Juvenile Idiopathic Arthritis (JIA) is also known as Juvenile Rheumatoid Arthritis (JRA). This is the most common type of arthritis among children under 17 years of age. Juvenile idiopathic arthritis causes persistent joint pain, stiffness & swelling. Some children suffering from JIA may also experience symptoms only for a few months, while others may be having symptoms for the rest of their lives. Moreover, there are some types of JIA which can cause serious complications like eye inflammation & growth problems. Treatment for juvenile idiopathic arthritis generally focuses on controlling pain, preventing damage to joints & upon improving function.
Most common signs & symptoms of JIA include the following.
- Pain – While children may not complain of joint pain, parents can usually notice that they are limping, especially the first thing when they wake up in the morning after resting.
- Stiffness – Parents may also notice that the child is appearing clumsier than usual, more particularly after naps or when he/she wakes up in the morning.
- Swelling – Joint swelling is most common, but it is often first noticed only in large joints like the knees.
Juvenile idiopathic arthritis may affect any one or many joints. Moreover, in some cases juvenile idiopathic arthritis may affect the entire body & cause fever, rashes & swollen lymph nodes. Just like many other types of arthritis, juvenile idiopathic arthritis is characterized by instances when symptoms generally flare up followed by times when they disappear.
Parents must take their child to the doctor in case he/she is having joint pain, stiffness or swelling for more than 7 days, especially when this is accompanied by fever.
Juvenile idiopathic arthritis is normally found to occur when the immune system of the body attacks its own tissues & cells. However, it is yet not known as to why this happens, but both environmental factors & heredity seem to play equal roles. Certain mutations of genes may also make an individual more susceptible to environmental influences like viruses, which may eventually trigger this condition.
It is found that some types of juvenile idiopathic arthritis are more common among girls than among boys.
There are several serious complications which can result for juvenile idiopathic arthritis patients. However, keeping a careful watch on condition of children & seeking proper medical attention will greatly reduce risks from complications.
- Eye Problems – There are some types of juvenile idiopathic arthritis which can cause uveitis (eye inflammation). In case this condition is left untreated, it can result in cataract, glaucoma & even blindness in some patients. However, eye inflammation most often occurs without symptoms & therefore it is important for children with juvenile idiopathic arthritis to be regularly examined by ophthalmologists (eye specialists).
- Growth Problems – Juvenile idiopathic arthritis can also quite often interfere with growth of children including bone development. Then there are some medications which are used in treating juvenile idiopathic arthritis, like corticosteroids, which can also inhibit growth.
When pediatricians or family doctors suspect that the child is having juvenile rheumatoid arthritis, they may refer the patient to a rheumatologist who is a doctor specializing in arthritis. He/she would be the right person to confirm diagnosis & explore treatment options.
- What Parents of Patients Should Do Prior to Initial Appointment
Prior to initial appointment, parents of JIA may want to write down a list which includes the following.
- Detailed descriptions of the symptoms the child is displaying.
- Information regarding medical problems the child has had in past.
- Information about medical problems which tend to run in the family.
- List of all medications & dietary supplements which the child is taking.
- List of questions which parents may want to ask doctors.
- What Doctors Would Like to Know From Parents of Patients
Doctors may like to ask some of the following questions concerning the JIA patient.
- Which joints seem to be affected by arthritis?
- When did these symptoms first begin?
- Are these symptoms coming & goint?
- Is there anything which seems to make these symptoms better or worse?
- Is joint stiffness found to worsen after a period of rest?
Diagnosing juvenile rheumatoid arthritis can often be very difficult because joint pain is usually caused due to several different types of problems. Moreover, there is no single test so as to confirm diagnosis, but these tests can often be useful in ruling out other conditions which also produce similar signs & symptoms.
- Blood Tests – Some of the most common blood tests which are conducted for suspected cases of juvenile rheumatoid arthritis include the following.
- ESR – Erythrocyte Sedimentation Rate – Sedimentation rate is basically the speed at which red blood cells settle at the bottom of a test tube. Elevated sed-rates generally indicate inflammation. ESR measurement is normally used to rule out a number of other conditions. This will eventually help rheumatologists classify the type of juvenile rheumatoid arthritis & to determine the extent of inflammation.
- C-Reactive Proteins – This blood test will also measure the level of general inflammation in body, but at a scale which is different from that of ESR.
- Anti-Nuclear Antibody – These are proteins which are commonly produced by immune system of patients with certain types of autoimmune diseases including arthritis.
- Rheumatoid Factor – This is an antibody which is commonly found in blood of children with rheumatoid arthritis.
- CCP – Cyclic Citrullinated Peptide – CCP is another antibody like the rheumatoid factor, which is found in blood of children with rheumatoid arthritis.
However, no significant abnormality is commonly found in these blood tests among many children with juvenile idiopathic arthritis.
