Minor skin scrapes, sore arm, and fever are common in children. But when swelling, stiffness, and pain happen without any apparent cause, it may be alarming.
Juvenile arthritis is a condition that leads to such issues. And it is not easy to address the problem unless you are strong and make your child strong.
MomJunction tells you about the causes, symptoms and treatment options for juvenile arthritis and also the care you need to take at home.
What Is Juvenile Arthritis?
Juvenile arthritis (JA) is a general term used to refer to all types of arthritis caused in children under 16 years of age.
The autoimmune disease targets the synovium, a tissue that covers the joints. The condition makes the thin synovium to swell and inflame.
JA can affect any joints of the body. Usually, it affects the knees, feet, and hands, but in some cases, it may affect internal organs too.
Arthritis may have more than 100 different conditions leading to pain, inflammation or stiffness in the joints.
[ Read: Knee Pain In Children ]
What Are The Various Types Of Juvenile Arthritis
The most common type of JA is the juvenile idiopathic arthritis (JIA), where idiopathic means “from unknown causes”. JIA is an umbrella term used to refer to the more chronic and specific types of arthritis.
Also known as juvenile rheumatoid arthritis, JIA can affect children of all ages across races and ethnic backgrounds.
As JIA is an umbrella, it has several sub-categories within it: (1)
- Systemic onset arthritis: Also known as Still’s disease, it starts as a whole-body reaction and affects different organs of the body.
This type causes high fever and rashes on the torso, arms, and legs. It may also cause inflammation of the lining of the lung and the heart, known as pleuritis and pericarditis respectively. This can lead to swelling of the lymph nodes and enlargement of the liver and spleen.
- Pauciarticular onset disease: Or oligoarthritis usually affects girls. Fewer than five joints are affected and the common joints are knee, ankle and wrist. Oligoarthritis sometimes affects the iris. This condition is called iritis, or iridocyclitis. Children usually outgrow this condition when they become adults.
- Polyarticular disease: Or polyarticular juvenile idiopathic arthritis (pJIA) affects five or more joints. It targets the smaller joints of the body, such as the toes and fingers. pJIA is more commonly seen in girls than in boys and is more severe than the other two types. Often, this continues into adulthood.
- Juvenile psoriatic arthritis: This may affect children who have arthritis along with a skin condition called psoriasis. Symptoms of psoriatic arthritis in children include pitted fingernails, swelling and joint pain.
- Enthesitis-related arthritis: It affects the spine, hips, eyes, and entheses (connective tissue between bone and ligament). Enthesitis-related arthritis occurs mostly in boys who are older than eight years.
The other types of juvenile arthritis are (2):
- Juvenile dermatomyositis results in muscle weakness and rashes on the eyelids and knuckles.
- Juvenile lupus affects the joints, skin, kidneys, blood and other areas.
- Juvenile scleroderma is, again, an umbrella of some similar conditions that harden and tighten the skin.
- Kawasaki disease is an inflammatory condition that usually affects children below five years of age (3). The child will have a fever, redness in the eyes, rashes and other symptoms.
- Mixed connective tissue disease has a combination of features from arthritis, lupus dermatomyositis and scleroderma.
- Fibromyalgia is more common in girls and usually occurs after puberty. It is characterized by chronic pain, stiffness, and fatigue.
The types of JA are many, but the reasons behind the problems could be the same.
[ Read: Growing Pains In Kids ]
What Causes Arthritis In Children?
JA is an autoimmune disease and hence the exact reasons are unknown.
- JA occurs because the immune system, which protects the kid from infections, mistakenly attacks and damages its own body tissues.
- JA is believed to occur in a two-step process — the genetic factor makes the child prone to develop arthritis, and then some other determinant, such as a virus, may outset the condition.
Autoimmune diseases are idiopathic and reasons are unknown. But they are triggered by a determinant or a risk factor.
What Factors Increase The Risk Of JIA?
While the risks are still being researched, the below factors can increase the chances of JIA (4):
- Genetic factors: Abnormalities in chromosomes, especially the genes related to chromosome 6, are found to increase the risk. A few other genes (PTPN22 and VTCN1) are also likely to cause the problem.
- Not breastfeeding enough: Several studies have connected breastfeeding to JIA. Children who have not been breastfed at all or for long are more likely to have the condition than those who grew up on their mother’s milk.
- Infections: Research has found that infections such as streptococcal and viruses such as parvovirus B19 could lead to JIA. However, how these infections affect the autoimmune diseases is not known.
- Smoking during pregnancy: Though the evidence is inconclusive, a small study has found that smoking more than ten cigarettes a day during pregnancy can increase the risk of JIA in the babies, especially girls.
- Other factors: The mother’s age, her marital status, the season of birth, mode of delivery, number of older siblings, birth weight and gestational age are likely to have an influence.
