Arthritis, which is inflammation or degeneration of the joints, affects children as well as adults. Arthritis in children is called juvenile arthritis, and July is Juvenile Arthritis Awareness Month.

Juvenile arthritis can cause permanent joint damage and impact the child’s growth and physical development, so early intervention and treatment is imperative. Read on to learn more.

The most common type of childhood arthritis is juvenile idiopathic arthritis (JIA). The term “idiopathic” means the exact cause for the disorder is unknown. We do know that JIA is an autoimmune disease. In this case, the body’s germ-fighting immune system malfunctions and targets the joints’ synovial membrane (tissue lining), causing inflammation.

Researchers don’t know why this happens but believe a combination of genetic and environmental factors may be involved.

In the US, juvenile idiopathic arthritis affects about one of every 1,000 children, or about 300,000 children. There are several types of JIA. The three main types are oligoarticular, polyarticular and systemic.

About 50 percent of children with JIA have the oligoarticular type, which typically affects fewer than five joints, most often the knee, ankle and elbow. In most cases, this type is mild and symptoms may lessen or go away over time. Children with oligoarticular arthritis are at high risk for developing inflammation of the eyes (uveitis). To prevent vision loss, your child should have regular examinations by an eye doctor.

About 30 percent of children with juvenile arthritis have the polyarticular type, which affects five or more joints. It often affects the smaller joints such as those in the hands and feet. It can, however, impact larger joints, including those in the neck and jaw. Typically, polyarticular arthritis affects the same joints on both sides of the body.

Systemic arthritis, also called Still’s disease, occurs in about 10 to 20 percent of children with JIA. It affects the entire body, not just the joints. Systemic JIA typically begins with a fever and rash that come and go. In many cases, it leads to inflammation of internal organs such as the heart, liver, spleen and lymph nodes. If not treated appropriately, children with systemic JIA may develop severe arthritis in their joints that continues into adulthood.

Symptoms of JIA may come and go. Sometimes, symptoms are worse (flares) and sometimes symptoms get better (remission). Symptoms vary depending on the type of JIA and may include joint pain, swelling and tenderness; joint stiffness; limping; difficulty with fine motor activities; persistent fever; rash; weight loss; swollen lymph nodes; fatigue or irritability; growth problems; eye redness or pain; and blurred vision.

To diagnose and treat JIA, your child’s pediatrician may refer you to a pediatric rheumatologist, a specialist in arthritis and related conditions in children. The rheumatologist will perform a physical examination and review of your child’s symptoms. The specialist may order tests on your child’s blood and joint fluid, as well as x-rays or an MRI to help rule out other causes for the symptoms and classify the type of arthritis.

The goals of treatment for JIA are to control symptoms, prevent joint damage and maintain function. Treatment also aims to identify, treat and prevent complications of the disorder.

Treatment for juvenile arthritis generally involves medication and therapy. Medications used include nonsteroidal anti-inflammatory drugs (NSAIDs), which can often quickly reduce inflammation and relieve pain. If NSAIDs don’t relieve symptoms, the next step is disease-modifying anti-rheumatic drugs (DMARDs).

DMARDs suppress the immune system on a broad level, helping to prevent progression of the disease and saving the joints from permanent damage. However, these drugs may take weeks or months to relieve symptoms. Biologic response modifiers are another type of medication that block specific immune signals that cause inflammation. They help to prevent progression of JIA, achieve remission and protect against permanent joint damage.

Corticosteroids are strong inflammation-fighting medications that typically bring fast relief when injected into an affected joint. However, they have many possible side effects, including weakened bones, upset stomach and mood swings, so they are generally only used for short periods.

Physical and occupational therapy play important roles in the treatment of children with arthritis. Physical therapy can help relieve pain, improve and maintain range of motion in the affected joints and strengthen the muscles that support the joints. Occupational therapy teaches how to increase or preserve mobility so the child can more easily perform activities of daily living.

