Juvenile Arthritis

Juvenile Arthritis- Know It All!

Editorial

Juvenile Arthritis- Know It All!

All you need to know about Juvenile Idiopathic Arthritis.

Juvenile Arthritis

Know your ailment well, so you can manage it better!!

Here we come with Juvenile Idiopathic Arthritis today!

Overview:

Juvenile Arthritis is a category of skin disorders leading to swollen, itchy, scaly, rough and red skin. Signs can vary from mild to extreme. Ichthyosis may only affect the skin but certain types of the disease can also damage internal organs.

Most people inherit ichthyosis from a mutated (altered) gene from their parents. Some individuals, however, develop a form of acquired (nongenetic) ichthyosis from another medical condition or certain medications. Though ichthyosis is currently not healed, research is underway, and medications are available to help relieve the symptoms.

The outlook for people with ichthyosis differs according to the form and nature of the disease. Most people with ichthyosis require ongoing care to help make the disorder more manageable.

Juvenile Arthritis

Types of Juvenile Arthritis:

Seven different subtypes of juvenile idiopathic arthritis, each with distinct symptoms, exist. In each subtype, however, a child may experience arthritis symptoms of joint pain , swelling, tenderness, hot, or stiffness that last for more than six consecutive weeks.

The subtypes are:

Systemic juvenile idiopathic arthritis (formerly known as systemic juvenile rheumatoid arthritis):

Systemic means the arthritis can affect the whole body, rather than just a specific organ or joint. A child has arthritis with, or that was preceded by, a fever that has lasted for at least 2 weeks. The fever has come and gone, but spiked, or hit its highest temperature, for at least 3 days. The fever occurs with at least one or more of the following:

  • Generalized enlargement of the lymph nodes.
  • Enlargement of the liver or spleen.
  • Inflammation of the lining of the heart (pericarditis) or the lungs (pleuritis).
  • The characteristic rheumatoid rash, which is flat, pale, pink, and generally not itchy. The individual spots of the rash are usually the size of a quarter or smaller. They are present for a few minutes to a few hours, and then disappear without any changes in the skin. The rash may move from one part of the body to another.

Oligoarticular juvenile idiopathic arthritis (formerly known as pauciarticular juvenile rheumatoid arthritis):

During the first 6 months of illness a child has arthritis that affects one to four joints. Two such subcategories are:

  • Persistent oligoarthritis, which means the child never has more than four joints involved throughout the disease course.
  • Extended oligoarthritis, which means that more than four joints are involved after the first 6 months of the disease.

Polyarticular juvenile idiopathic arthritis — rheumatoid factor negative (formerly known as polyarticular juvenile rheumatoid arthritis — rheumatoid factor negative):

A child has arthritis in five or more joints during the first 6 months of disease, and all tests for rheumatoid factor (proteins produced by the immune system that can attack healthy tissue, which are commonly found in rheumatoid arthritis and juvenile arthritis) are negative.

Psoriatic juvenile idiopathic arthritis:

A child has both arthritis and psoriasis (a skin disease), or has arthritis and at least two of the following:

  • Inflammation and swelling of an entire finger or toe (this is called dactylitis)
  • Nail pitting or splitting
  • A first-degree relative with psoriasis.

Enthesitis-related juvenile idiopathic arthritis:

The enthesis is the point at which a ligament, tendon, or joint capsule attaches to the bone. If this point becomes inflamed, it can be tender, swollen, and painful with use. The most common locations are around the knee and at the Achilles tendon on the back of the ankle. A child is diagnosed with this condition if he or she has both arthritis and inflammation of an enthesitis site, or has either arthritis or enthesitis with at least two of the following:

  • Inflammation of the sacroiliac joints (at the bottom of the back) or pain and stiffness in the lumbosacral area (in the lower back).
  • A positive blood test for the human leukocyte antigen (HLA) B27 gene.
  • The onset of arthritis in males after age 6 years.
  • A first-degree relative diagnosed with ankylosing spondylitis, enthesitis-related arthritis, or inflammation of the sacroiliac joint in association with inflammatory bowel disease or acute inflammation of the eye.

Undifferentiated arthritis:

A child is said to have this condition if the signs and symptoms of arthritis do not fulfill the criteria for one of the other six categories or if they fulfill the criteria for more than one category.

