103 degrees Fahrenheit or higher) and a rash in the arms or legs, that lasts for at least two weeks. This type can affect the entire body or involve many systems of the body. Other symptoms include: inflammation of the heart or lungs, or their outer linings; anemia; enlarged lymph nodes, and enlarged liver or spleen. About 10% of children have this type, and both boys and girls are equally affected.
- Oligoarthritis: also known as Juvenile Rheumatoid Arthritis, affects five or fewer joints in the first six months that the child has the disease. The most common joints that are usually affected include: the knees, ankles, elbows, and wrists. Children with Oligoarthritis are most likely to get chronic eye inflammation than those with other types, and will have to see an eye doctor frequently. This type of arthritis is more common in females than males, and many children will outgrow this disease by the time they are adults.
- Polyarthritis: or Polyarticular JIA causes inflammation in five or more joints, often the small joints of the fingers and hands, but weight-bearing joints as well as the jaw can be affected. Polyarthritis can be rheumatoid factor positive or negative. Rheumatoid factor positive closely resembles adult rheumatoid arthritis and can be a more severe disease than rheumatoid factor negative. This disease occurs in 25% of children, and is also more common in girls than in boys.
- Psoriatic Arthritis: involves arthritis combined with the skin disorder, psoriasis. Psoriasis may begin many years before any joint symptoms appear. Joint symptoms include: pain and swelling in one or more joints that often affect the wrists, knees, ankles, fingers, and toes. Symptoms of Psoriasis include: a scaling red rash that is commonly seen behind the ears, on the eyelids, elbows, knees, or at the scalp line. Children with this type of arthritis often have pitted fingernails.
- Enthesitis - Related JIA: characterized by tenderness where the bone meets a tendon, ligament, or other connective tissue. This tenderness, which is known as enthesitis, accompanies the joint inflammation of arthritis, and most often affects the hips, feet, and knees. This type is more common in boys between the ages of 8 and 15.
- Undifferentiated Arthritis: the term used when a Juvenile Arthritis doesn't fit into any of the above categories, or when symptoms span more than two types.
Symptoms of Juvenile Arthritis
Children with Juvenile Arthritis can have no symptoms at all, or their symptoms may vary based on the type of arthritis that they have. In general, symptoms of Juvenile Arthritis include:
- Joint stiffness
- Pain, swelling, or tenderness in the joints
- Limping - or in infants and toddlers, the child may not be able to perform the motor skills that they learned
- Persistent fever, sometimes high
- Weight loss
- Eye redness or eye pain
- Blurry vision
While there is no test that is specific to Juvenile Arthritis, the diagnosis is made based on the exclusion of other conditions that may cause similar symptoms. The doctor will most likely begin by performing a complete medical examination, including gathering medical history. Then, the doctor may request further testing, such as: lab tests, urinalysis, x-rays, MRI scans, blood culture, tests for viruses and Lyme disease, a bone marrow exam, bone scans, and other various tests that would eliminate any other diseases.
Treatment for Juvenile Arthritis
Different types of Juvenile Arthritis require different types of treatments or treatment plans. The doctor will best be able to recommend what is the most effective plan for their patient. In general, exercise and medications are used as treatments for Juvenile Arthritis.
- NSAIDs: which are anti-inflammatory medications that are used to treat pain and swelling, including ibuprofen and naproxen.
- Slow-Acting, Anti-Rheumatic Drugs: or SAARDs, are used to treat pain and swelling over time, and typically take several weeks or more to work. They have also been called Disease-Modifying, Anti-Rheumatic Drugs, (DMARDs) and can be combined with NSAIDs.
- Corticosteroids: are used to treat pain and swelling. Sometimes, before any other treatment is tried, steroids are given as an injection into the affected joint.
- Antimetabolites: is an aggressive drug therapy aimed at helping reduce further joint damage and preserve joint function.
The ultimate goals for patients who have Juvenile Arthritis are: to have a relief in pain, a reduction in swelling, an increase in joint mobility and strength, and to prevent any joint damage and complications. If your child is experiencing any of the above symptoms, be sure to take them to their doctor to get a thorough examination and the correct diagnosis.