It may begin with a swollen knuckle, a spiking fever, or an unexplained rash. But no matter what symptoms appear, hearing the word "arthritis" in a diagnosis for your child can be unexpected and confusing.
Arthritis is an inflammation of the joints, meaning that the joints get swollen, warm, and painful. Nearly 300,000 children in the United States have some sort of arthritis. Arthritis can be short-term — lasting for just a few weeks or months, then going away forever — or it can be chronic and last for months or years. In about half of cases, it can last a lifetime.
The most prevalent form of juvenile arthritis is juvenile idiopathic arthritis (JIA) (also known as juvenile rheumatoid arthritis, or JRA). It is very different from adult rheumatoid arthritis.
It's not known exactly what causes JIA in kids. Research indicates that it is an autoimmune disease. In autoimmune diseases, white blood cells can't tell the difference between the body's own healthy cells and germs like bacteria and viruses. The immune system, which is supposed to protect the body from these harmful invaders, instead releases chemicals that can damage healthy tissues and cause inflammation and pain.
To effectively manage and minimize the effects of arthritis, an early and accurate diagnosis is essential. By understanding the symptoms and characteristics of each type of JIA, you can help your child maintain an active, productive lifestyle.
JIA usually appears in kids between 6 months and 16 years old. The first signs often are joint pain or swelling or warm joints. Many rheumatologists (doctors specializing in joint disorders) find that the greater the number of joints affected, the more severe the disease and the less likely that the symptoms will eventually go into total remission. Remission is a medical term for temporary or permanent recovery.
There are seven types of JIA:
The first signs of arthritis, which can be subtle or obvious, include limping or a sore wrist, finger, or knee. Joints may suddenly swell and remain enlarged. Stiffness in the neck, hips, or other joints also can occur.
Inflammation of the iris (the colored area of the eye) may happen with or without active joint symptoms in any type of JIA. This inflammation, more likely to happen in girls than boys, is called iridocyclitis, iritis, or uveitis. Kids and teens with JIA should see an ophthalmologist (an eye doctor) regularly to check for this.
To diagnose JIA, the doctor will take ask you questions about your child’s symptoms, find out whether other family members have had similar problems, and do a thorough physical examination. The doctor may order X-rays or blood tests to rule out other conditions or infections, such as Lyme disease, that may cause similar symptoms or occur along with the arthritis.
Other tests may include:
In some cases, the doctor may want an orthopedic surgeon to examine your child's joints and take samples of joint fluid or synovium (the lining of the joints) for examination and testing.
In many cases, JIA is treated with a combination of medication, physical therapy, and exercise. In some cases, a child may require corticosteroid injections into the joint. In very rare cases, kids and teens may need surgery. The health care providers, including the primary care physician, rheumatologist, and physical therapist, will work together to develop the best method of treatment.
The goals of treatment are to relieve pain and inflammation, slow down or prevent the destruction of joints, and restore use and function of the joints to promote optimal growth, physical activity, and social and emotional development.
For inflammation and pain, the doctor or pediatric rheumatologist may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, such as Advil, Motrin, or naproxen (Naprosyn or Aleve). These can help reduce inflammation and pain by limiting the release of harmful chemicals from white blood cells.
Higher or lower dosages might be needed, depending upon your child's response to the medication. The doctor or rheumatologist should explain what the medication is meant to do and what side effects, if any, it could cause. It's important for your child to continue taking the medication until the doctor says to stop.
Doctors sometimes prescribe corticosteroids (like prednisone) for arthritis flares, but they try to keep these to a minimum to reduce problems that can come with prolonged steroid use, such as skin changes, weight gain, abnormal blood pressure, diabetes, and bone mass changes.
If NSAIDs don't control joint inflammation, your doctor may prescribe other medications such as methotrexate. In addition, treatment options now include a newer class of medications called biologics. The U.S. Food and Drug Administration (FDA) has approved many of these medicines for kids and teens with JIA. Some are subcutaneous injections (injections given just under the skin) that can be done at home. Others are intravenous (IV) infusions through a vein that are done regularly at the hospital.
An appropriate physical therapy program is essential to the management of any type of arthritis. A physical therapist will explain the importance of certain activities and recommend exercises suited to your child's specific condition. The therapist may recommend range-of-motion exercises to restore flexibility in stiff, sore joints and other exercises to help build strength and endurance.
When pain strikes, it's natural for your child to want to sit still. But it's important to maintain a regular exercise program. Muscles must be kept strong and healthy so they can help support and protect joints. Regular exercise also helps to maintain range of motion.
At home and at school, your child should have regular exercise and physical fitness programs. Safe activities include walking, swimming, and bicycling (especially on indoor stationary bikes). Be sure that your child warms up the muscles through stretching before exercising. Make exercise a family activity to build fun and enthusiasm.
Ask the doctor and physical therapist about sports restrictions. Some, especially impact sports, can be hazardous to weakened joints and bones. And make sure your child eats a balanced diet that includes plenty of calcium to promote bone health.