A physical or occupational therapist may recommend your child wear a splint or brace to protect the affected joints to reduce inflammation and prevent contractures, the tightening or shorting of the muscles and joints, which causes a deformity.

With prompt and appropriate treatment, most children with arthritis develop normally and can live active, full lives.

Patti DiPanfilo

It’s probably pretty common for people to equate the term arthritis with osteoarthritis, the wear-and-tear form of arthritis that’s common in adults as we get older. But that’s just one type of arthritis. There are many more, including types that specifically affect children. In general terms, that group of disorders is referred to as childhood arthritis or juvenile arthritis.

The most common type of juvenile arthritis is juvenile idiopathic arthritis or JIA. JIA affects approximately one in 1,000 children under age 16 in the United State or about 300,000 children. JIA is an autoimmune disorder in which the body’s own immune system attacks a joint’s cells and tissues, specifically the synovium, the tissue lining the inside of the joint.

In response to the immune system attack, the synovium makes more fluid than needed inside the joint, and that excess fluid leads to swelling, pain and stiffness. This inflammation can eventually damage cartilage and bone, causing joint dysfunction. Without appropriate treatment, JIA can affect a child’s overall growth and development. JIA can also affect a child’s eyes.

There are several subtypes that fall under the JIA umbrella. They all involve chronic or long-lasting joint inflammation. To be considered chronic, the inflammation must have been affecting the joints for more than six weeks. The three main subtypes are characterized by their symptoms and number of joints involved.

Systemic JIA. This type affects about 10 to 20 percent of children with JIA. It generally begins with a high fever that can be accompanied by a rash. This type may cause inflammation of internal organs such as the heart, liver, spleen and lymph nodes as well as the joints. It affects boys and girls equally and rarely affects the eyes.

Oligoarticular JIA. This is the most common type of arthritis in kids and teens. It involves fewer than five joints in its first stages, most often the knee, ankle and wrist joints. It affects about 50 percent of children with arthritis and is more common in girls than in boys. It may spread to involve more joints and can also cause inflammation of the eyes. Many children outgrow this type by adulthood.

Polyarticular JIA. About 30 percent of children with JIA have this type. It affects five or more joints, often the same joints on both sides of the body. This type can affect the neck and jaw joints, as well as the small joints of the hands and feet. It can begin at any age and is more common in girls than in boys.

Symptoms vary depending on the type of JIA the child has, but there are some general symptoms, including:

• Joint stiffness, especially in the morning or after resting
• Pain or tenderness in the joints
• Joint swelling
• Limping
• Persistent fever
• Rash
• Fatigue or reduced activity level
• Eye redness, eye pain or blurred vision

The exact cause of JIA is unknown. Researchers believe that some children possess certain genes that make them more susceptible to developing the disease, then exposure to something in the environment, such as a virus, triggers the disease to begin. It’s not hereditary, however. It’s rare for more than one child in a family to develop JIA.

Early diagnosis and treatment are key to controlling inflammation, preventing joint damage and keeping the child as healthy and functional as possible. There is no one test for JIA. Doctors diagnose the condition using a variety of methods. They generally begin their assessments by taking a thorough medical history of the patient and performing a full physical examination.

Doctors may also order certain tests. These may include laboratory tests on blood, joint and tissue fluids to rule out other conditions as the cause of the symptoms. X-rays may be taken as well to look for any injuries or unusual development of the bones of the joints.

The goal of treatment for JIA is to reduce swelling, relieve pain, prevent damage and maintain function of the joints. There is typically a team of health care professionals involved in the child’s treatment, including physical and occupational therapists, dietitians, social workers and even school nurses working in concert with the child’s doctor.

Because JIA is an autoimmune disorder, medication is often used in its treatment. If only a few joints are involved, doctors may begin by injecting steroids directly into the affected joints to reduce inflammation and relieve pain. Another option is adding a group of medications called disease modifying drugs or DMARDS.

