Arthritis is known as inflammation of the joints resulting in pain and swelling. Even though a lot of people are convinced that arthritis is an illness of old age, different forms of arthritis can strike just about anybody at any age. When arthritis happens to children below the age of sixteen, it is then called juvenile arthritis. Around 285,000 children in the United States suffer from some type of this illness.
The most widespread types of juvenile arthritis include:
* Juvenile rheumatoid arthritis is also known as juvenile idiopathic arthritis ??? This is the most frequently occurring type of juvenile arthritis. Juvenile rheumatoid arthritis is believed to be an autoimmune illness. This means that, due to mysterious reasons, the body’s immune system attacks some of its own tissue the same way it would respond against a foreign invader, for example a virus or bacteria. In juvenile rheumatoid arthritis, the lining of the joint (also called synovial membrane) gets inflamed and enlarged, restricting movement and bringing about pain and tenderness. Enzymes that are released by the inflamed membranes lead to further damage by eroding the bone and cartilage. This type of joint and bone damage may result in problems in a growing youngster. If the growth areas of the bones are stricken, the bones can grow at various rates so that one bone may develop unusually in shape or size. There can appear various consequences, for instance, that one leg might be permanently shorter than the second one.
Juvenile rheumatoid arthritis can be divided into three subcategories:
o Systemic onset type, which starts with a whole-body (systemic) reaction, such as high fevers; skin rash on the legs, arms and trunk; joint inflammation; and symptoms of inflammation of various body organs, including enlarged lymph nodes or lining of the lungs (pleurisy). A child may experience one or more episodes of systemic onset juvenile rheumatoid arthritis that finally goes away, however some disorders may continue through the adulthood.
o Pauciarticular onset disease, in which not more than five joints are stricken, is the most frequent type of juvenile rheumatoid arthritis. The huge joints ??? such as knees, elbows, and ankles ??? are frequently affected, however in the majority of cases not the same joints on both sides of the body. For instance, the knee on one side may be stricken and the ankle on the other. Symptoms include such conditions as: pain, swelling, stiffness, redness and warmth at the affected joint. Children suffering this form of juvenile rheumatoid arthritis are particularly vulnerable to an eye inflammation known as iridocyclitis. These children require frequent evaluation of an ophthalmologist, probably as frequently as every three months, due to the fact that no visible or recognizable symptoms may occur and permanent eye damage can appear even if other symptoms of juvenile rheumatoid arthritis are carefully controlled. Treatment for iridocyclitis is enormously successful. Many or even the majority of children with pauciarticular onset juvenile rheumatoid arthritis will probably outgrow the disease with no ongoing arthritis.
o Polyarticular disease, that involves five or more joints, normally affects the small joints, such as those in fingers and toes, even though bigger ones can be involved as well. Symptoms include the same inflammatory symptoms as other forms of juvenile rheumatoid arthritis, together with low-grade fever and bumps known as rheumatoid nodules near the joints involved. Usually, the disease affects the same joints on both sides of the body. Polyarticular juvenile rheumatoid arthritis occurs more widespread in girls than in boys, is normally more serious than the other two forms, and frequently results in long-term joint problems. In 5 per cent to 10 per cent of cases, the antibody known as rheumatoid factor may be detected in a blood test, which later classifies the juvenile rheumatoid arthritis as seropositive. Seropositive juvenile rheumatoid arthritis is quite similar to adult rheumatoid arthritis, and frequently persists into adulthood.
* Juvenile ankylosing spondylitis ??? This illness affects the large joints of the lower body, especially the lower back and hips. Crucial symptoms include lower back pain or stiffness, particularly in the early morning. The pain is alleviated by physical activity. It strikes boys more frequently than girls.
* Reiter’s syndrome ??? This form of arthritis may develop several weeks to months after a kid has been exposed to some types of bacteria, especially shigella, salmonella or yersinia connected with diarrhea. The illness normally begins unexpectedly. The most important symptoms are fever accompanied by pain and inflammation in several joints, conjunctivitis (eye inflammation) and painful urination.
* Juvenile psoriatic arthritis ??? This form of chronic arthritis affects some children who suffer psoriasis, and appear to have a genetic component. Together with joint pain and inflammation, the most common symptoms are pitted fingernails, psoriasis and a raised, scaly rash behind the ears, in the area of the navel, along the scalp or other areas of the body.
* Juvenile systemic lupus erythematosus (lupus) ??? Even though lupus normally does not emerge before the period of adolescence, when it appears in children it is quite similar to lupus in adults. This illness may lead to inflammation and tissue damage in various areas of the body, particularly the skin, joints, blood vessels, brain, heart, muscles or kidneys. The illness frequently occurs in episodes that come and go for no particular reason. The most common symptoms include: a rash on the cheeks, sensitivity to sunlight, mouth or nose sores, joint pain, seizures or other signs of neurological problems, and chest pain.
