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Juvenile Arthritis – The Adult Disease Kids Get Too

Juvenile arthritisNearly 300,000 children in the United States have some sort of arthritis. Surprised? If you are like most people, you associate the symptoms of arthritis with aging, usually involving inflammation of the joints accompanied by swelling, heat, and pain. In adults initial signs may be overlooked or attributed to some other condition – a high fever, swelling and stiffness in a finger, the neck or hips, or the appearance of a rash with an unknown cause. Surprisingly, these same symptoms in a child often indicate a diagnosis of arthritis. The condition may last for only a few short weeks or months and then vanish entirely, or in chronic cases the duration may encompass many months to years. For a handful of children the condition spans their entire lifetime.

What Is Juvenile Arthritis?

Arthritis is categorized as a musculoskeletal condition comprised of 100 plus different types of illness or disorders that share common symptoms: the destruction of joints, bones, muscles, cartilage and other connective tissues, resulting in reduction of physical movement, sometimes to the point of immobility. When involving children under the age of 16, an umbrella term of “Juvenile Arthritis” (JA) encompasses a variety of autoimmune and inflammatory disorders. Arthritis’ primary target is inflammation of a joint, but JA can also impact eyes, skin and the gastrointestinal tract in children.

What Are the Causes of Juvenile Arthritis?

A specific cause of JA has not been documented for most forms of the disease, although research classifies it as an autoimmune disease. The immune system, which is supposed to protect the body from these harmful invaders, instead releases chemicals that can damage healthy tissues and cause inflammation and pain. There is not enough evidence to propose that toxins, foods or allergies cause JA to develop in children either. However, some research indicates a potential for genetic predisposition, which, when initiated by certain factors, may set off the arthritis.

What is the Most Common Type of JA?

About 50,000 U.S. children have developed what is termed juvenile idiopathic arthritis (JIA), also called juvenile rheumatoid arthritis (JRA), although symptoms differ significantly from adult RA. The initial signs of JIA are usually joint pain and/or swelling, reddened and warm joints for at least six weeks in children between the ages of 6 months to 16 years. Unfortunately, the greater the number of joints affected, the more severe the diagnosis, which reduces the potential for the disease to go into total remission.

There are seven major types of JIA:

Systemic JIA – The whole body is affected: with intermittent high fevers and rash; enlarged spleen and lymph nodes; swelling, pain, and stiffness in many joints.

Oligoarthritis.  Pain, stiffness, or swelling in four or less joints, usually knee and wrist joints.

The iris of the eye may also become inflamed independent of joint symptoms.

Polyarticular arthritis, rheumatoid factor negative. More prevalent in females, includes swelling or pain in five or more joints as well as bumps or nodules in areas of the body subjected to pressure from sitting or leaning. The small joints of the hands are affected as well as the weight-bearing joints like the knees, hips, ankles, feet, and neck, often accompanied by a low-grade fever.

Polyarticular arthritis, rheumatoid factor positive. Is comparable to adult rheumatoid arthritis, there is a higher risk of joint damage with erosions.

Psoriatic arthritis. This type of JIA is accompanied by a psoriasis rash, and fingernails and/or toenails might be also be affected.

Enthesitis-related arthritis: The lower extremities and the spine are affected, and inflammation where tendons join bones is common. Children with Crohn’s Disease and ulcerative colitis are at risk.

Undifferentiated arthritis: Symptoms can’t be categorized or don’t fit into more than one category.

Diagnosis and Treatment

To effectively manage and minimize the effects of arthritis, an early and accurate diagnosis is essential. Dr. Charkawi will determine a diagnosis following a detailed medical history, a thorough physical exam, and potentially X-rays or blood tests to rule out other conditions with similar symptoms. A referral to a pediatric rheumatologist may be necessary for further testing.

JIA can be managed with a combination of medication and/or corticosteroid injections, physical therapy, and exercise. In more serious cases, a child may require corticosteroid injections into the joint or surgery. By understanding the symptoms and characteristics of each type of JIA, you can help your child maintain an active, productive lifestyle. At Johns Creek Family Medicine our primary treatment objectives are to relieve pain and inflammation, prevent permanent damage to joints, and restore use and function of the joints. We provide family internal medicine residents in Johns Creek, Alpharetta, Milton, Cumming, and Suwanee and to help your child manage the condition so that they can live a life where arthritis is a part of their identity, but does not define it.

For inspiring stories, follow this link: http://www.kidsgetarthritistoo.org/living-with-ja/parenting-stories/taylor-six.php

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