Juvenile arthritis is an autoimmune disease. This means that the body attacks its own cells and healthy tissues. Arthritis results from the articular inflammation underway in four phases:
- The joint becomes inflamed
- The joint stiffens (contracture)
- The joint suffers damage
- The growth of the municipality has changed
In some cases, the symptoms of juvenile arthritis are mild and do not progress towards more serious diseases and joint deformities. In severe cases, juvenile arthritis can produce serious damage to joints and tissues. It can also cause problems with bone development and growth.
For many years it was believed that most children end up overcoming juvenile arthritis. It is now known that half of children diagnosed with juvenile arthritis will continue to have arthritis active 10 years after the diagnosis unless they receive aggressive treatment.
Types of juvenile arthritis
There are three main types of juvenile arthritis. This classification is based on symptoms, the number of joints involved and the presence of certain antibodies in the blood. Doctors classify juvenile arthritis to help them predict how the disease will progress.
The three main types of juvenile arthritis are:
Oligoarticular (previously known as pauciarticular) means “few joints”. In this type of juvenile arthritis, only a few joints are affected. About 50% of children with juvenile arthritis have oligoarticular type. Girls younger than 8 years are more likely to develop it.
In half of children with oligoarticular juvenile arthritis, only one joint is involved, usually a knee or ankle. This is called monoarticular juvenile arthritis. In most cases, this arthritis is very mild and, over time, the symptoms may decrease or disappear altogether.
For some children, this arthritis affects four or less larger joints. The affected joints include the knee, ankle or wrist. The involvement of fingers or toes is unusual.
Oligarticular juvenile arthritis can also cause eye inflammation. To prevent blindness, the child may need regular eye exams from a doctor who specializes in eye diseases (ophthalmologist). Eye problems can continue into adulthood.
About 30% of children with juvenile arthritis have the polyarticular type. This type of arthritis is more common in girls than boys.
Polyarticular juvenile arthritis affects five or more smaller joints (such as hands and feet). Usually, the affected joints are located on both sides of the body. This type of juvenile arthritis can also affect the large joints.
Children with a certain antibody in the blood, called rheumatoid factor IgM (RF), often have a more severe form of the disease. Antibodies are proteins in the blood usually used by the body to fight infection through an immune response. In this form of arthritis, the IgM RF antibody attacks the tissues of the body. Doctors believe this is the same type of arthritis of adult rheumatoid arthritis.
About 20% of children with juvenile arthritis have the systemic type.
This type of juvenile arthritis causes swelling, pain and limited movement in at least one joint. Additional symptoms include rash and inflammation of internal organs such as heart, liver, spleen and lymph nodes. A fever of at least 102 degrees a day for 2 weeks or more suggests this diagnosis.
If not properly treated, children with systemic juvenile arthritis can develop arthritis in many joints and suffer from severe arthritis that continues into adulthood.
Nobody knows exactly what causes juvenile arthritis. Researchers believe that some children have genes that make them more likely to contract the disease. Exposure to something in the environment (such as a virus) triggers juvenile arthritis in these children. Juvenile arthritis is not hereditary, so it is very rare for more than one child in a family to obtain it.
Juvenile arthritis affects every child differently and can last for indefinite periods of time. There may be times when symptoms improve or disappear (remissions). There are other times when symptoms get worse (exacerbations). Sometimes, a child may have one or two flares and never have symptoms again. Other children may have frequent flare-ups and symptoms that never disappear.
The most common symptoms of juvenile arthritis include:
- Painful joints in the morning that improve in the afternoon. Sometimes, the first sign of the disease is a morning lameness, caused by an affected knee. Even the hands and feet may be affected.
- Swelling and joint pain can also be noted. Although young children can not complain of pain, a child may feel irritable or tired and do not want to play. Sometimes, juvenile arthritis causes swollen lymph nodes in the neck and other parts of the body.
- The joints can become inflamed and warm to the touch. In less than half of juvenile arthritis cases, internal organs can ignite.
- Muscles and other soft tissues around the joint may weaken.
- In some cases, children have a high fever and a light pink rash, which can disappear very quickly.
- Some children develop growth problems. The joints can grow too fast or too slowly, unevenly or on one side. This can make one leg or arm longer than the other. Overall growth may also slow down.
- Some children with juvenile arthritis have eye problems called iridocyclites. This is treatable by an ophthalmologist (ophthalmologist). The presence of eye problems helps to confirm the diagnosis. Without treatment, iridocyclitis can cause damage to the eyes that can not be cured. Most patients do not show symptoms with iridocyclitis and the only way to diagnose this early is the slit lamp examination.
