Juvenile Arthritis (JA) or Childhood Arthritis: Symptoms, Treatment- NSAIDs, PT
Juvenile arthritis is a term used for explaining many several inflammatory and autoimmune conditions which develop in children of 16 years or below.
Arthritis is a condition which commonly affects the joints. The word arthritis factually means joint inflammation, arth means joint and 'itis' means inflammation. Juvenile arthritis leads to a condition in which skin, gastrointestinal tract and eyes may also get affected.
Juvenile arthritis is an autoimmune disorder. In this condition the body damages its own tissues and cells.
When a child develops swollen joints for six weeks in a row or longer then the result most likely is juvenile arthritis. Children affected with juvenile arthritis often suffer with aching joints. Juvenile arthritis mostly causes pain in the little joints in the toes and fingers, shoulder joint and the knee joint.
In mild cases of juvenile arthritis, the symptoms are mild and do not evolve into severe joint disease or deformities whereas in more severe cases the juvenile arthritis often results in damaging the tissues and joints seriously leading to problems with bone growth and development.
Types of Juvenile Arthritis (JA) or Childhood Arthritis
Juvenile arthritis is classified into three types. The classification for juvenile arthritis is based on the presence of certain antibodies in the blood, symptoms, and the number of joints involved.
Oligoarticular Juvenile Arthritis: Oligoarticular juvenile arthritis was formerly called as pauciarticular juvenile arthritis that is only few joints are affected. Oligoarticular juvenile arthritis affects only few joints, however half of the cases of oligoarticular juvenile arthritis often affects only one joint which could be of either an ankle or a knee which is known as monoarticular juvenile arthritis. This type is very mild in nature and the symptoms also alleviate and cease to exist with time. Only four or only large joints are generally affected in most of the children. Small joints like fingers or toes are seldom involved.
Oligoarticular juvenile arthritis may also result in the condition of eye inflammation. Regular eye checkups must be done for preventing blindness. Problems of the eye often continue with increasing age.
Polyarticular Juvenile Arthritis: Polyarticular juvenile arthritis affects about five or more smaller joints, which involve joints of the hands and feet. Generally the joints will be affected on both sides of the body. This type may also affect the larger joints.
Children containing antibody known as IgM rheumatoid factor in their blood suffer from more severe type of disease. Antibodies are the blood proteins which help the body while fighting with an infection via an immune system. In polyarticular juvenile arthritis, the IgM rheumatoid factor antibody damages the body's own tissues. It is believed that polyarticular juvenile arthritis is similar to the adult rheumatoid arthritis.
Systemic Juvenile Arthritis: Systemic juvenile arthritis causes pain and limitation of motion in at least a single joint. Aside from this, symptoms also include rashes and inflammation of organs like spleen, lymph nodes, heart as well as liver. The individual has high grade fever for a period of two weeks or even more. It must be treated appropriately else the individual may develop arthritis in numerous joints which continues to aggravate with age
Epidemiology of Juvenile Arthritis (JA) or Childhood Arthritis
Juvenile arthritis is a chronic disease, which lasts for a long time. Juvenile arthritis is a very frequent type of arthritis suffered by children. Juvenile arthritis is a condition which affects children below 16 years of age. The condition of juvenile arthritis is suffered by around 250000 children below 16 years in United States.
Juvenile arthritis covers about 50 percent cases of oligoarticular juvenile arthritis. This condition is frequent among girls below 8 years of age.
Juvenile arthritis cover about 30 percent cases of polyarticular juvenile arthritis. This condition is more frequent among girls than boys.
Juvenile arthritis cover about 20 percent cases of systemic juvenile arthritis
Causes and Risk Factors of Juvenile Arthritis (JA) or Childhood Arthritis
The main cause of juvenile arthritis is still not known, however there are few reasons suspected to cause juvenile arthritis.
- Juvenile arthritis may be caused due to virus spread through environmental exposure, which often affects children easily.
- Few children may genetically develop the condition of juvenile arthritis, but this is a very rare case.
- If a child is affected with juvenile arthritis, it is unlikely that other children may also be affected in the family as this disease is not hereditary.
Signs and Symptoms of Juvenile Arthritis (JA) or Childhood Arthritis
Signs and symptoms of juvenile arthritis are different for different children. Fluctuation in the symptoms may be seen where there may be periods of time where the symptoms flare up one or two times and then subside and there may be periods where the symptoms may totally cease to exist. There may also be cases where the symptoms may frequently come and go and are always present.
