Juvenile Arthritis

Formally called Juvenile Rheumatoid Arthritis, juvenile arthritis is only described in children under the age of 16.  Only in the last 10 years has the word \”rheumatoid\” dropped from the name.  This was done as it was essentially a misnomer. Juvenile arthritis is not a disease process similar to rheumatoid arthritis, but different.  Juvenile arthritis also has several other names such as juvenile idiopathic arthritis, juvenile chronic arthritis and childhood arthritis.  And, just as the generic term ‘arthritis’ refers to over 100 different medical conditions, juvenile arthritis is actually a collection of three different diseases that are arthritic in nature.

One of these three disease conditions included under the umbrella term of juvenile arthritis will affect one in every 1000 children in the United States.  These children often suffer from pain, stiffness and swelling that will last longer than six weeks and cannot be attributed to an injury or any other illness.  In some cases, juvenile arthritis will initially presents after an injury but researchers have found that these injuries are not the cause, only the trigger.

And, while researchers are aware of some of the instances which trigger the onset of juvenile arthritis, they have not found a definitive cause.  Presently, researchers believe that there are no genetic factors for juvenile arthritis since it does not run in families and it doesn\’t appear that mothers pass it to their children.  How the disease will progress appears to be well known but the Why continues to be a mystery.

Because a definitive cause cannot be identified this also does not allow researchers or physicians to identify a single symptom or test that will diagnose juvenile arthritis, a preventative measure to stop it from developing or a curative treatment protocol.  In terms of diagnoses, physicians will use a combination of blood tests and x-rays to rule out other diseases, such as rheumatic fever.  They also use these tests to gauge the extent of the disease which helps them to more accurately plan the treatment protocol.

The most qualified specialists to treat children who present with arthritis are Rheumatologists.  This is a subspecialty of physician who has more years of special education, testing and continuing education which qualifies them to diagnose and treat diseases that cause inflammation in the musculoskeletal system and other bodily organs.

Children who suffer from juvenile arthritis are usually diagnosed in the first six months following the onset of any symptoms.  Pauciarticular arthritis is the most common of the forms of juvenile arthritis and accounts for approximately one half of all the cases diagnosed. (1) This condition will affect four joints or less, affects more girls than boys it is usually diagnosed for the age of four.  Some of these children will also develop inflammation in the eyes from the disease which can lead to blindness if it is not treated appropriately. (2)

Treatment for Pauciarticular arthritis includes the use of omega-3 fatty acids that decrease the amount of medication the child needs to maintain a level of comfort.  Children who go on to develop systemic symptoms are very rare and in some cases the arthritis will spontaneously resolve in several years.

Polyarticular arthritis accounts for 40% of children who are diagnosed with arthritis each and every year.  This condition involves at least five joints and will often affect them symmetrically.  In other words, if the left hand is affected than the same joints in the right eye and will also be affected.  It is more likely to affect a small bones and joints in the body.  If the larger joints are affected it will actually change the way in which they grow and will affect the way in which the child walks.  When this happens children will develop a limp and are more at risk to developing osteoarthritis later in life because of the imbalance in their gait. (3,4)

Children with polyarticular arthritis will present in the pediatrician\’s office with fever, rash and a decreased appetite.  Those who are over the age of 10 may also be positive for rheumatoid factor and can suffer a more severe form of the disease.

The last form of juvenile arthritis affects the least number of children.  Systemic arthritis affects more boys than girls and accounts for only 10% of those diagnosed each year.  Systemic arthritis will affect joints and some organs and the children will suffer from skin rashes and inflammation of the internal organs such as the spleen and liver.  Children will arrive at the pediatrician\’s office complaining of complications from inflammation throughout the body and are usually between the ages of five and 10. (5)

Treatment for any of the juvenile arthritic conditions will center on decreasing pain and inflammation in order to improve the comfort level of the child, improve the growth and development of the bony structures and decrease the progression of the disease.  Interestingly, treatment usually includes exercise programs that do not stress the joints and tissues but help to build muscle in order to protect the joints.  These types of exercises can include swimming and stretching.  The goal is to release endorphins that decrease the perception of pain.

Juvenile arthritis is actually a catch phrase for a group of three different conditions that cause inflammation, pain and redness in the joints and some organ systems and children.  An accurate diagnosis is required in order to prescribe appropriate treatment protocols for the child and plan for his or her future.

(1) British Medical Journal: Pauciarticular Juvenile Rheumatoid Arthritis: Clinical and immunogenetic Aspects

(2) Journal of Pediatrics: Joint Distribution at Presentation in Children with Pauciarticular Arthritis

(3) American Family Physicians: Diagnostic Approach to Polyarticular Joint Pain

(4) The Merck Manual: Polyarticular Joint Pain

(5) National Institute of Arthritis and Musculoskeletal and Skin Diseases: Questions and Answers about Juvenile Arthritis