Symptoms of Juvenile Arthritis:

The most common signs and symptoms of juvenile idiopathic arthritis are:

  • Pain. While your child might not complain of joint pain, you may notice that he or she limps — especially first thing in the morning or after a nap.
  • Swelling. Joint swelling is common but is often first noticed in larger joints such as the knee.
  • Stiffness. You might notice that your child appears clumsier than usual, particularly in the morning or after naps.
  • Fever, swollen lymph nodes, and rash. In some cases, high fever, swollen lymph nodes, or a rash on the trunk may occur — which is usually worse in the evenings.

Juvenile idiopathic arthritis can affect one joint or many. There are several different subtypes of juvenile idiopathic arthritis, but the main ones are systemic, oligoarticular, and polyarticular. Which type your child has depended on symptoms, the number of joints affected, and if fever and rashes are prominent features.

Like other forms of arthritis, juvenile idiopathic arthritis is characterized by times when symptoms flare up and times when symptoms disappear.

Juvenile Arthritis

Causes:

Most forms of juvenile arthritis are autoimmune disorders in which the body’s immune system — which normally helps to fight off bacteria or viruses — mistakenly attacks some of its own healthy cells and tissues. The result is inflammation, marked by redness, heat, pain, and swelling. Inflammation can cause joint damage.

Doctors do not know why the immune system attacks healthy tissues in children who develop juvenile arthritis. Scientists suspect that it is a two-step process. First, something in a child’s genetic makeup gives him or her a tendency to develop juvenile arthritis; then an environmental factor, such as a virus, triggers the development of the disease.

Not all cases of juvenile arthritis are autoimmune, however. Recent research has shown that some people, such as many with systemic arthritis, have what is called an autoinflammatory condition. Although the two terms sound similar, the disease processes behind autoimmune and autoinflammatory disorders are different.

Autoimmune Disorders:

When the immune system is working properly, foreign invaders such as bacteria and viruses provoke the body to produce proteins called antibodies. Antibodies attach to these invaders so the immune system can recognize and destroy them. In an autoimmune reaction, the antibodies attach to the body’s own healthy tissues by mistake, signaling the body to attack them. Because they target the self, these proteins are called autoantibodies.

Autoinflammatory Disorders:

Autoinflammatory conditions also cause inflammation, as do autoimmune disorders. And they also involve an overactive immune system, as do autoimmune disorders. Autoinflammation, however, isn’t caused by autoantibodies. Instead, autoinflammation involves a more primitive part of the immune system which causes the destruction of harmful substances by white blood cells in healthy people. For unknown reasons, when this system goes awry, it causes inflammation. Autoinflammatory diseases often cause fever and rashes, in addition to inflammation.

Complications:

Juvenile idiopathic arthritis can cause several serious complications. But keeping a close watch on the condition of your child and seeking adequate medical attention can greatly reduce the risk of such complications:

  • Probleme with the eyes. Some forms may cause inflammation in the eyes (uveitis). If left untreated, this condition can lead to cataracts, glaucoma and even blindness.
  • Often, eye inflammation occurs without symptoms so it is important that an ophthalmologist regularly examines children with this condition.
  • Problems with Growth. Young idiopathic arthritis can interfere with the growth and development of your child’s bones. Some medicinal products used for treatment, mostly corticosteroids, can also inhibit growth.
Juvenile Arthritis

Who Develops this disease?

Some forms of idiopathic juvenile arthritis are more prevalent in girls.

How to diagnose:

Symptoms must have started before age 16 before a doctor diagnoses your child with juvenile arthritis. Doctors usually suspect juvenile arthritis in conjunction with several other possible conditions when they see children with persistent joint pain or swelling, unexplained skin rashes and fever associated with lymph node swelling or internal organ inflammation. A doctor is also considering a diagnosis of juvenile arthritis in children with unexplained limpness or excessive clumsiness.

There is no single test which can be used by a doctor to diagnose juvenile arthritis. A doctor will examine your child carefully and will consider his or her medical history and the results of several tests that will help confirm juvenile arthritis or rule out other conditions. The main factors that go into making a diagnosis of juvenile arthritis are specific findings or problems that relate to the joints.

Symptoms:

  • A doctor must consider not only the symptoms your child has when diagnosing juvenile arthritis but also the length of time these symptoms have been present. Joint swelling or other joint changes that the doctor may observe must be present for at least 6 weeks continuously.
  • You can help the doctor of your child correctly diagnose juvenile arthritis by keeping a record of the symptoms and changes in your child’s joints, noting when they first appeared and when they were worse or better.

