Children of any age can suffer from arthritis. It is estimated that 1 child in every 1,000 will deal with it. So far, in the United States, around 300,000 children have been diagnosed. Juvenile Arthritis impacts their mental and physical well being. Doctors believe it affects children in the form of an autoimmune disease. The white blood cells in the body cannot distinguish a difference between healthy cells and germs/viruses. The immune system, which is designed to protect the body from bad cells, begins to release large amounts of chemicals in the body to destroy the germs and viruses, but in some cases it also causes damage to healthy tissues. This damage begins to cause pain and inflammation. At this point, doctors do not know exactly what causes some children to have it versus those who do not. Some suspect that it depends on the combination of genes children inherit from family members. The widely accepted term used to describe the numerous types of chronic arthritis in children is Juvenile Idiopathic Arthritis (JIA).
How is a Diagnosis Reached?
Often in cases of JIA, it takes time for doctors to reach a final diagnosis because some children only develop low-key symptoms at first. In many cases, joint pain and swelling are not the first symptoms to occur. In cases affecting adults, a blood test can be administered to determine whether they are suffering from rheumatoid arthritis, however, in the cases of children suffering the test often comes back as “negative rheumatoid factor blood test”. These factors can make it difficult to reach a diagnosis. To reach a final conclusion, doctors must refer to physical findings, medical history, and by excluding other possible ailments with similar symptoms.
With JIA, the child’s inflammation begins before the age of 16, but rarely ever affects children in the first 6 months of their life. Symptoms include joint pain in one or multiple joints, tenderness, swelling, warmth in affected joints, loss of fine motor skills, reluctance to use affected limbs, and reduced activity levels. However, JIA can also include eye inflammation, skin rashes, and inflammation in the internal organs. If pain and joint inflammation persist anywhere from 6 weeks to 3 months, it is considered Chronic Juvenile Arthritis.
Types of JIA:
There are several different subtypes of JIA. Each type has different symptoms but all include chronic joint inflammation.
Oligoarticular JIA affects about 50% of all children who develop arthritis. It can be divided into 2 groups, Persistent and Extended, depending on the number of joints affected. Girls seem to suffer from this particular arthritis more than boys. In its first stage, it can affect 4 or less joints. Knees and wrists are the most common joints to be affected by this type of JIA. Children who are younger than 7 when they develop Oligoarticular JIA are more likely to have their joint disease diminish, however, they are more at risk of developing Iritis or Uveitis(eye inflammation). This eye inflammation can last even after the arthritis subsides, and can result in vision loss. Older children who develop this type of JIA are more than likely to have their symptoms last into adulthood, and have multiple joints affected.
Systemic Onset JIA affects about 10% of children diagnosed with JIA. It affects the whole body and begins with repetitive fevers that can reach 103 degrees or higher. These fevers can get worse in the evening; fevers are also known to drop back to normal randomly. Children suffering from this type of JIA often feel very ill during the fever, appear pale, and develop a salmon-colored rash. The rash may disappear or reappear quickly and randomly. This particular form of arthritis also causes internal organ inflammation, especially in the spleen. Lymph nodes can become enlarged. It is common for doctors to perform blood tests due to the fevers and ongoing symptoms; they often discover anemia and elevated white blood cell counts. Swelling in the joints can be slow to affect the child, sometimes taking months to years after fevers begin. However, once the arthritis sets in, it can persist long after the fevers and other symptoms vanish. Eventually, the child will have multiple joints affected by pain, stiffness, and swelling.
Polyarticular JIA is divided into two categories. Since it is believed that this type is actually Rheumatoid Arthritis, a blood test is performed in instances of Polyarticular JIA. One group tests Positive Rheumatoid Factor (RF+) while the other group’s test results come back as Negative Rheumatoid Factor (RF-). This form of JIA begins at any age and affects 5 or more joints. Girls are mostly affected by Polyarticular JIA. A low-grade fever is known to accompany this form. Also bumps and nodules can develop in areas of the body that receive a lot of pressure from sitting or leaning. Polyarticular JIA affects weight-bearing joints like the neck, hips, knees, ankles, feet, and all of the small joints in hands. Those with Positive test results have a high risk of joint damage with erosions and will deal with pain well into adulthood.
