Juvenile Arthritis

WHAT IS JUVENILE ARTHRITIS?
Juvenile arthritis is a chronic condition that causes inflammation in one or more joints and begins before the age of 16. There are several different patterns of juvenile 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 inflammatory eye problems. Regular eye exams are essential. Others are older 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 that begins at an earlier age than usual.

CAUSES
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.

HEALTH IMPACT

DIAGNOSIS
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.

TREATMENT
The choices of drugs for children are similar to those for adult arthritis and include nonsteroidal antiinflammatory agents such as ibuprofen and slower acting agents such as methotrexate, sulfasalazine, and hydroxychloroquine for more severe cases. 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. Certain drugs such as steroids (cortisone) must be used with caution because of adverse effects on growth and other side effects. Some drugs for adults are not FDA-approved for use in children.

Physical and occupational therapy can prevent disability. Splints, a regular home exercise program or outpatient treatment are often effective.

Children should participate in regular school activities, extracurricular activities and family responsibilities, as much as possible. 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.
Websites:
www.arthritis.org
www.arthritis.org/communities/about_ajao.asp.