Family History:

  • Getting juvenile arthritis is exceedingly rare for more than one family member. But children with a family member who has juvenile arthritis often run a significantly higher risk of developing it.
  • Research indicates that, in families with a history of some autoimmune disorder, juvenile arthritis is also more probable. One research found that families of children with juvenile arthritis are more likely than families of children without juvenile arthritis to have an autoimmune condition such as rheumatoid arthritis, multiple sclerosis, or thyroid inflammation (thyroiditis of Hashimoto). Having an autoimmune disease in your family might, therefore, increase the doctor’s suspicion that the joint symptoms of your child are triggered by juvenile arthritis, or any other autoimmune disease.

Lab Tests:

Laboratory tests, which are usually blood tests, can not provide a clear diagnosis to the doctor alone. However, a doctor may use these tests to help rule out other conditions and classify your child’s type of juvenile arthritis. A doctor may order tests on blood to:

  • Anticyclic citrullinated peptide (anti-CCP) antibodies. Anti-CCP antibodies may be detected in healthy people years before onset of clinical rheumatoid arthritis. They may predict the eventual development of undifferentiated arthritis into rheumatoid arthritis.
  • Rheumatoid factor (RF). Rheumatoid factor, an autoantibody that is produced in large amounts in adults with rheumatoid arthritis, also may be detected in children with juvenile arthritis, although it is rare. The RF test helps the doctor differentiate among the different types of juvenile arthritis.
  • Antinuclear antibody (ANA). An autoantibody directed against substances in the cells’ nuclei, ANA is found in some juvenile arthritis patients. However, the presence of ANA in children generally points to some type of connective tissue disease, helping the doctor to narrow down the diagnosis. A positive test in a child with oligoarthritis markedly raises his or her risk of developing eye disease in the future.
  • Erythrocyte sedimentation rate (ESR or sed rate). This blood test, which measures how fast red blood cells fall to the bottom of a test tube, can tell the doctor if inflammation is present. Inflammation is the key sign of juvenile arthritis and a number of other conditions.

X-Rays:

Your doctor can order x-rays if he or she suspects bone injury or irregular bone growth. Some x-rays may reveal changes in soft tissue early on in the disease. In general, when bones may be damaged, x-rays are more useful later on in the disease.

Other Tests:

Since there are many causes of joint pain and swelling, before diagnosing juvenile arthritis, the doctor can use other laboratory tests to help rule out the conditions. Many of the specifications include:

  • Physical injury.
  • Bacterial or viral infection.
  • Lyme disease.
  • Inflammatory bowel disease.
  • Lupus.
  • Dermatomyositis.
  • Some forms of cancer.
Juvenile Arthritis

Treatment Options:

The main goals of treatment are to:

  • Preserve a high level of physical and social functioning.
  • Maintain a good quality of life.

To achieve these goals, doctors recommend treatments that:

  • Reduce swelling.
  • Maintain full movement in the affected joints.
  • Relieve pain.
  • Prevent, identify, and treat complications.

To meet those goals, most children with juvenile arthritis require a combination of medicine and other therapies.

Medications:

  • NSAIDS:Examples of NSAIDs include aspirin , ibuprofen, naproxen, and sodium naproxen. Sometimes they are the first kind of medicine physicians recommend for juvenile arthritis. Both NSAIDs function similarly by blocking compounds that lead to inflammation and pain called prostaglandins. — NSAID is a different chemistry, however, and each has a slightly different effect on the body. Some kids seem to respond better to one NSAID than another, for unknown reasons. NSAIDs can only be used for the shortest time it takes at the lowest possible dosage.
  • You can purchase some NSAIDs over the counter, while some others require a prescription, including a subset called COX-2 inhibitors.
  • All NSAIDs may have serious side effects, so please consult your child’s doctor before you give any. Your doctor can monitor your child if he or she routinely takes NSAIDs to prevent juvenile arthritis.
  • NSAID side effects include issues with the stomach; skin rashes; high blood pressure; fluid retention; and heart, liver and kidney issues. The longer a person uses NSAIDs, the more likely they will have side effects, from mild to serious. Many other medicines can not be taken while a person is taking NSAIDs because NSAIDs change or replace these other medicines in the way the body uses.
  • Disease-modifying antirheumatic drugs (DMARDs): If NSAIDs do not relieve symptoms of juvenile arthritis in your child, the doctor may prescribe this kind of medication. DMARDs delay the development of juvenile arthritis but as it can take weeks or months to alleviate symptoms, they are also treated with NSAID. While several different forms of DMARDs exist, several doctors recommend one that is called methotrexate.
  • Researchers have found that for certain children with juvenile arthritis whose symptoms are not improved by other drugs, methotrexate is safe and reliable. Since children only require small doses of methotrexate to alleviate symptoms of arthritis, potentially harmful side effects are uncommon. The most severe complication may be liver damage, which a doctor can aid with routine blood tests and check-ups to avoid. It ‘s critical for people taking methotrexate to watch carefully for side effects. When side effects are detected early, the dosage can be decreased by the doctor and side effects removed.
  • Corticosteroids: If your child has very extreme juvenile arthritis, it can require stronger medicines to avoid serious symptoms, such as inflammation of the cardiac sac (pericarditis). The treatment plan can include corticosteroids, such as prednisone, to control serious symptoms. This drug can be administered directly into a joint through IV (intravenous), mouth, or injection. Corticosteroids are highly potent anti-inflammatory medications. Corticosteroids can interfere with the normal development of your child and can cause other side effects, such as a round face, weaker bones and an increased risk of infection. If the drug manages extreme symptoms, the doctor can gradually decrease the dosage, and avoid it entirely in time. Stopping from taking corticosteroids unexpectedly can be risky. Follow the guidance of the doctor closely on how to administer or reduce the dose. Injecting a corticosteroid compound into the infected joint or joints will also provide rapid relief for inflammation in one or only a few joints without the systemic side effects of oral or IV medication.
  • Physical Therapy is also considered as a good option sometimes.

