The symptoms can vary. It can begin with a spiking fever, an unexplained rash, or a swollen knuckle.
Whatever the symptoms may be, having your child diagnosed with “arthritis” can be daunting, confusing and, yes, unexpected.
What is arthritis?
Essentially, arthritis is an inflammation of the joints. When inflamed, the joints can get warm, swollen, stiff and painful. Approximately 1 in 1,000 children in the United States alone develops some type of arthritis.
In some cases, the condition can be short-term—lasting only a few weeks or months then disappearing forever—or it can be chronic and persists for months or years. The most common form of juvenile arthritis is juvenile idiopathic arthritis or JIA. It is also otherwise known as juvenile rheumatoid arthritis (JRA).
What is juvenile rheumatoid arthritis?
Juvenile rheumatoid arthritis is considered the most prevalent type of arthritis in children under 16 years of age. The condition is characterized by persistent joint swelling, pain and stiffness. Some types of JRA can result in serious complications like eye inflammation and growth problems like deformities.
What causes JRA?
The exact cause of juvenile rheumatoid arthritis is not known. Some research, however, indicates it might be an autoimmune disease.
In people with autoimmune conditions, the immune system is unable to differentiate between the harmful substances (bacteria and viruses) and their own healthy cells. This can cause the immune system to attack harmless cells like they are foreign invaders.
In children afflicted with JRA, the immune system releases chemicals that damage healthy tissues like ligaments, cartilage and bone, resulting in pain and inflammation in the joints.
What are the different types of juvenile rheumatoid arthritis?
JRA can develop in children between 6 months and 16 years old.
There are seven types of JRA:
- Oligoarthritic – this condition often develops in only a few joints like the ankle or the knee. Symptoms can include joint swelling, stiffness, and pain. There are two types of oligoarthritis—extended and persistent. The type is determined by the number of joints affected.
- Psoriatic arthritis – children with this type of arthritis are also likely to suffer from the psoriasis rash (a red and scaly rash that often starts in the knees, scalp, elbows, eyelids, and behind the ears).
- Systemic JRA – this type affects the entire body. One of the most prevalent symptoms of the condition is high fever that often occurs in the evenings. At the onset of the fever, the child can feel very ill, develop a rash, and appear pale. The spleen and the lymph nodes might also become enlarged. Rashes can also appear and disappear—manifesting in one area and then moving to another.
- Polyarticular arthritis, rheumatoid factor positive – this kind behaves a lot like adult rheumatoid arthritis. Children with polyarticular arthritis either have anti-cyclic citrullinated peptide (CCP antibody) or a protein called rheumatoid factor (RF) in their blood. Those afflicted with the condition have a higher risk of suffering from joint damage with erosions compared to those afflicted with other types.
- Enthesitis-related arthritis – oftentimes, this kind of arthritis affects the spine and legs. Children affected can also have inflammation of the entheses (the area where the tendons join the bones). Enthesitis-related arthritis can also include juvenile ankylosing spondylitis (a condition characterized by inflammation of spinal joints) and arthritis linked with inflammatory bowel diseases (like ulcerative colitis and Crohn’s disease).
- Polyarticular arthritis, rheumatoid factor negative – at least 1 in 4 children with JRA have polyarthritis. The condition is also more common in girls than in boys. Common symptoms include pain and swelling in five (or more) joints. In most cases, the weight-bearing joints like the hips, ankles, feet, neck, and knees are affected. Nodules or bumps, as well as low-grade fever, might also develop in children with the condition.
- Undifferentiated arthritis – this type includes arthritis that fits into more than one categories and those that do no not fit into any of the above categories at all.
How is the condition diagnosed?
To accurately diagnose the condition, a pediatric orthopaedics specialist will ask questions about the child’s symptoms and conduct a thorough physical exam.
Blood tests and X-rays may also be ordered to rule out other infections and conditions—like Lyme disease—that may share similar symptoms.
Other tests may include:
- Erythrocyte sedimentation rate
- Blood culture
- Complete blood count (CBC)
- Antinuclear antibody (ANA)
- C-reaction protein
- Rheumatoid Arthritis factor
What are the treatment options for JRA?
Usually, the management of JRA involves a combination of exercise, physical therapy, and medication. In some cases, a corticosteroid injection into the joint will be recommended. In very rare instances, surgery may be required.
Treatment goals include minimizing the inflammation, relieving the pain, preventing (or slowing down) damage to the joints, restoring function and use of the joints, and promoting physical activity, optimal growth, and emotional and social development.
To ease the pain and reduce the inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) like salicylates and ibuprofen may be prescribed. Dosage can vary depending on the child’s response to the medication.
If joint inflammation is not controlled by NSAIDs, other medications like methotrexate might be given. The treatment regime escalates according to severity, a scheme also known as DMARD (disease-modifying anti-rheumatic drugs).
A physical therapy program is considered vital in the management of arthritis regardless of type. A physical therapist will recommend exercises tailored to the child’s specific condition. At times, splinting may be necessary to rest highly inflamed joints.
Exercises that will enhance endurance and strength and range-of-motion exercises that help restore flexibility will also be taught.
A regular exercise program is important to keep the muscles healthy and strong so it can protect and support the joints. Recommended activities can include swimming, walking, and bicycling.
To play safe, ask the doctor about likely sports restrictions. Keep in mind that some sports, especially the high impact ones can be hazardous to joints that are already deformed, weakened, or damaged.