Children may not show obvious symptoms
While arthritis is generally thought of a degenerative condition of the aged, forms of it can also be found in children younger than 16. According to the National Institutes of Health, there are more than 100 types of arthritis. Juvenile arthritis, juvenile rheumatoid arthritis, juvenile chronic arthritis or juvenile idiopathic arthritis are all terms for the same class of arthritis (JIA being the one being currently accepted by the medical community).
According to the NIH, juvenile arthritis is usually an autoimmune disorder in which the immune system attacks some of the body’s own healthy cells and tissues for reasons that are not yet fully explained. It is very different from osteoarthritis in which the cartilage wears or breaks down.
Dr. Tom Pressly is chief of the juvenile arthritis clinic at Shriners Hospital, and has a private practice in the Willis-Knighton Health System. “Arthritis is in ammation – redness, swelling, pain, warmth – of a joint,” Pressly said. “There are 300,000 American children that have arthritis. The classic type is juvenile idiopathic arthritis.
These chronic conditions (lasting more than six weeks) are called idiopathic because we don’t know the exact cause of why their immune system is irritated.”
In regard to differentiating between JIA and other childhood aches and pains, Pressly said, “There are a multitude of causes of musculoskeletal pain in children ranging from overuse syndromes, injuries and bone malformation to serious illnesses. Less serious aches and pains of children are worse after activity and go away after a few days. JIA has swollen, hot, painful joints, with occasional loss of motion, which is worse in the morning and after rest.”
There are several major types of JIA, which are distinguished by depending how many and what joints are involved: systemic arthritis, oligoarthritis, polyarthritis, psoriatic arthritis, enthesitis-related arthritis and undifferentiated arthritis.
Other important distinguishing features are the presence of back pain, eye involvement, chest pain, nodules, fever and rashes.” In diagnosing JIA, doctors will likely question the patient as to symptoms and family history, and may require lab tests, X-rays, and/or a physical exam to eliminate other possible conditions.
Some of the lab tests that the NIH says may be required are:
• Anticyclic citrullinated antibodies – antibodies that may be detected years before symptoms present themselves, and can predict onset of rheumatoid arthritis
• Rheumatoid factor – an autoantibody produced in large amounts by adults with rheumatoid arthritis, and can sometimes be detected in children with JIA
• Antinuclear antibody – another autoantibody found in some JIA patients which can help doctors narrow down the particular diagnosis
• Erthrocyte sedimentation rate (“sed rate”) – a blood test which measures how fast red blood cells fall to the bottom of a test tube as a measure of in ammation Although symptoms may differ according to the subtype of JIA, and children with it may have no obvious symptoms, the NIH lists the following warning symptoms, which taken together in combination could indicate juvenile idiopathic arthritis:
• stiffness in joints especially in the morning;
• painful, tender, or swollen joints;
• limping (mornings, especially);
• weight loss;
• persistent fever;
• fatigue and irritability;
• rashes – particularly faint, pink rashes that develop over knuckles, across the cheeks and bridge of nose, but may occur anywhere; and
• eye in ammation, pain, or blurred vision.
There are typically periods when the symptoms of JIA improve, and others when they “ are.” The pattern of remission and areups vary widely and are individual to the child. Physicians may recommend limiting certain kinds of activities during ares which can be resumed when the condition improves.
Pressly said, “Warning signs to have a child examined for juvenile arthritis are swollen, painful, warm joints with decreased motion, which last longer than two weeks. Other warnings are associated fever, rashes, weight loss and sleep disturbance. Children as young as toddlers may have swollen, painful, warm, red joints that are worse when they wake up in the morning or after naps. Typically, children with JIA will be grumpy and do not want to move and desire just to be held.
“The treatment of JIA has markedly improved over the last ten years through improved understanding of the immune system, the use of methotrexate, and the development of biologic agents such as adalimumab or etanercept being available to treat the more serious cases. Milder cases are often treated with NSAIDs such as naproxen and ibuprofen.”
Pressly said,“There is nothing that parents can do to prevent the development of JIA in their children. However, early diagnosis and treatment makes a difference.”
For more information about juvenile arthritis, go to www.childrenandarthritis.org.
– Michael Stone
