Arthritis is an inflammation of the joints that causes pain and swelling. Juvenile arthritis is the term used for arthritis in children. The most common form of juvenile arthritis is juvenile idiopathic arthritis (JIA).
Arthritis is a group of more than 100 diseases. It’s only one category of rheumatic diseases. Rheumatic diseases can cause pain, stiffness, and swelling in the joints, and bones. Rheumatic diseases can also affect other areas of the body, including organs. Some rheumatic diseases affect connective tissues. These types of tissues include muscles, tendons, and ligaments. The diseases are known as connective tissue diseases. Other types of diseases are caused by the body's immune system attacking its own healthy cells and tissues. These are known as autoimmune disorders.
Experts don’t know what causes juvenile arthritis and most types of rheumatic diseases. In many cases, the cause may vary depending on the type of disease. Certain factors that may play a part in one or more types of these diseases include:
- The immune system
- Genes and family history
- Nervous system problems
- Metabolic problems
- Excessive wear and tear and stress on the body
- Environmental triggers
- The effect of some hormones on the body
Juvenile arthritis and rheumatic diseases can affect children of any age and any ethnic background. But some types are more common in some children, such as:
- Juvenile rheumatoid arthritis (JRA). This condition more often affects children younger than age 15.
- Systemic lupus erythematosus (lupus). This occurs more often in girls.
- Ankylosing spondylitis (AS). This bone disease is more common in boys.
Each type of rheumatic diseases has its own set of symptoms. And symptoms can occur a bit differently in each child. But the most common symptoms in all the diseases include:
- Joint pain
- Swelling in 1 or more joints
- Joint stiffness that lasts for at least 1 hour in the early morning
- Chronic pain or tenderness in the joints
- Warmth and redness in the joint area
- Limited movement in the affected joints
- Extreme tiredness (fatigue)
- Fevers that don't go away, or that come back
These symptoms may seem like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.
The process starts with a health history and a physical exam. You child may need tests. These include blood tests such as:
- Antinuclear antibody (ANA) test. This checks the levels of antibodies in the blood.
- Complete blood count (CBC). This is done to see if white blood cell, red blood cell, and platelet levels are normal.
- Creatinine. This checks for kidney disease.
- Sedimentation rate. This can detect inflammation.
- Hematocrit. This test measure the number of red blood cells.
- Rheumatoid factor test. This test checks to see if rheumatoid factor is present in the blood.
- White blood cell count. This can measure the level of white blood cells in the blood.
- Uric acid. This can help diagnosis gout.
Other tests may be done, such as:
- Joint aspiration (arthrocentesis). A small sample of the synovial fluid is taken from a joint. It's tested to see if crystals, bacteria, or viruses are present.
- X-rays or other imaging tests. These are done look at the extent of damage to a joint.
- Urine test. This is done to check for protein and various kinds of blood cells.
- HLA tissue typing. This is done to look for genetic markers of ankylosing spondylitis.
- Skin biopsy. Tiny pieces of tissue are taken to check under a microscope. This helps to diagnose a type of arthritis that involves the skin, such as lupus or psoriatic arthritis.
- Muscle biopsy. Tiny pieces of tissue are taken to check under a microscope. This helps to diagnose conditions that affect muscles. These include polymyositis or vasculitis.
Treatment will depend on your child's symptoms, age, and general health. It will also depend on what type of disease your child has, and how severe the condition is. A treatment plan is tailored to your child with his or her healthcare team. The healthcare team will include your child's primary healthcare provider. It may also include a rheumatologist, orthopedist, physical therapist, and other healthcare providers.
There is no cure for most juvenile arthritis and other rheumatic diseases. The goal of treatment is often to limit pain and inflammation, and help retain joint function. Certain organs, such as the eyes and heart, are also checked often for problems. Treatment plans often use both short-term and long-term methods.
Short-term treatments include:
- Medicines. Short-term relief for pain and inflammation may include pain relievers such as acetaminophen, ibuprofen, or other nonsteroidal anti-inflammatory medicines. Talk with your child's healthcare provider before giving any of these medicines to your child.
- Heat and cold. Pain may be eased by using moist heat (warm bath or shower) or dry heat (heating pad) on the joint. Pain and swelling may be eased with cold (ice pack wrapped in a clean, thin towel) on the joint.
- Joint immobilization. Using a splint or brace can help a joint rest and protect it from further injury.
- Massage. Lightly massaging painful muscles may increase blood flow and bring warmth to the muscle.
Long-term treatments include:
- Disease-modifying antirheumatic drugs (DMARDs). These medicines may slow down the disease and treat any immune system problems linked to the disease. Examples of these medicines include methotrexate, hydroxychloroquine and sulfasalazine.
- Corticosteroids. These medicines, such as prednisone, reduce inflammation and swelling. They can be taken by mouth or IV (intravenously), or as a shot.
- Biologics. These are medicines to help stop the inflammation process in the body. These include etanercept, golimumab, and infliximab.
- Weight loss. Extra weight puts more stress on joints such as the hips and knees.
- Exercise. Certain exercises may help ease joint pain and stiffness. These include swimming, walking, low-impact aerobic exercise, and range-of-motion exercises. Stretching may also help keep the joints flexible.
- Use of assistive devices. Canes, crutches, and walkers can help to keep stress off certain joints and to improve balance.
- Surgery. In severe cases of disease, a child may need surgery to fix or replace a joint. There are 2 main types of surgery: repair and replacement. Surgery to repair a damaged joint may include removing debris in the joint, fusing bones, or correcting a bone deformity. If a joint is too damaged for repair, it may need to be replaced with an artificial joint.
If only a few joints are affected, arthritis may cause little or no joint damage. Some children may have long-term (chronic) pain and disability. Other complications include slowed growth, anemia, and problems with the eyes or heart.
Help your child manage his or her symptoms by sticking to the treatment plan. Encourage exercise and physical therapy. Find ways to make it fun. Work with your child’s school to make sure your child has help as needed. Work with other caregivers to help your child take part as much possible in school, social, and physical activities. Your child may also qualify for special help under Section 504 of the Rehabilitation Act of 1973. You can also help your child find a support group to be around with other children with similar health conditions.
If your child’s symptoms get worse or he or she has new symptoms, let the healthcare provider know.
- Arthritis is an inflammation of the joints that causes pain and swelling. Juvenile arthritis is the term used for arthritis in children.
- Arthritis is one type of rheumatic disease. Arthritis affects joints, muscles, tendons, ligaments, and bones. Rheumatic diseases can affect other body parts. These include organs such as the heart and eyes.
- Common symptoms include joint pain, swelling, stiffness, and warmth.
- Experts don’t know what causes juvenile arthritis and most types of rheumatic diseases.
- Treatment options include medicines, heat and cold, massage, exercise, physical therapy, and surgery.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
August 14, 2018
Nelson Textbook of Pediatrics. Kliegman, RM. 2007;18:Chap. 155.
Diane Horowitz MD,John Hanrahan MD,Raymond Kent Turley BSN MSN RN