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Understanding Arthritis in Children
Children may experience joint aches, which occur where bones meet, like the knees, shoulders, fingers, and toes. Various factors can lead to joint pain in children. But if joint swelling persists for six weeks or more, it is an indication of chronic arthritis. Causes of chronic arthritis include;
- Juvenile arthritis
- Lupus
- Dermatomyositis
What is Juvenile Arthritis?
Juvenile arthritis, or arthritis in children, is when the immune system attacks healthy tissues, causing inflammation, joint stiffening, damage, and altered growth.- Symptoms : Swelling, stiffness, and reduced mobility.
- Progression : Without treatment, it can lead to severe joint damage and growth issues.
- Treatment : Aggressive treatment is crucial. Research shows untreated children often experience active arthritis even a decade later.
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Get A Second OpinionTypes of Juvenile Arthritis
Juvenile arthritis can be classified based on several factors:
- Symptoms
- The number and types of joints involved
- Presence of specific blood markers
This classification helps doctors predict disease progression. Here are the main types:
Oligoarticular
The meaning of Oligoarticular is "few joints", where only a few joints are affected. About 50% of children with juvenile arthritis are affected by this type. Oligoarticular is more common in girls under eight years old.
- Oligoarticular arthritis involves a single joint, typically a knee or ankle, which is called monoarticular juvenile arthritis.
- This arthritis requires only mild treatment.
- Oligoarticular juvenile arthritis may cause eye inflammation.
- Regular eye exams are crucial to prevent blindness, as eye issues can persist into adulthood.
Polyarticular
About 30% of children with juvenile arthritis were found to have polyarticular arthritis. This type of arthritis is more common in girls and affects five or more joints, including large joints (knees, ankles) and small joints (hands, feet). It often affects both sides of the body.
Antibodies are proteins in the blood that the body typically uses to fight infections through an immune response. However, in this form of arthritis, the IgM RF antibody mistakenly attacks the body's tissues.
Key points:
- Role of Antibodies : Proteins in the blood that fight infections.
- IgM RF Antibody : This type of arthritis targets the body's tissues instead.
- Similar to Adult Rheumatoid Arthritis : Doctors believe this condition is akin to adult rheumatoid arthritis and may require more intensive treatment.
Psoriatic Arthritis in Children
Children with psoriatic arthritis experience both arthritis and one of the following:
- A skin condition called psoriasis
- A parent or sibling with psoriasis
- Some children have involvement in just a few joints
- Others have several joints affected, which can include both small and large joints
The number of affected joints can vary:
Enthesitis-Related Arthritis
This is a type of juvenile arthritis. It involves inflammation in:
- Tendons
- Ligaments
- Joints
- Sometimes the spine
The symptoms of enthesitis arthritis are joint pain without noticeable swelling and back pain, which often appears later in life. This type is commonly seen in boys over the age of 6.
The exact cause of juvenile arthritis condition is unknown. Researchers think some children have genes that increase their risk of developing the disease.
Environmental factors, such as a virus, might trigger juvenile arthritis in these children.
Juvenile arthritis is typically not hereditary. It is rare for more than one child in a family to be affected.
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Book an AppointmentWhat are the Symptoms of Juvenile Arthritis?
Juvenile arthritis shows affects each child differently and can last for varying periods. Sometimes, the symptoms improve, disappear, or become worse (flare-ups).
Some children may experience only one or two flare-ups and then never have symptoms again, while others may have frequent flare-ups with persistent symptoms.
The most common symptoms of juvenile arthritis:
- Morning Joint Pain : This pain improves by the afternoon. The first sign might be a morning limp, often caused by an affected knee. Hands and feet can also be affected.
- Joint Swelling and Pain : Young children might not complain of pain but may appear irritable, tired, and unwilling to play. Lymph node swelling in the neck and other body parts can occur.
- Inflamed Joints : Joints may become warm to the touch.
- Muscle Weakness : Muscles and other soft tissues around the joint may weaken if the child cannot run and play normally.
- Fever and Rash : In some cases, children have a high fever and a light pink rash that appears only during fever episodes.
- Growth Problems : Joints may grow too fast, too slowly, unevenly, or to one side, potentially making one leg or arm longer than the other. Overall growth may also slow.
- Eye Problems (Uveitis) : Treatable by an ophthalmologist, uveitis can cause eye damage if untreated. Most patients do not have symptoms, so early diagnosis requires a slit lamp examination by an eye doctor.
How Diagnosis of Juvenile Arthritis is Done?
Early diagnosis and treatment can help to:
- Control inflammation
- Relieve pain
- Prevent joint damage
- Maintain a child's ability to function.
Your child's doctor will order various tests. A complete medical history, physical examination, and blood tests will help rule out other conditions that cause arthritis. Additional tests, such as X-rays, ultrasounds, and MRI scans, may also be used.
