Juvenile arthritis is a chronic condition which
causes inflammation in one or more joints and begins before the
age of 16. There are several different patterns of arthritis.
Though all have joint inflammation in common, they behave very
differently, may require different treatment approaches and have
different outcomes.
Systemic onset type begins with very high fevers, frequently has a skin rash and shows evidence of inflammation in many internal organ systems as well as the joints. About 10 percent of children with arthritis have this type.
- Pauciarticular onset disease affects fewer than five joints. About half of all children with arthritis are in this category. Some of these are very young, from infancy to about age 5, and have a risk of developing eye problems. Regular eye exams are essential. Others are older [usually over age 8] and may evolve into one of the adult forms of arthritis.
- Polyarticular disease has more than five joints affected, (often many more) and can begin at any age. Some of these children have adult type rheumatoid arthritis which began at an earlier age than usual.
The causes of juvenile arthritis are unknown. Some genetic markers are more common in certain types of childhood arthritis or in children who develop particular complications from it. Although this genetic makeup may be associated with an increased chance of developing arthritis, these conditions are not regarded as hereditary and rarely affect more than one family member. Some features of these diseases suggest that there may be infectious triggers in a genetically predisposed child, but no specific infectious cause has been identified.
- About 285,000 children in the United States have juvenile arthritis.
- The child may be affected by absenteeism from school, reduced participation in peer activities or limited career options.
- The parents and siblings are impacted by the psychological and financial stress of chronic illness in a family member.
Juvenile arthritis may be difficult to diagnose because often children compensate well for loss of function and may not complain of pain. Observations of limping, stiffness when awakening, reluctance to use a limb or reduced activity level may be clues. Tests commonly positive in adult arthritis (rheumatoid factor in the blood or changes on x-rays) are usually negative in childhood types. A number of other conditions can mimic juvenile arthritis, such as infections, childhood malignancies, musculoskeletal conditions or other less common rheumatic disease, and further evaluation to exclude these may be necessary before a diagnosis is confirmed.
Control the inflammation with medications:
The choices of drugs for children are similar to those for adult arthritis and include nonsteroidal anti-inflammatory agents like ibuprofen, ketoprofen, naproxen and piroxicam, and slower acting agents such as methotrexate for more severe case. The doses must be adjusted for the size of the child. Preference may be given to liquid preparations or less frequently dosed medications to help with compliance, and certain drugs such as steroids (cortisone) must be used with caution because of effects on growth. Some drugs for adults are not approved for use in children.
Prevent or correct loss of range and function:
Physical and occupational therapy can prevent disability, and splints, a regular home exercise program or outpatient treatment are often effective.
Encourage normal physical and emotional development:
Children should participate in regular school activities, extracurricular activities and family responsibilities.
Education and support:
Families with children with rheumatic disease may be eligible for resources such as assistance through state agencies or vocational rehabilitation. Contact with other families dealing with similar issues may be helpful, and the American Juvenile Arthritis Organization (a branch of the Arthritis Foundation) provides educational materials, regional and national conferences, and networking opportunities for children and young adults who grew up with arthritis.
Optimal care for juvenile arthritis is provided by a pediatric rheumatology team (pediatric rheumatologist, physical and occupational therapist, social worker and nurse specialist) who have extensive experience and can most effectively diagnose and manage the complex needs of a child and family. They can coordinate with the child’s pediatrician, adult rheumatologists, other physicians (ophthalmologist, orthopedic surgeon), other health professionals (dentist, nutritionist or psychologist), and schools and community resources necessary for the child’s best long-term physical and psychosocial well-being.
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