- Imaging Tests – These include X-Rays or MRI (magnetic resonance imaging) which is taken in order to exclude other conditions like the following.
- Congenital Defects
Imaging tests are also performed from time to time following diagnosis in order to monitor development of bone in children & for detection of joint damage.
Treatments for juvenile idiopathic arthritis normally focus on helping children maintain certain level of physical activity alongside social interaction. In order to accomplish this, doctors may utilize a combination of several strategies so as to relieve swelling & pain, & prevent complications while maintaining full movement & strength.
- Medications for Juvenile Idiopathic Arthritis – Pain relievers is the only medications which are required for some children suffering from juvenile idiopathic arthritis. However, other children may need help of other medications which are designed to limit progression of this disease as well. Typical medications which are required as treatment for juvenile idiopathic arthritis include the following.
- NSAIDs – Non-Steroidal Anti-Inflammatory Drugs – These types of medications designed to reduce swelling & pain generally include naproxen (Aleve) & ibuprofen (Motrin, Advil). Stronger NSAIDs are also available on prescription. Side effects of NSAIDs include liver problems & upset stomach.
- DMARDs – Disease-Modifying Anti-Rheumatic Drugs – These medications are prescribed by doctors only when NSAIDs have failed to relieve symptoms of swelling & joint pain. They may also be taken in combination with NSAIDs & are often used to slow down the progress of juvenile idiopathic arthritis. Common DMARDs which are used for children include sulfasalazine (Azulfidine) & methotrexate (Trexall).
- TNF – Tumor Necrosis Factor Blockers – TNF blockers like adalimumab (Humira) & etanercept (Enbrel) can effectively help reduce pain, swollen joints & morning stiffness in children with juvenile idiopathic arthritis. But these types of drugs are also found to increase risk of infections along with mild chances of developing cancers like lymphoma.
- Immune Suppressants – Since juvenile idiopathic arthritis is caused by an overactive immune system, medications which suppress the immune system can often prove useful. Some good examples of this class of drugs include tocilizumab (Actemra), anakinra (Kineret), rituximab (Rituxin) & abatacept (Orencia). However, immunosuppressant drugs increase risk of infections & some types of cancers in rare cases.
- Corticosteroids – Medications like prednisone is often used to control juvenile idiopathic arthritis symptoms until DMARDs take effect & to prevent developing complications like pericarditis (inflammation of sac around heart). Corticosteroids are either orally administered or as injections directly into the joint. Moreover, these drugs can also interfere with normal growth & increase susceptibility to infection as well. This is why they are generally used for only short periods of time
- Therapies for Juvenile Idiopathic Arthritis – Doctors generally recommend juvenile idiopathic arthritis patients to work with physical therapists in order to keep joints flexible & for maintaining muscle tone & range of motion. Physical or occupational therapists make additional recommendations regarding proper exercises & protective equipments for children. They may also recommend that children with juvenile idiopathic arthritis also make use of splints or joint supports in order to help protect joints & to keep them in proper functional position.
- Surgery for Juvenile Idiopathic Arthritis – It is only in very severe cases of juvenile idiopathic arthritis that surgery may be required so as to improve position of a joint.
It is for the caregivers to help children with juvenile idiopathic arthritis learn self-care techniques which limit effects of this disease. Some of these techniques may include the following.
- Regular Exercising – Exercising is very important since it promotes both joint flexibility & muscle strength. Swimming is considered an excellent sport merely because it places minimal stress on joints.
- Cold or Hot Applications – Stiffness commonly affects many juvenile idiopathic arthritis patients, more particularly in the mornings. Though some children respond very well to ice packs, there are others who prefer hot packs, hot bath or hot showers.
- Eating Well – Many children with juvenile idiopathic arthritis are found to have poor appetites. Then there are many others who gain excessive weight due to physical inactivity or use of medications. Healthy diet will therefore go a long way in helping maintain appropriate weight. Adequate amount of calcium in diet is extremely important because children with juvenile idiopathic arthritis are at high risk of developing osteoporosis (weak bones) due to their medical condition. Moreover, decreased physical activity & weight bearing along with use of corticosteroids can pose high risk as well.
Members of the family also play critical roles in helping children cope with juvenile idiopathic arthritis. Parents can also take the following steps in order to help children cope with their medical condition.
- Treat children with juvenile idiopathic arthritis like other normal children in the family, as far as possible.
- Allow children with juvenile idiopathic arthritis to express anger about having this condition. Explain to them that this disease is not caused by anything they have done.
- Encourage children with juvenile idiopathic arthritis to participate in physical activities, however, keeping in mind limitations recommended by doctors & physical therapists.
- Parents should also discuss conditions of children with juvenile idiopathic arthritis & associated issues with teachers & administrators at school.
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