When we hear the word “arthritis,” the image that might spring to mind is elderly people hunched over, hands crabbed with painful lumps. Arthritis is not a condition reserved for the elderly. Over 300,000 kids in the U.S. suffer from juvenile arthritis, and July is Juvenile Arthritis Awareness Month. This month is set aside annually to raise awareness and support for children and families affected by this debilitating condition, as well as to raise money for research and study.
What is juvenile arthritis?
Juvenile arthritis is not quite the same as arthritis experienced by older people. There are several types of juvenile idiopathic arthritis (JIA, previously referred to as juvenile rheumatoid arthritis, or JRA):
- Systemic onset JIA: The rarest form of JIA, system onset JIA makes up only 10-20% of juvenile arthritis cases. It generally appears between the ages of five and ten and affects the entire body, including pain in all joints and a rash on the body. This is also referred to as “Still’s disease,” named after the doctor who first diagnosed this illness.
- Olioarticular JIA: This type of juvenile arthritis impacts fewer than five joints.
- Polyarticular JIA: “Poly” means many, and this type causes pain, redness, and swelling in more than five joints.
- Enthesitis-related JIA: This type of juvenile arthritis impacts boys more than girls and begins usually between the ages of eight and 15. Swelling and pain in the tendons and ligaments restricts range of motion to varying degrees, depending on the severity.
- Psoriatic arthritis: This type of arthritis is not restricted to children only. Initial diagnosis may be of psoriasis, a skin condition that causes patchy, flaky skin and may progress to joint pain and inflammation.
Unlike most adult forms of arthritis that are caused by wear and tear or joint degeneration and inflammation, juvenile arthritis is an autoimmune disorder. Children do not have fully formed immune systems, and their bodies begin to attack the joints, causing swelling, inflammation, and pain. Kids as young as six months can exhibit symptoms of JIA, and the initial severity of the disease, along with the number of joints affected, often predicts if total remission will be achievable.
Who is at risk?
Some children test positive for a genetic link that may cause juvenile arthritis, but others who have the same gene may not develop this condition. Some types of juvenile arthritis are more common in one gender than the other, but there are no other particular risk factors for this disease. It is almost as if a momentary lapse in the development of the immune system happens at just the right time under the right conditions for the disease to take hold. There is some indication that certain viruses may trigger this autoimmune disorder, but research is still unclear.
What are the symptoms of juvenile arthritis?
The most prevalent symptom for most types of juvenile arthritis is pain and swelling in the joints of the body. Psoriatic arthritis often presents initially as a rash, followed soon thereafter by pain in the joints.
Other symptoms include:
- Decreased range of motion in joints
- Limping after getting up from a nap or after sitting for long periods of time
- Stiffness first thing in the morning
Very young children may not be able to articulate what exactly hurts and where, so they may have behavioral symptoms such as fussiness, crying, or irritability that goes beyond age-appropriate levels of those behaviors. Some children may also develop a fever. If these symptoms persist for more than a week, it’s time to see a doctor.
How is juvenile arthritis treated?
A first-line treatment of juvenile arthritis is non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, but these can cause stomach and liver problems when taken long term. Doctors may prescribe disease-modifying antirheumatic drugs (DMARDs) in conjunction with NSAIDs to help slow the progress of the disease. Biologic agents such as etanercept (Enbrel) and adalimumab (Humira) can help reduce swelling and stiffness in the morning but have been found to increase the chances of some types of cancers. Doctors may also try to suppress the immune response with biologic agents such as abatacept (Orencia), rituximab (Rituxin), anakinra (Kineret), and tocilizumab (Actemra).
Corticosteroids can be used to control dangerous inflammation during the time it takes DMARDs to take effect, but they are not a long-term solution for children.
Physical therapy may be used in conjunction with splints or braces to correctly position growing joints that may be moved out of place by swelling and inflammation. In extreme cases, surgery to properly position the joint may be recommended.
Complementary therapies such as eating well and staying active should be part of a treatment plan. Children should get plenty of calcium-rich foods and stay away from processed foods that can exacerbate inflammation. Exercise to keep joints fluid and mobile is an essential part of managing juvenile arthritis.
Juvenile Arthritis Awareness Month offers many different ways for family and friends of those suffering from JIA to get involved.
If you or someone you love suffers from juvenile arthritis, what actions will you take to spread the word and build awareness this month?
Image by Frank Jacobi via Flickr