DMARDS may be used when many joints are involved or when the JIA doesn’t respond to the steroids. DMARDS include drugs such as methotrexate and the biologics such as Enbrel, Remicade and Humira. These medications cause side effects and children taking them must be monitored closely.

Physical and occupational therapy also play a role in the treatment of JIA. Physical therapy exercises are important because they help in recovering and preserving range of motion and function of the joints. They also maintain muscle tone, and strong muscles aid smooth joint movement. Occupational therapy teaches the child ways to perform daily activities with limited joint function.

It’s clear that arthritis is not just for seniors. Many children struggle with painful, swollen and inflamed joints as well. If you know a child struggling with arthritis, be understanding and supportive. Help them if they ask for it, but for the most part, allow them to perform activities on their own. With treatment, children with arthritis can live normal, healthy lives.

Arthritis is often associated with age, and when I say “age,” we usually think of people getting arthritis as they get older. But that’s not the complete picture. The Arthritis Foundation reports that an estimated 300,000 children in the US suffer from a form of the disease known as juvenile arthritis.

July is Juvenile Arthritis Awareness Month. This is a good time to learn more about this childhood affliction. There are many types of juvenile arthritis, but we’ll concentrate on the most common form, juvenile idiopathic arthritis or juvenile rheumatoid arthritis.

When something is referred to as idiopathic, it means the exact cause of the problem is unknown. Experts do know that juvenile rheumatoid arthritis is an autoimmune disease, a disorder that leads the body’s own protective immune system to attack healthy cells and tissues. This disorder causes inflammation in the tissue that lines the inside of joints, leading to pain and dysfunction.

Each of the different forms of juvenile arthritis has its own set of signs and symptoms, but some of the most common symptoms, especially with juvenile rheumatoid arthritis include:

• Joint stiffness, especially in the morning
• Pain and tenderness
• Joint swelling
• Redness and warmth
• Limping and difficulty walking
• Reduced activity level
• Difficulty doing daily activities

Juvenile arthritis can affect one or many joints. In addition, it can also affect the eyes, skin, muscles and gastrointestinal tract. Juvenile arthritis afflicts children of any age, but most often occurs in those age 16 or younger.

Diagnosing juvenile rheumatoid arthritis can be a challenge. Early in the course of the disease, pain may be minimal and joint swelling may not be obvious. There are no tests to diagnose the problem, and a blood test that helps diagnose rheumatoid arthritis in adults is not definitive for children. The diagnosis is made based on your child’s medical history, the physical examination and the exclusion of other possible reasons for the symptoms.

If you suspect juvenile arthritis, it’s best to contact a specialist in arthritic conditions, such as a pediatric rheumatologist. The doctor is actually part of a team providing care to your child. Other members of the team include physical and occupational therapists, nurses, possibly a social worker, and other doctors to treat problems associated with the arthritis.

There is no cure for juvenile arthritis. However if it is diagnosed early on and the proper treatment is given, the condition can go into remission. That’s when your child has responded well to treatment and no longer has symptoms. The disease is still there, it just isn’t active.

The goals of treatment for juvenile arthritis are to control symptoms, prevent joint damage and maintain function. The treatments used are aimed at relieving pain, reducing swelling and increasing joint mobility and strength. While each form of juvenile arthritis has its own treatment, care for rheumatoid arthritis generally includes targeted exercises, medication and a healthy lifestyle.

Your child may be the one with juvenile arthritis, but it affects the entire family. But family members can help by being supportive and treating the child as normally as possible. Here are some other things you can do, courtesy of the National Institute of Arthritis and Musculoskeletal and Skin Diseases:

• Get to know your child’s disease. Learn all you can about it.
• Consider joining a juvenile arthritis support group.
• Encourage your child to do the exercises taught by the physical and occupation therapists.
• Stay in touch with your child’s school to help make school tasks as easy as possible.
• Most of all, keep an open dialogue with your child about the disease, its symptoms and treatments.