Enthesitis-Related Arthritis (ERA), also referred to as Spondyloarthritis, affects about 15% of children diagnosed with JIA. ERA mainly affects the lower extremities and the spine and also involves inflammation where ligaments and tendons begin to attach to the bone. It most commonly occurs in older children (8-15 years). Boys are affected by this type more than girls. The severity of symptoms varies; for some it is mild and the duration is short. Others have severe episodes that last for long periods of time. Children with ERA often report joint pain, back pain, and stiffness, but it might not be accompanied with obvious swelling. Back inflammation can last into adulthood. In extreme cases, it can cause inflammatory bowel disease such as Ulcerative Colitis and Crohn’s Disease.
Psoriatic Arthritis is a form of arthritis that can affect children with psoriasis, which causes silvery scales on top of red patches of skin. Most children are diagnosed with psoriasis first, even though, most often, the joint pain starts before the skin issues occur. Symptoms are joint pain, stiffness, and swelling. Flare-ups may be followed with periods of remission. It ranges in severity from mild to severe. Any part of the body can be affected, even fingernails and toenails. If it is not treated, this type of arthritis can become disabling.
Undifferentiated JIA is a diagnosis given when a child’s symptoms either point to multiple types of JIA listed above or do not fit into any of the categories listed above.
What Happens Once a Diagnosis is Reached?
Once a diagnosis is reached, the treatment plan centers around relieving joint pain and preventing permanent disability from occurring. Depending on the severity of the Arthritis, doctors will recommend a physical therapy plan as well as medicines. In most cases, a medical team is developed to meet the specific needs of the type of arthritis being dealt with, and may include: a pediatrician, an occupational and/or physical therapist, a rheumatologist, and an ophthalmologist. In cases of JIA that involve eye inflammation, it is very important to have regular check-ups with an ophthalmologist. Children may not have visible symptoms, but the inflammation can lead to permanent partial vision loss or blindness.
Below is a short list of things that are known to help with pain management:
- Physical therapy can be very important for the child’s future because it can prevent contractures, which is a condition where the muscles, tendons, and other tissues shorten and harden making it hard to stretch in these areas. In the long run, this can lead to deformities and joint rigidity.
- Occupational therapy is beneficial because the child is taught how to integrate self-care activities in order to maintain an active childhood. An Occupational Therapist can keep children playing and taking in part in school activities without causing the child’s symptoms to worsen.
- Assistive Devices can help children do things a little easier. They will help children close, open, move, or hold onto something much easier.
- Rest- As important as it is to keep the child active, it is just as important to make sure the child gets plenty of rest. Many doctors recommend trying to find a good balance of rest and activity each day. Some quiet time where they simply rest their painful joints is very beneficial to the child.
- Heat Therapy- Unless the child’s joints are already red and warm, heat therapy is a great way to give some relief from pain. Heat is beneficial at relieving pain and stiffness in joints, muscles, tendons, and ligaments because it increases blood flow, oxygen, and nutrients to them. This can be administered by having the child rest with a heat pack or hot water bottle for 20 minutes at a time. Another suggestion is to have the child begin his or her day by taking a warm shower.
- Stretches after heat therapy can be beneficial to loosen some of the stiffness that is experienced.
- Keep Joints Warm– Many children who suffer from JIA find that they have better days and less stiffness if they are kept warm through the night. It is a common for them to use an electric heating blanket, wear footed pajamas or thermal underwear, or just make sure to use plenty of blankets.
Will Medication be Prescribed?
Doctors will prescribe medications for a child who has been diagnosed with JIA. The most prescribed medications are Non-steroidal Anti-inflammatory Drugs (NSAIDs). Depending on severity levels, Disease-Modifying Antirheumatic Drugs (DMARDs) may be recommended. Cortisone Injections may also be given to reduce inflammation, especially in cases of Oligoarticular JIA. In many cases, doctors will develop a combination of drugs that seem to work best for the child.
