Children sometimes complain about aches in their joints that could result from a variety of causes. But if a child’s joints are swollen for at least six consecutive weeks, he or she may have juvenile arthritis.
“It’s estimated that one in 250 kids have juvenile arthritis, which is more than the number who have juvenile diabetes,” said Dr. Martin Farber, chief of rheumatology at Ellis Hospital and a member of the board of directors for the Arthritis Foundation.
Although juvenile arthritis is one of the most common chronic childhood diseases, it often goes undetected or misdiagnosed. If left untreated, irreversible joint damage may occur.
“Juvenile arthritis is a difficult disease to diagnose as many people do not think that children can get arthritis,” said Dr. Patience White, chief public health officer for the Arthritis Foundation. “Early diagnosis is essential. There are treatments available today that if started early can prevent a lifetime of disability.”
Juvenile arthritis is an autoimmune disease, which means that the body attacks its own healthy cells and tissues.
“The cause for most forms of inflammatory arthritis is felt to be a misfiring of the body’s immune system,” said Farber. “So somewhere along the line, your immune system, which is designed to recognize foreign things and then to mobilize forces to fight those foreign things, is recognizing something in the patient’s body as foreign, which it is not.”
Cause a mystery
No one knows exactly what causes juvenile arthritis. Researchers believe some children have genes that make them more likely to get the disease. Exposure to something in the environment — for example, a virus — triggers juvenile arthritis in the children. Juvenile arthritis is not hereditary — so it is rare for more than one child in a family to get it.
Common symptoms include morning stiffness that improves by afternoon and joint redness and swelling. Although a young child may not complain of pain, a child may feel irritable or tired or not want to play.
Joints may become inflamed and warm to the touch. In fewer than half of cases of juvenile arthritis, internal organs may become inflamed.
Muscles and other soft tissues around the joint may weaken.
In certain cases, children with juvenile arthritis show signs of a fever and light pink rash, which may disappear very quickly.
Some children have an eye-related problem called uveitis, which is treatable by an ophthalmologist.
Farber said when children are having persistent symptoms that their pediatrician is having a difficult time treating, they may need to be seen by a rheumatologist for more advanced kinds of evaluation and therapy.
“The gains we have made in therapies for adult forms of inflammatory arthritis have spilled over into our treatment of children so that their prognosis is much better today than it was 10 or 15 years ago,” said Farber.
Early diagnosis and treatment can control inflammation, relieve pain, prevent joint damage and maintain a child’s ability to function.
“Diagnosis is mainly clinical,” said Farber. “We use the old-fashioned technique of taking a good history and physical. Lab work is supportive, but you can’t make a diagnosis based on lab work alone, because there are frequent false positives.”
Course of treatment
Treatment of juvenile arthritis is designed to reduce swelling, maintain movement of affected joints and relieve pain, as well as identify, treat and prevent complications.
Nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen or naproxen are the first type of medication used.
Disease-modifying anti-rheumatic drugs are the next step if NSAIDS do not relieve symptoms. The most commonly used drug is methotrexate. Others include hydroxychloroquine and sulfasalazine.
Biologic agents are a new class of drugs that also slow or spot the progression of the disease. They include enbrel, humira and remicade.
Cortiocosteroids are also used to treat severe juvenile arthritis. Given by mouth or injected into a vein, they reduce serious symptoms but they can cause unwanted side effects such as interfering with a child’s growth.
Medications may be needed for several years until juvenile arthritis is no longer active.
“The outlook for these kids is better than it’s ever been,” said Farber. “The availability of these new drugs has revolutionized the way we treat both kids and adults.”
Luke Richardson, 9, a fourth-grader at Malta Avenue Intermediate School in Ballston Spa, was diagnosed with juvenile arthritis when he was 4 years old.
“He started off with high fevers and a rash, but he had no swollen joints, which threw the doctors off at first,” Luke’s mother, Christine Richardson recalled. “About six months after the diagnosis, he started getting swelling in his knees, his wrist, his ankles and all over.”
Luke was on six medications for his arthritis before he saw a rheumatologist at the Shriner’s Hospital in Springfield, Mass., who put him on a daily injection of kineret, a medicine used to reduce the pain and swelling associated with moderate to severe arthritis.
“He’s doing much better,” said his mother. “We don’t see the fevers anymore or the rash. He deals with it very well. It’s almost like a way of life for him. He plays soccer and basketball, and that night he might not feel so good. It’s a give and take. Dealing with a chronic disease is not easy. But Luke is tough. It’s made him very strong. He says he wants to be a doctor someday.”
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