If your child has more than one of the above risk factors, then you may want to monitor the signs and symptoms of juvenile arthritis.
[ Read: Muscular Dystrophy In Children ]
What Are The Symptoms Of JA?
The following are the signs and symptoms of juvenile arthritis (5):
- Pain in the joints
- Swelling or inflammation of the joints
- Fatigue or tiredness
- Swelling in lymph nodes in the neck and other areas
- Appetite loss
- Inflammation of the eye
- Restricted motion
- Difficulty performing daily activities like walking, running or playing
One early sign of JA is limping in the morning.
There are times when symptoms get worse; this phase is known as flares. And there are times when they get better, known as remission.
While some kids have one or two flare-ups, some may have symptoms that never leave. Juvenile arthritis is also sometimes responsible for stunted growth in children.
Therefore, if you observe the above symptoms in the child, take them to a doctor for a diagnosis.
How Is Juvenile Arthritis Diagnosed?
The doctors usually suspect arthritis when a child has chronic joint pain or inflammation, skin rashes, and fever.
For an accurate diagnosis, doctors may perform a physical examination, record family history, and recommend blood tests and an X-ray.
Is There Any Cure For Juvenile Arthritis?
There is no permanent cure for arthritis, but some children get complete ‘remission’ from it, meaning that the disease is no longer active.
However, any physical damage caused in the joint will remain as it is.
[ Read: Back Pain In Kids ]
What Is The Treatment For Juvenile Arthritis?
While there is no cure for JIA, remission is possible with “early aggressive treatment”. The goal of the treatment is to relieve inflammation, reduce pain and improve the overall quality of life.
- Besides proper nutrition, the treatment plan usually includes medication, exercising, eye and dental care.
- The initial goal of drug therapy is to reduce inflammation and pain.
- The long-term objective is to prevent the progression of the disease and destruction of joints, cartilage, and bones.
- Surgery is rarely used to treat JIA. However, it may be done to rectify discrepancy in the length of legs, straighten a bent joint or replacement of a damaged joint.
- Eye inflammation or uveitis can occur in children. It is, therefore, imperative for them to get their eyes checked regularly.
A standard medication for juvenile arthritis includes (6):
- Nonsteroidal anti-inflammatory drugs or NSAIDs: These medicines decrease pain at low doses and provide anti-inflammatory effect at high does. The drugs are used for children below 12 years of age. The common NSAIDs are ibuprofen, indomethacin, tolmetin and naproxen sodium.
- Disease-modifying antirheumatic drugs or DMARDs: They are used in combination with NSAIDs when the later alone fail to relieve the symptoms. Methotrexate is a DMARD proven to be efficient in the treatment of JIA. The normal treatment dose is 0.5–1 mg/kg/week.
- Corticosteroids: They are the most efficient anti-inflammatory drugs but have serious side-effects such as growth retardation, glucose intolerance, obesity, and pathological bone fractures. Also, they are not known to mitigate the joint damage. However, they may be used in lower doses.
- Biologic drugs: Inadequate performance of the drugs and their inability to address the long-term problems related to JIA, have paved the way for biological drugs. These are used if the long-acting drugs do not show any results within three to six months of initiating the treatment. Some of the biological drugs are etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira) and anakinra (Kineret).
The treatments can relieve the child of the symptoms of juvenile arthritis, but you need to complement the treatment with proper care at home.
Are There Any Home Care Tips For JA?
A significant part of self-care deals with learning to cope with the challenges of arthritis.
Children with arthritis should get enough physical exercise and good nutrition. Here are some tips that you can follow at home:
- Perform the range-of-motion exercises to help with joint stiffness.
- Use a hot or cold pack to relieve the stiffness.
- Take a hot bath.
- Swimming, cycling, etc., will keep the child active. Joints that get no movement are at a greater risk of developing osteoarthritis.
- Support and encourage the child to stay physically active and mentally healthy.
- Distinctive exercises and guarding equipment may be used to reduce the risk of injury.
- Provide the child with a good diet that includes fruits, vegetables, nuts, and fish.
- Avoid saturated fats and foods that could result in overweight because the excess weight will exert pressure on the joints.
Timely treatment and proper care could make the child have better health while growing up because JA could lead to some complications.
[ Read: Vitamin D Deficiency In Kids ]
What Are The Complications Of Juvenile Arthritis?
If arthritis in children is left untreated, it can lead to the following complications (7):
- Bone problems
- Damage to joints
- Stunted growth
- Lung problems
- High blood pressure
- Macrophage activation syndrome (MAS), which is a life-threatening inflammation
Having JIA is not easy for a child. It affects them physically and mentally. Help your child to learn about and understand the disease and the process of treatment. Let them express their feelings, even anger or grief. You may also consider professional counseling, if required.
Do you have an experience to share? Let us know in the comment section.