NSAIDs are a viable source for relieving pain. They work by blocking Cyclooxygenase (COX) enzymes. There are two types COX-1 and COX-2 and they both produce prostaglandins in the body which lead to inflammation, pain, and fever. By blocking these enzymes, NSAIDs reduce swelling and pain associated with JIA. Many people are able to use them without dealing with any side effects. However, some researchers claim that prolonged use and high dosages can be very bad for individuals. The documented possible side effects are rashes, upset stomach, stomach bleeding, stomach ulcers, high blood pressure, heart problems, kidney problems, and fluid retention which leads to swelling around the lower legs, feet, ankles, and hands.
Corticosteroid medicine is injected into joints and may temporarily reduce inflammation, thereby relieving pain. The shots must be given by a doctor. The doctor will more than likely use a local anesthesia to help during the injections. Some may even give a mild sedative in order to ensure the child is calm during the procedure. Many children experience relief, some may have relief for months maybe even a year. Children can only receive a maximum of 3 injections a year due to serious, potential complications associated with cortisone injections. Below is a list of those risks:
- Death of nearby bone (osteonecrosis)
- Joint infection
- Nerve damage
- Thinning of skin and soft tissue around the injection site
- Temporary flare of pain and inflammation in the joint
- Tendon weakening or rupture
- Thinning of nearby bone (osteoporosis)
- Whitening or lightening of the skin around the injection site
NSAIDs and cortisone injections can prove to be only partially effective so many doctors resort to using Disease-modifying Anti-rheumatic Drugs (DMARDs). So far, these drugs are considered to be the most successful treatment. Doctors have seen success in the numbers of cases achieving remission, as well as, fewer children having long-term joint damage occur. DMARDs target certain components of the immune system and assist in slowing the progression of Rheumatoid Arthritis. Different forms of DMARDs are available; not all work the same way for each individual or form of JIA. A trial and error approach is taken until the correct medication is paired with the child. For children, the most common DMARDs prescribed is Methotrexate. Just like with all medications, bad aspects always accompany the good. Common side effects are upset stomach, rash, damage to the liver or bone marrow, and possible birth defects. When consuming this medication, regular blood work is a must. Doctors find that long-term use in children may not be great for them. The U.S Food and Drug Administration (FDA) now requires warning labels on all boxes of biological DMARDs due to new evidence linking it to increased risk of malignancy and cases of lymphoma.
Is Further Research Being Done?
As more cases of Juvenile Arthritis arise, Doctors and Researchers are working hard to understand the differences between the forms of Arthritis that affect children. With so many factors of JIA, such as the broad age range of children affected as well as the numerous forms. Juvenile Arthritis does not follow a specific pattern of activity; some children have more advanced cases while others have mild effects. Multiple factors are used to evaluate the severity of the disease, quality of life, and levels of disability. Over the past 25 years drastic changes have occurred in the treatment and control of symptoms, but at this point, no cure is available. Hopefully, Doctors find a revolutionary key that opens the doors of progress towards managing JIA symptoms for the children.
If you have a child, who is suffering from some type of JIA, you should consider using Real Time Pain Relief. It is a topical pain reliever that provides relief in minutes. Unlike some pain relievers out there that only contain a few ingredients known to relieve pain, Real Time Pain Relief contains 19 ingredients including Aloe Vera, Arnica, Capsicum, and Glucosamine. It also uses Emu Oil due to its transdermal nature. This means that Emu Oil can match the skin’s cell structure so closely that the natural protection barriers of your skin will allow Emu Oil to penetrate through all layers of the skin carrying all of the beneficial ingredients along with it! It poses fewer side effect risks than all medications prescribed for JIA and is even free of Parabens and Sodium Lauryl Sulfate! It is also the only topical pain reliever available that contains low amounts of menthol (1.5%). The FDA warns that topical pain relievers containing more than 3% menthol can cause skin burns so RTPR is committed to maintaining low levels of menthol. Your child will receive the benefits associated with menthol, which are relief from muscle aches, pain, and cramps, without the discomfort that accompanies lotions with high concentrations of Menthol.