National Juvenile Arthritis Awareness Month

July 18, 2012

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Most people think of arthritis as a disease reserved for the elderly. It can be, however, juvenile arthritis can also affect children who are still growing and developing. Juvenile arthritis (JA) refers to any form of arthritis or arthritis-related condition that develops in children or teenagers who are less than 18 years of age. Approximately 294,000 children under the age of 18 are affected by pediatric arthritis and rheumatologic conditions. Below is some information from the Arthritis Foundation to educate you on JA and teach you ways you can help.

WHO GETS JUVENILE ARTHRITIS?.

No known cause has been pinpointed for most forms of juvenile arthritis, nor is there evidence to suggest that toxins, foods or allergies cause children to develop the disease. Some research points toward a genetic predisposition, which means the combination of genes a child receives from family members may cause the onset of arthritis when triggered by other factors.

Oligoarthritis and polyarthritis are both more common in girls, while boys and girls are equally vulnerable to systemic arthritis. Boys are more commonly diagnosed with enthesitis-related arthritis. Like everything else, there are exceptions to every rule, so work with your child’s doctor to get a proper and timely diagnosis.

No single blood test confirms juvenile arthritis. In fact, blood testing will reveal relatively little in terms of your child’s diagnosis. In children, the key to diagnosis is a careful physical exam, along with taking a medical history.

Along with the physical exam itself, your child’s doctors will take a number of other diagnostic steps – such as laboratory work and x-rays and other imaging tests - in part to rule out other potential causes of symptoms. Blood work, for example, can rule out the possibility of an underlying infection.

TREATMENT OF JUVENILE ARTHRITIS

The most important step in properly treating your child’s JA is getting an accurate diagnosis. The diagnostic process can be long and detailed, but be patient. Your child’s pediatrician will likely recommend that you visit a pediatric rheumatologist who will then take a complete health history to determine the length of time and type of symptoms present.

Unfortunately, there is no cure for juvenile arthritis. The goal of treatment for JA is to relieve inflammation, control pain and improve your child’s quality of life. Most treatment plans involve a combination of medication, physical activity, eye care and healthy eating.

Every treatment plan is unique and requires that your child's health care team, which might include a pediatric rheumatologist, dentist, ophthalmologist, nurse practitioner and physical therapist, among others.

Medications

Medications used to treat JA can be divided into two groups: those that help relieve pain and inflammation (nonsteroidal anti-inflammatory drugs, or NSAIDs, corticosteroids and analgesics) and those that can alter the course of the disease, put it into remission and prevent joint damage, a category known as  disease-modifying anti-rheumatic drugs (DMARDs) and a newer subset known as biologic response modifiers (biologics).

Each child responds to his or her treatment plan differently, so there’s no set course of attack for JA. Your child's doctor might try several different medications and/or dosages until your child responds positively to treatment. Some medications affect the immune system or have other side effects, making careful and frequent monitoring very important.

Splints and Orthotics

Splints are commonly used in children with arthritis to help keep joints in the correct position and to relieve pain. Usually, an occupational or physical therapist will evaluate your child and make a splint designed specifically for him. Orthotics or shoe inserts might be used to compensate for any difference in leg length or to improve balance.

Physical/ Occupational Therapy

Physical therapy can help restore motion and flexibility in joints that have become stiff.  A physical therapist will help your child perform gentle exercises designed to keep her joints limber while building muscle, strength and endurance. An occupational therapist can evaluate your child and help her learn how to perform daily activities – such as bathing, dressing or even wearing a back pack – without aggravating her arthritis. The goal of occupational therapy is to help your child participate fully in school, at home and in other activities.

Surgery

While unlikely, it is possible that your doctor will at some point recommend that your child have surgery to relieve pain (fusion surgery), straighten out a bent or deformed joint (soft-tissue release) or replace a damaged joint (joint replacement).

Maintain a Healthy Lifestyle and Body

Your doctor will likely recommend that your child engage in moderate physical activity on a regular basis. Exercise keeps joints flexible and strong, while maintaining range of motion and minimizing stiffness. While exercise can be painful, it ultimately is essential to a successful treatment plan. Some good activities to consider are swimming, family walks and bike rides. These activities are low impact, fun and easy on your child’s joints.

Children with arthritis may have to contend with weight loss or weight gain, depending on the state of their disease and the medications they’re taking. If weight loss is an issue, often due to jaw pain or fatigue, your child’s doctor might recommend a higher calorie diet rich in nutrients. If your child gains weight due to the side effects of medications or limited activity, his doctor may recommend that a visit to a registered dietician to help you and your child develop a healthy diet. Children with arthritis need to maintain a healthy weight  – every extra pound places additional pressure on knees, hips and ankles.

Eye Care

Uveitis (inflammation inside the eye) and iritis (inflammation of the iris)  are common complications found inseveral forms of juvenile arthritis. If your child develops one of these conditions, her doctor will likely recommend she visit a pediatric opthamologist, a specialist who treats children with eye and vision issues. Frequent eye exams will help prevent arthritis-related eye problems, but if one does occure, there are many treatments available.

Dental Care

Children with arthritis may experience challenges trying to open their jaw widely enough to properly brush and floss their teeth. Your child’s dentist can suggest tools such as toothbrush handles, floss holders and other instruments to aid in proper dental care. An occupational therapist an also work with your child to increase mobility in her jaw.

WHAT CAN I DO TO HELP? 

There are many events, runs, walks, and programs that you can participate in to help those who suffer from juvenile arthritis. Information about these events can be found at http://www.arthritis.org/programs-events.php

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