Medical History
The doctor will review the child's complete medical history and also want to know;
- How long has the child been experiencing joint pain and swelling?
- Have the symptoms improved or worsened?
- Does your child feel stiff when getting up after resting?
Other potential causes of the symptoms that are looked for:
- An injury
- Another illness. e.g., infections, cancers, or other autoimmune diseases.
- A family history of autoimmune diseases
Physical Examination
The child will be examined for the signs of;
- Swelling
- Warmth
- Decreased range of motion
- Muscle loss (atrophy) in the muscles near the affected joints
- Laboratory Tests : Blood, joint, and tissue fluid tests to rule out other conditions and classify juvenile arthritis type.
- X-rays : Clear images of bone for injury or unusual bone development assessment.
- Ultrasound : Examination of joints to determine inflammation levels.
- Magnetic resonance imaging (MRI) scans detect inflammation in joints or around tendons and assess the degree of inflammation, structural changes, and injuries. Sedation may be necessary for young children to remain still during the MRI.
Treatment Options for Juvenile Idiopathic Arthritis.
A pediatric rheumatologist is a specialist who treats juvenile arthritis. The treatments are designed to;
- Reduce swelling
- Maintain movement of affected joints
- Relieve pain
- Maintain growth of the joint
There are two types of treatments available for Juvenile Arthritis;
- Nonsurgical Treatment
- Surgical Treatment
Nonsurgical Treatment
Medications are crucial in treating juvenile arthritis. The doctor decides the time period for which the medication is to be used based on the child's condition.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce inflammation, relieve pain/stiffness, and help calm down the disease.
- Example: ibuprofen, naproxen
- Disease-modifying anti-rheumatic drugs (DMARDs) are recommended if NSAIDs don't work. It helps slow down the disease's progression. Sometimes, DMARDs are used along with NSAIDs.
- Example: Methotrexate
- Biologic agents are used if DMARDs are insufficient or in severe cases. It helps to slow or stop disease progression.
- Corticosteroids should be used as directed by the doctor. These are stronger medications used for severe cases, which are given orally, intravenously, or directly into a joint. The side effects include;
- Interference with growth
-
Weight gain
- Bone weakening
- Increased infection risk
In addition to these medications, a warm bath may help with re-joints joints.
Surgical Treatment
- Surgery is rarely suggested for juvenile arthritis treatment.
- However, in severe cases or with significant complications, surgery might be required to correct joint positioning, particularly if a joint has become deformed.
- Joint replacement, commonly utilized for arthritis in adults, isn't typically recommended for children.
- Proper treatment of juvenile arthritis is crucial as it safeguards the joint and reduces the risk of long-term damage that might necessitate joint replacement.
Complications Associated with Juvenile Idiopathic Arthritis
Untreated Juvenile Idiopathic Arthritis (JIA) can lead to several serious complications, including:
- Permanent Joint Damage
- Growth Interference
- Chronic Arthritis and Disability
- Vision Problems
- Inflammation of Heart or Lung Membranes
Living with Juvenile Arthritis
There are many treatment options for juvenile arthritis, all aimed at achieving remission. Remission means the child has no detectable swelling or inflammation through exams or imaging.
- Goals of Treatment : The primary objectives are to achieve remission and preserve the child's quality of life. It includes enabling them to participate in play, sports, school, and social activities.
- Support Resources : School administrators, social workers, and teachers can be important resources. They can develop helpful lesson plans to educate classmates about juvenile arthritis.
- Expectations with Treatment : With proper treatment, children should be able to attend school regularly and have excellent long-term outcomes. Although pain may sometimes limit physical activity, children with juvenile arthritis can often fully participate in sports when their symptoms
Frequently Asked Questions
Types of arthritis that affect children include juvenile idiopathic arthritis (JIA), juvenile dermatomyositis, juvenile lupus, juvenile scleroderma, and Kawasaki disease.
Common symptoms of arthritis in children are joint pain, stiffness, swelling, and reduced range of motion.
The causes of arthritis in kids can be genetic, autoimmune, or triggered by infections or environmental factors.
Arthritis in children is diagnosed through physical exams, medical history, blood tests, and imaging studies like X-rays or MRIs.
Risk factors for childhood arthritis include family history, genetic predisposition, and certain infections or environmental exposures.
Treatment options include medications (NSAIDs, DMARDs, biologics), physical therapy, lifestyle changes, and sometimes surgery.
Arthritis in children is usually managed rather than cured, although some children may experience remission.
Juvenile arthritis can affect a child's daily life by causing pain, limiting physical activity, and impacting school attendance and social interactions.
Diet changes, such as eating anti-inflammatory foods and maintaining a healthy weight, along with regular exercise, can help manage childhood arthritis.
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