Symptoms of Juvenile Arthritis
Symptoms differ depending on the kid and the precise condition. Typical symptoms include:
* At least one joint that is persistently swollen and tender, or even red and warm to the touch
* Pain during joint movements, even though a lot of young children do not complain of pain
* Stiffness or reduced ability to move joints, particularly when waking
* Limping
* Joints that look knobby or deformed
* Bent posture or limbs
Other symptoms of juvenile arthritis may include:
* Uneven (asymmetric) growth patterns (one leg longer than the second one, for instance)
* Blurry vision, eye pain or redness
* Low-grade fever
* Skin rash
* Tiredness
* Irritability
* Chest pain
* General complaints of pain
Diagnosis
Juvenile arthritis is very complicated to diagnose due to the fact that a lot of diseases demonstrate similar symptoms. Moreover, there is no test that pinpoints the diagnosis. If your kid demonstrates symptoms or signs of juvenile arthritis, probably you will be referred to a pediatric rheumatologist. The rheumatologist will analyze your child’s medical history in order to find clues, for instance, joint inflammation that has persisted for at least six weeks. For instance, one of the most important diagnostic criteria for juvenile rheumatoid arthritis is joint inflammation that has persisted for six weeks of more. Blood tests may be performed in order to search for antibodies that frequently develop in people suffering from some forms of arthritis, even though these antibodies are frequently absent in kids. X-rays may be conducted to search for injure to cartilage or, in severe cases, bone. Moreover, some other tests may be carried out in order to look for other disorders that could explain the symptoms, such as tests for infection; Lyme disease is an infectious cause of arthritis that may strike kids and mimic juvenile rheumatoid arthritis.
Expected Duration
In the majority of cases, juvenile arthritis is a lifelong condition. Nevertheless, for many people, symptoms steadily decrease or even entirely go away as they enter adulthood.
Prevention
Due to the fact that nobody knows what the exact cases of juvenile arthritis are, there is no way to prevent it.
Treatment
The major objective of treatment is to regulate inflammation to prevent further damage to the joints, and also to manage symptoms so that the child can function properly. Nonsteroidal anti-inflammatory medications (NSAIDs) are normally the first medicines tried to alleviate joint inflammation. They act by reducing the amount of an enzyme present in affected joints that avtivates inflammation. This same enzyme, though, is helpful in protecting the stomach, hence NSAIDs frequently brings about stomach irritation and ulcers. Low doses of NSAIDs are obtainable over-the-counter, including ibuprofen (Advil, Motrin and other brand names) and naproxen (Naprosyn, Aleve and others). Celecoxib (Celebrex) is a newer prescription medication, known as a COX-2 inhibitor, that is believed to be more secure for the stomach due to the fact that it does not have as much of influence on the enzyme protecting the stomach. Alert: Two of the COX-2 inhibitors have been removed from the market ??? valdecoxib (Bextra) on April 7, 2005 and rofecoxib (Vioxx) in September 2004.
In serious cases, children suffering juvenile arthritis may be treated with more prevailing medicines or a combination of a few drugs. Corticosteroids (such as prednisone) are fast-acting, anti-inflammatory agents that may be used to bring to an end dangerous inflammation, such as when the lining of the heart has become inflamed (pericarditis) or in order to stabilize a child in an acute stage of the illness. These medications may bring about very serious side effects, such as weight gain, weakened bones, an elevated vulnerability to infections and interference with growth. Normally, they are prescribed for only a brief spell. They need be taken precisely as recommended.
Other medications, called disease modifying anti-rheumatic medications (DMARDs) ??? such as methotrexate (Rheumatrex and others) ??? work more steadily, however frequently offer relief if other medicines have failed. These medications may wreak liver damage or other complications, and therefore healthcare providers will watchfully monitor blood tests in kids taking DMARDs. Other medicines may also be successful, including hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), azathioprine (Imuran), cyclophosphamide (Cytoxan) and cyclosporine (Neoral, Sandimmune). Thalidomide may be successful for particular children experiencing JRA, however care needs to be taken in order to avoid pregnancy while taking this medication and it may lead to nerve damage. The latest, injectable treatments, such as etanercept (Enbrel;recently approved for juvenile rheumatoid arthritis), infliximab (Remicade) and anakinra (Kineret) may also be highly successful for some kids suffering juvenile rheumatoid arthritis.
In some cases, surgery is necessary if joint damage is serious or joint deformity has developed.
Children suffering juvenile arthritis ought to be supported to maintain as normal lifestyle as possible. Even though they may experience some pain, physical activity is essential to help the joints keep moving and functioning properly. When symptoms are under control, it is beneficial for your kid to be involved in usual play and sports activities. In severe cases, physical therapy may also be suggested in order to keep the joints moving as freely as possible. Tutoring or special attention offered by teachers may be necessary if the child has a long break at school because of the disease. Moreover, counseling might be suggested in order to help the child cope with the emotional aspects of having a long-lasting (chronic) disease.
When To Contact A Specialist
Contact your health care provider if a child experiences fever or rash together with symptoms of arthritis, such as persistent joint pain, swollen joints, limping and imperfect motion.
Prognosis
Due to the fact that the symptoms and damage resulting from juvenile arthritis can differ significantly, also the outlook varies considerably. Some forms of arthritis have spells of flaring up and spells when symptoms recede. Treatment is applied can regulate symptoms for the majority of people, and a lot of children "outgrow" the disease. Nevertheless, severe types of the illness may lead to growth problems if the growth plates in the long bones are damaged. Very sick children also can have long breaks at school, and joint damage can result in long-term joint problems. Additionally, the medicines used for the treatment of juvenile arthritis may lead to other problems, such as stomach ulcers, weakened bones and liver damage.