Early diagnosis and treatment can control inflammation, relieve pain, prevent joint damage and keep the child’s ability to function.
The doctor will order a wide range of tests. A complete medical history and physical examination, blood tests and X-rays will help the doctor rule out other conditions that cause arthritis.
The doctor will examine the complete medical history of the child.
He or she will want to know how long his child has had problems with joint pain and swelling and if the symptoms have improved or worsened. The doctor will want to know if the child feels stiff when he gets up after rest and if the joints are swollen. He or she will look for other causes of symptoms, such as a wound, another disease – such as Lyme disease – or a family history of autoimmune diseases.
The doctor will examine the child’s joints. He or she will check for signs of swelling, heat and reduced range of motion. The doctor will also examine the muscles near the affected joints, looking for signs of narrowing (atrophy).
Blood tests, joints and tissue fluids can help to rule out other conditions that could cause similar symptoms. These tests can also be used to classify the type of juvenile arthritis.
X-rays provide clear images of dense structures like bones. The doctor can order them to look for bone lesions or any unusual development of bones.
A child with juvenile arthritis will probably need treatment from a pediatric rheumatologist. This doctor is specialized in helping children with arthritis and related conditions.
The treatment of juvenile arthritis is designed to reduce swelling, maintain full movement of the affected joints and relieve pain. Because juvenile arthritis may have complications, such as joint contraction, soft tissue damage (such as tendons), or joint problems, any treatment program will identify, treat, and prevent complications.
Drugs. The most important part of any treatment plan for juvenile arthritis is the medication. The child may need some medication for several years until juvenile arthritis is no longer active. Your child’s doctor will determine when it is time to stop the medication after the pain, swelling and heat disappear.
- Non-steroidal anti-inflammatory drugs (NSAIDs) are often the first type of medication recommended. These are usually ibuprofen or naproxen and are mainly used to reduce inflammation and alleviate pain. NSAIDs will help calm the disease.
- Disease-modifying antirheumatic drugs (DMARDs) are the next step if NSAIDs do not alleviate symptoms. DMARDs slow down or stop the progression of juvenile arthritis, but may take weeks or months to alleviate the symptoms. The most commonly used drug is methotrexate. Occasionally azulfidine is prescribed. Your doctor may wish your child to take anti-rheumatic drugs that modify the disease along with non-steroidal anti-inflammatory drugs.
- Biological agents are a new class of drugs that slow or stop the progression of the disease. These are usually used only if the disease-causing antirheumatic drugs do not seem to work or if the patient has SI joint arthritis.
- Corticosteroids are more potent drugs that can be used in the treatment of severe juvenile arthritis. Given orally (orally) or injected into a vein (intravenously), corticosteroids can reduce severe symptoms, such as inflammation of the sac around the heart. If only one or two joints are involved, corticosteroids can be injected directly into the joint. Corticosteroids, however, can cause unwanted side effects, such as interfering with a baby’s growth, weight gain, weakening of the bones and increased susceptibility to infections. It is important to follow your doctor’s instructions exactly when taking corticosteroids.
Therapy. Exercise helps maintain muscle tone. Furthermore, it helps to preserve and restore the joint range of movement and functionality. Your doctor can recommend a physiotherapist to design an appropriate exercise program. It is important to balance the activity with rest.
Although pain sometimes limits sport and physical activity, children with juvenile arthritis can often participate fully when symptoms are under control. Swimming is a particularly good exercise because it uses many joints and muscles without weighing down the joints. In some cases, splints and other devices can help maintain joint alignment.
Splints. Splint is useful in children with juvenile arthritis, both at night and during the day, to reduce inflammation and prevent contractures. The splints (plastic braces or other materials) are often used in the arm and in the hand to prevent contractures of the fingers and wrists.
Additional options. In addition to medications, hot baths or an electric blanket can help soothe aching joints.
Surgery is not often necessary in the treatment of juvenile arthritis. In very severe forms of juvenile arthritis or with very serious complications, surgery may be necessary to improve the position of the joint. An example of this could be when a joint has deformed.
Joint replacement – frequently used to treat adults with arthritis – has almost no place in the treatment of children.
Living with juvenile arthritis
There are many treatment options for juvenile arthritis. The main goal of all treatment options is to induce the remission of arthritis. The treatment also focuses on protecting the quality of life of children, allowing them to participate in gaming, sports, school and social activities.
In addition to treatment options, a child’s school and teachers can be an important resource. They may be able to develop useful lesson plans that teach classmates about juvenile arthritis.
With proper attention, most children with juvenile arthritis progress normally during school years.