How to Cope up:

  • Juvenile arthritis affects the whole family, all of whom must deal with the unique challenges of this disorder. Juvenile arthritis will constrain your child’s involvement in social and after-school activities and make school work harder. There are many things your family can do to support your child physically and emotionally.
  • For the best quality treatment. Make sure your child receives proper medical attention and follows orders from the doctor. Have a paediatric rheumatologist handle the care of your child where appropriate. If such a specialist is not near by, consider taking your child only once or twice a year. A paediatric rheumatologist should design a treatment plan and meet with your child’s doctor, who will help you execute it and track the progress of your child.
  • Know about your child’s condition and its care as best as you can. Many treatment options are available, and given that juvenile arthritis in each child is different, what works for one child does not work for another. If the drugs recommended by the doctor don’t relieve symptoms or cause adverse side effects, you and your child can speak with the doctor about alternative options. When symptoms are under control your child can be more involved.
  • Consider entering a community group.
  • Try seeking other parents and children faced with similar experiences. It will help you-and your kid-knowing that you’re not alone. Some organisations provide support programmes for juvenile arthritis sufferers and their families.
  • Give your child the most appropriate care possible. Try not to cut your baby too slack just because he or she has arthritis. In siblings, too much coddling can prevent your child from being responsible and independent, which can trigger resentment.
  • Encourage your child to take exercise and physical therapy. Exercise and physical therapy play an significant role in the treatment of juvenile arthritis for many youths. Parents should plan for the children to take part in activities prescribed by the doctor. Many doctors recommend playing team sports or doing other things during the symptom-free periods. The aim is to help keep the joints healthy and flexible, provide other children with time to play, and promote positive social growth.
  • Act closely with the school your child is in. Help your child’s school create an effective lesson plan, and educate the teacher and classmates of your child about juvenile arthritis. Some children with juvenile arthritis may be away from school for extended periods and need the teacher to send home assignments. Any small changes — such as getting an extra set of books, or leaving class a few minutes early to get on time to the next meeting — can be a great help. Most children usually advance through school with due attention.
  • Converse with your kids. Explain why having juvenile arthritis is nobody ‘s fault. Some kids think juvenile arthritis is retribution for something they’ve done. Let your child know that you are always willing to listen, and support him or her in any way you can.
  • Act with social workers or therapists. They can help you and your child adapt more easily to the changes in lifestyle that can bring about juvenile arthritis.

Exercise is the Key:

While pain often prevents physical activity, exercise is essential to decreasing the effects of juvenile arthritis and maintaining joint function and range of motion.

Most children with juvenile arthritis will engage completely in physical and certain sports activities when their symptoms are under control. Swimming is a good workout because, without putting weight on the joints, it requires multiple joints and muscles. A doctor or physiotherapist may prescribe activities and exercises.

Your child’s doctor can advise you to avoid those activities during a disease flare, depending on the joints involved. If the flare has stopped, your child will begin normal activities again.

References:

https://arthritisaustralia.com.au/wordpress/wp-content/uploads/2017/09/Final_Time_to_Move__JIA.pdf

https://www.mayoclinic.org/diseases-conditions/juvenile-idiopathic-arthritis/symptoms-causes/syc-20374082

https://www.niams.nih.gov/health-topics/juvenile-arthritis/

By,

Gopala Krishna Varshith,

Content Developer & Editor,

Clipo.