Juvenile arthritis

Health, Dr Tatenda Simango

Juvenile arthritis (JA), also known as pediatric rheumatic disease is not a specific disease. It’s an umbrella term to describe the inflammatory and rheumatic diseases that develop in children under the age of 16.

The exact causes of JA are unknown but researchers believe that certain genes may cause JA when activated by a virus, bacteria or other external factors. There is no evidence that foods, toxins, allergies or lack of vitamins cause the disease.

Most kinds of JA are auto-immune or auto-inflammatory diseases. That means the immune system, which is supposed to fight against foreign invaders like viruses and germs, gets confused and releases inflammatory chemicals that attack healthy cells and tissue. In most JA cases, this causes joint inflammation, swelling, pain and tenderness, but some types of JA have few or no joint symptoms or only affect the skin and internal organs.

There are five types of juvenile arthritis:

Systemic arthritis, also called Still’s disease, can affect the entire body or involve many systems of the body. Systemic juvenile arthritis usually causes high fever. The rash is usually on the trunk, arms, and legs. Systemic juvenile arthritis can also affect internal organs, such as the heart, spleen and lymph nodes, but usually not the eyes. Boys and girls are equally affected.
Oligoarthritis, also called pauciarticular juvenile rheumatoid arthritis, affects fewer than five joints in the first six months that the child has the disease. The joints most commonly affected are the knee, ankle and wrist. Oligoarthritis can affect the eye, most often the iris. This is known as uveitis, iridocyclitis, or iritis. This type of arthritis is more common in girls than in boys, and many children will outgrow this disease by the time they become adults.
Polyarthritis, also called polyarticular juvenile idiopathic arthritis (pJIA), involves five or more joints in the first six months of the disease, often the same joints on each side of the body. This type of arthritis can affect the joints in the jaw and neck as well as those in the hands and feet. This type is also more common in girls than in boys and more closely resembles the adult form.
Psoriatic arthritis affects children who have both arthritis and the skin disorder psoriasis. The child might get either the psoriasis or the arthritis years before developing the other part of the disease. Children with this type of arthritis often have pitted fingernails.
Enthesitis-related arthritis is a type of arthritis that often afflicts the spine, hips, eyes and entheses (the places where tendons attach to bones). This type of arthritis occurs mainly in boys older than 8 years of age. There is often a family history of arthritis of the back (called ankylosing spondylitis) among the child’s male relatives. JA may cause joints to look red or swollen and feel stiff, painful, tender and warm.

This can cause difficultly moving or completing everyday tasks. Joint symptoms may worsen after waking up or staying in one position too long.

The goals of JA treatment are to:

Slow down or stop inflammation and prevent disease progression.
Relieve symptoms, control pain and improve quality of life.
Prevent or avoid joint and organ damage.
Preserve joint function and mobility for adulthood.
Reduce long-term health effects.

The most common signs and symptoms of juvenile idiopathic arthritis are:

Pain. While your child might not complain of joint pain, you may notice that he or she limps — especially first thing in the morning or after a nap.
Swelling. Joint swelling is common but is often first noticed in larger joints such as the knee.
Stiffness. You might notice that your child appears clumsier than usual, particularly in the morning or after naps.
Fever, swollen lymph nodes and rash. In some cases, high fever, swollen lymph nodes or a rash on the trunk may occur — which is usually worse in the evenings.

Blood tests can be conducted to help confirm the diagnoses and see the extend of illness or progress of treatment. Other investigations that can be done include X-rays` or magnetic resonance imaging to assess for fractures, cancers or congenital defects.

Some types of juvenile idiopathic arthritis can cause serious complications, such as growth problems, joint damage and eye inflammation.

Treatment focuses on controlling pain and inflammation, improving function, and preventing damage. Physical or occupational therapist may also recommend that your child make use of joint supports or splints to help protect joints and keep them in a good functional position.

Getting regular exercise. Exercise is important because it promotes both muscle strength and joint flexibility. Swimming is an excellent choice because it places minimal stress on joints.
Applying cold or heat. Stiffness affects many children with juvenile idiopathic arthritis, particularly in the morning. Some children respond well to cold packs, particularly after activity. However, most children prefer warmth, such as a hot pack or a hot bath or shower, especially in the morning.
Eating well. Some children with arthritis have poor appetites. Others may gain excess weight due to medications or physical inactivity. A healthy diet can help maintain an appropriate body weight.

Adequate calcium in the diet is important because children with juvenile idiopathic arthritis are at risk of developing weak bones due to the disease, the use of corticosteroids, and decreased physical activity and weight bearing.

Family members can play critical roles in helping children cope with their condition. As a parent, you may want to try the following:

Treat your child like other children in your family as much as possible.
Allow your child to express anger about having juvenile idiopathic arthritis. Explain that the disease isn’t caused by anything he or she did.
Encourage your child to participate in physical activities, keeping in mind the recommendations of your child’s doctor and physical therapist.
Should attend school, discuss your child’s condition and the issues surrounding it with teachers and administrators at his or her school.

Till next week stay safe.