Given Below Are Few Of The Most Common Symptoms Of Juvenile Arthritis:
- Pain in the joints in the mornings which exacerbate by afternoon.
- Pain and swelling in the joints could also be experienced.
- Child may often feel tired and irritable.
- In few cases, lymph node swelling in the neck and other body parts could also be experienced.
- Inflammation of the joints may be experienced along with warmth to touch.
- Weakness in the soft tissues surrounding the joints and muscles may also be experienced.
- Joint stiffness and contracture.
- Internal organs may be inflamed in some severe cases.
- Some children may suffer with high fever.
- A light pink rash could also be noticed, which suddenly disappears.
- Growth problems may be seen in some children wherein the joints may develop too fast or too slow, and sometimes uneven growth leading to limb length discrepancy.
- Eye problems called iridocyclitis may be seen in some cases. Timely treatment is important to prevent blindness.
Treatment for Juvenile Arthritis (JA) or Childhood Arthritis
Treatment of juvenile arthritis focuses mainly on reducing swelling and relieving pain to maintain full functioning of the joint. Also secondary complications such as joint contractures and soft tissue damage need to be treated as appropriate to prevent further complications.
- Medications: Medications play an important role in treatment of juvenile arthritis. Medications may be needed for certain period, which can be months to years depending on the severity of the disease until juvenile arthritis becomes totally inactive.
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): NSAIDs help in reducing both inflammation and pain. Generally, NSAIDs include naproxen and ibuprofen.
- Disease-Modifying Anti-Rheumatic Drugs: Disease-modifying anti-rheumatic drugs are often used when the NSAIDs fail to work properly. Disease-modifying anti-rheumatic drugs helps in slowing down and stopping the development of juvenile arthritis. This may take a long period such as weeks or months to treat the disease. Methotrexate is a very frequently prescribed drug for the treatment of juvenile arthritis. Azulfidine is very rarely prescribed drug. Sometimes disease-modifying anti-rheumatic drugs are also taken in combination with nonsteroidal anti-inflammatory drugs.
- Biologic Agents: Biologic agents are a fresh class of drugs which help in slowing down and stopping the development of juvenile arthritis. These are often used when the disease-modifying anti-rheumatic drugs fail to work properly. Biologic agents also help in treatment of arthritis of the sacroiliac joint.
- Corticosteroids: Corticosteroids are frequently used for the treatment of severe juvenile arthritis. These are either consumed orally or injected into a vein. Corticosteroids often decrease serious symptoms like inflammation of the sac surrounded by the heart. In case of involvement of one or two joints, direct injection of the corticosteroids into the affected joint is performed. Corticosteroids may also carry some side effects with them which often result in weakened bones, increased susceptibility to infections, impact on child's growth and weight gain.
Physical Therapy for Juvenile Arthritis (JA) or Childhood Arthritis
Physical therapy and exercise helps in maintaining muscle tone and improving range of motion of the joints. Physical therapy program is designed based on the symptoms and joints involved. Proper rest periods are also important along with physical therapy and exercise in order to allow the body to recover. Swimming and hydrotherapy is recommended as it involves many of the muscles and joints of the body without putting much weight on the joints. Braces and splints can be used in order to support the joints and help in maintaining joint alignment.
Surgical Treatment for Juvenile Arthritis (JA) or Childhood Arthritis
Surgery is performed in severe cases only when conservative measures fail. The surgery is performed only for correcting the position of the affected joint, which often happens in the case of a deformed joint.
Joint Replacement: This procedure is mostly used for the treatment of arthritis in adults. Children could not be treated with such methods.
Investigations for Juvenile Arthritis (JA) or Childhood Arthritis
A complete history and thorough physical examination looking for signs and symptoms of juvenile arthritis such as joint swelling and tissue atrophy near the joints is performed to suspect the diagnosis of juvenile arthritis. There are no particular tests available to diagnose juvenile arthritis, however, some of the tests, which may help in diagnosing juvenile arthritis are given below.
The Lab Tests Which Often Assist In Diagnosing Juvenile Arthritis May Include:
- Anti-CCP antibody test.
- Rheumatoid factor test.
- Erythrocyte sedimentation rate.
- Synovial fluid analysis.
- Complete blood count.
- C-reactive protein.
Other Tests May Include:
- Joint x-rays.
- Joint ultrasound or MRI.