Arthritis in children
Arthritis in children
Types of Juvenile Arthritis
Juvenile Rheumatoid Arthritis
Juvenile Spondyloarthropathies
Juvenile Psoriatic Arthritis
Juvenile Dermatomyositis
Juvenile Vasculitis
Juvenile Non-inflammatory Disorders
Supportive issues
The word arthritis literally means joint inflammation. Arthritis can be a chronic illness, meaning that it may last for months or years. Juvenile arthritis refers to arthritis or an arthritis-related condition (rheumatic disease) that occurs later in adolescent age.
The most common form of arthritis in children is juvenile rheumatoid arthritis
(JRA). Estimates vary on the number of children in the U.S. who have JRA; however,
it is one of the most common chronic childhood illnesses. Children also are
affected by arthritis as a feature of more than 100 other diseases including
diseases that affect the spine, connective tissue diseases, and non-inflammatory
disorders such as fibromyalgia.
The causes of most forms of juvenile arthritis are unknown. Juvenile arthritis is not contagious and there is no evidence that foods, toxins, allergies or vitamin deficiencies play a role. Current research indicates that there may be a genetic predisposition to juvenile arthritis. Most of the symptoms are due to inflammation as a result of the immune system. Nonetheless, there are many effective treatments available to help you and your child manage juvenile arthritis.
There are many types of known arthritis. Early diagnosis and treatment are keys to preventing or slowing joint degeneration (damage).
Juvenile rheumatoid arthritis (JRA) is the most common form of arthritis in children. It often is a mild condition that causes few problems, but can produce serious complications in severe cases.
Symptoms of JRA include fatigue, joint stiffness following sleep or inactivity and weakness in muscles and other soft tissues. However, because JRA affects each child differently, your child may not experience all of these changes. Children also vary in the degree to which they are affected by any particular symptom.
The signs and symptoms of JRA vary from child to child, from day to day and even throughout the same day. One day it might seem that your child has gone into remission, which is a period when arthritis symptoms improve or even disappear. Other days your child might experience a flare, which is when arthritis is at its worst.
There is no single test to diagnose JRA. The diagnosis is determined by the presence of active arthritis in one or more joints for at least six weeks after other conditions have been ruled out.
There are three major types of JRA - polyarticular JRA, which affects five or more joints; pauciarticular JRA, which affects four or fewer joints; and systemic onset JRA, which also includes a high fever and a characteristic rash.
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Juvenile Spondyloarthropathies
The spondyloarthropathies are a group of diseases that involve the spine the joints of the lower extremities, most commonly the hips and knees. There are several different forms of spondylothopathies including juvenile ankylosing spondylitis, seronegative enthesopathy and arthropathy syndrome (SEA syndrome), arthritis associated with inflammatory bowel disease and reactive arthritis. Spondyloarthropathies occur more often in boys than in girls. Juvenile ankylosing spondylitis generally causes arthritis in the large joints of the lower extremities, such as the hips. A blood test for a protein called HLA-B27 is frequently positive in children with ankylosing spondylitis.
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Juvenile Psoriatic Arthritis
Juvenile psoriatic arthritis is a type of arthritis affecting both boys and girls that occurs in association with the skin condition psoriasis. However, the psoriasis may begin many years before or after the onset of arthritis. Skin findings of psoriasis include a scaling red rash commonly seen behind the ears, on the eyelids, elbows, knees and at the scalp line or the umbilicus. In addition, there may be changes of the fingernails such as pitting or ridging. There may be a family history of psoriasis or psoriatic arthritis.
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Juvenile Dermatomyositis
Juvenile dermatomyositis (JDMS) is an inflammatory disease that causes muscle weakness and a characteristic skin rash on the eyelids. About 20 percent of children with JDMS have arthritis.
Juvenile dermatomyositis is more common in girls and occurs most often in children between the ages of 5 and 14. The muscle weakness most commonly affects the muscles of the trunk, shoulders and upper legs. This causes problems with activities like running, climbing stairs, or getting up from a chair or the floor. Muscle pain or tenderness is a frequent complaint of children with JDMS but is not usually severe. Gastrointestinal involvement also may be a part of JDMS and can lead to poor absorption of medications, ulceration and perforation.
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Juvenile Vasculitis
Vasculitis means inflammation of the blood vessels. There are several distinct forms of vasculitis, each with unique clinical features. In addition, vasculitis may be seen in children with JDMS or lupus.
Henoch-Schonlein purpura (HSP) is the most common form of vasculitis in children. Signs and symptoms include a rash, arthritis, abdominal pain and much less commonly, kidney dysfunction. The rash is most commonly located on the buttocks and lower extremities, and consists of raised bruises that progress from red to purple to brown in color.
Kawasaki disease (KD) is a form of vasculitis that is most common in very young children and affects boys more often than girls. Symptoms of KD include fever, irritability, rash, red eyes bright red, swollen lips that crack and bleed, peeling of the skin on the fingers and toes, lymph node enlargement and sometimes arthritis. Heart involvement is the most serious complication of this disorder.
Polyarteritis nodosa is a vasculitis of small and medium-sized blood vessels. It can affect any organ system, but most frequently involves the skin, peripheral nerves, kidneys, intestines and joints.
Some other forms of juvenile vasculitis include cutaneous polyarteritis, Wegener’s granulomatosis and Behcet’s syndrome.
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Juvenile Non-inflammatory Disorders
Non-inflammatory disorders are important causes of chronic or recurrent pain in children. They may be due to heredity, as a result of injury or from unknown causes.
Treating Juvenile Arthritis
Early diagnosis and appropriate treatment provides children with the best possible opportunity for a good outcome. Your child’s treatment will be based on the kind of arthritis she has and on her specific symptoms. The goals of any treatment program for juvenile arthritis are to control inflammation, relieve pain, prevent joint damage and maximize functional abilities.
Your child’s treatment program will usually include medication, exercise, eye care, dental care and proper nutrition. Treatments such as surgery may be necessary for special long-term problems.
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Supportive issues :
Your child may feel angry or sad about having arthritis. But be aware that you as parents, siblings and other family members also may have emotional reactions about the disease and its effect on the family. Learning how to cope with arthritis will benefit everyone.
When you are first told your child has arthritis, you might feel shocked or disbelieving. You might also feel guilty and ask yourself if something you did or didn’t do caused your child’s arthritis. While these thoughts are common to parents whose children are ill, you are not to blame. Remember, you are not the cause of your child’s arthritis.
The child with arthritis may feel many different emotions. Children can feel hurt by an illness that isn’t their fault, blame parents for the illness, engage in self-pity, or become angry because of restrictions on activities. They may also resent other children who do not have the disease, including their brothers and sisters.
Siblings may feel left out and resentful because of the amount of time and attention the child with arthritis requires. Or they may feel guilty, as if they had somehow caused the illness.
Children may over identify with the brother or sister with special needs. Some feel pressure to achieve or make up for what their sibling can no longer do. Others want to involve themselves in care giving to the point that they give up their own normal activities. In these cases, try to help siblings find other ways to deal with their feelings. Let brothers and sisters settle their own differences. Whenever possible, encourage siblings to talk with peers who live in homes with similar concerns.
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