The word arthritis means inflammation of the joints. This inflammation causes pain, stiffness, swelling and decreased mobility. However, just feeling pain in the joints does not mean having arthritis. It is arthritis if there are signs of inflammation and if the pain in the joint is present during physical examination. Arthritis can be a chronic disease, which means it could last for months or years. Juvenile arthritis refers to arthritis or a condition related to arthritis (rheumatic disease) that occurs before the age of 16.
In India, almost 3,000,000 children have some form of juvenile arthritis. Arthritis also affects children as a symptom of other diseases, including those affecting the spine, skin, gastrointestinal tract and other organs.
The cause of most forms of juvenile arthritis is still unknown. Juvenile arthritis is not contagious and there is no evidence that food, toxins, allergies or lack of vitamins play a role in the development of this disease. Current research indicates that there may be a genetic predisposition to juvenile arthritis. In other words, the combination of genes that your child has inherited, in conjunction with other factors that are not defined at the time, can contribute to their development.
Most of the symptoms of juvenile arthritis are due to inflammation, presenting heat, swelling and redness. Usually, it is caused by an overly active immune system that causes damage to the body. When there is juvenile arthritis, the immune system (which is a natural defense mechanism of the body against infection) by some malfunction damages the joints. For this reason, juvenile arthritis is considered an autoimmune disease. Although the cause or causes are unknown, there are many arthritis treatment in Delhi that are effective and are available to help you and your child control juvenile arthritis.
Signs of inflammation in the joints:
- Reddened skin
- Sensitivity to touch
It is important to determine if your child has arthritis or a related condition, because the treatments are different in each case. Early diagnosis and arthritis treatment in Delhi is essential to prevent or reduce joint damage.
Although there is currently no cure for arthritis, there are several therapies. To get a diagnosis, your family doctor can send you and your child to a pediatric rheumatologist in Delhi. A pediatric rheumatologist is a doctor who specializes in treating children and people with arthritis. Later we present a section on diagnosis. It is a very good idea to get an early diagnosis, in this way you can also start the treatment in a timely manner. Early treatment will give better results and limit joint damage.
Below you will find a list of different types of juvenile arthritis.
TYPES OF YOUNG IDIOPATHIC ARTHRITIS (AIJ)
Juvenile idiopathic arthritis (JIA) is the most common form of arthritis in children. It is one of the most common chronic diseases of childhood, almost as common as juvenile insulin-dependent diabetes. Before it was known as Juvenile Rheumatoid Arthritis (JRA) and Juvenile Chronic Arthritis (JCA). Commonly it is a mild condition that causes few problems, but it could cause serious problems in severe cases.
Symptoms seen in joints with JIA include: swelling, stiffness, redness, warmth or pain in the affected joint, which often worsens upon awakening or after remaining motionless for a period of time. Among the additional symptoms that are not observed in the joints are: fatigue, insomnia, lack of appetite and weight loss. However, because the JIA affects each child differently, your child may not have all of these symptoms. In addition, some of these signs of arthritis may affect some children more than others.
The symptoms of JIA not only vary from one child to another. They also change from one day to the next and in your child, they could even vary during the same day. One day it may seem that your child has entered a remission stage. Remission is a period in which the symptoms of arthritis disappear and the results of physical examinations improve. Only your arthritis doctor in Delhi can decide whether or not your child is in remission and to do this, you should have an exam since arthritis is considered active even if only one joint is inflamed.
There will also be days when your child experiences episodes in which arthritis is more active. Your child may not feel well, have pain, or have a swollen, red, swollen joint that does not move well. Here are some tips to help your child when he has a relapse episode.
The diagnosis of JIA is based on the results of the physical examination and the execution of several laboratory tests could be used to corroborate it. The diagnosis is made by the presence of active arthritis in one or more joints for a minimum of six consecutive weeks and then rule out other diseases. There are several types of JIA:
- Oligoarthritis, which affects a few joints, the most common,
- Polyarthritis, which affects five or more joints,
- Systemic arthritis, which affects the entire body, occurs in almost 10% of cases,
- Arthritis associated with enthesitis often referred to as spondyloarthritis,
- Juvenile psoriatic arthritis, which affects the skin, and
- Undifferentiated arthritis.
These types of arthritis are described below.
The term oligo means “few,” in which case it affects few joints. It is the most common form of JIA, particularly in young children. This arthritis affects four or fewer joints, typically large joints (knees, ankles, or elbows). Particularly common in white children, where it accounts for approximately 40% of new cases of JIA and develops by the age of 7. Children with oligoarthritis are at increased risk of developing a chronic inflammation of the eye called uveitis. Girls are at greater risk of developing both disorders. Your child should visit regularly the ophthalmologist (doctor specializing in eye diseases).
Children with oligoarthritis who test positive for ANA blood (anti-tumour antibodies) face the most likely ocular inflammation and should be periodically checked for their eyes. However, children with oligoarthritis are also less prone to serious joint problems than those with other types of JIA.
The term poly means “many”, in this case, it affects many joints, 25% of cases of JIA are polyarthritis, this disease affects five or more joints and is manifested by more girls than boys, this arthritis usually affects small joints of the fingers and hands, although it can also include those that support a lot of weight, such as the knees, the hips, the ankles, and the feet, usually involving the same joints on both sides of the body, for example, both dolls, left and right Children with this disease have a lower risk of ocular inflammation. Annual consultation with the ophthalmologist is sufficient unless otherwise recommended.
Children with polyarthritis, who give the blood test of positive RF (rheumatoid factor) have a disease more like rheumatoid arthritis than those who give negative. Those who have this type of the disease are more susceptible to more severe joint symptoms and wear, than those who do not have RF.
Some additional symptoms are:
- Low fever;
- A positive rheumatoid factor (RF) blood test;
- Rheumatoid nodules (protrusions under the skin, most often in the elbow); and
- Anaemia (low erythrocyte count).
Polyarthritis can develop in the temporomandibular joint (TMJ or jaw joint) and in the cervical spine (neck). Arthritis in the temporomandibular joint can restrict the normal movement of the jaw. Your child may lose weight because chewing is uncomfortable or painful. It can also cause abnormal growth of the jaw. Arthritis of the neck can cause instability due to fusion of the bones of the cervical spine, with the possibility of injury to the spinal cord from relatively minor trauma.
The word “systemic” means that “it affects the whole body.” This is the least common form of juvenile idiopathic arthritis and can affect the child’s internal organs as well as the joints. Both boys and girls have the same risk of presenting this form of JIA. Symptoms include:
- High fever, 103 ° F (39 ° C) or higher, which can last for weeks or even months;
- Irritation with pale reddish-brown skin rash appearing on the chest, thighs, and sometimes other parts of the body (skin irritation usually accompanies fever and may appear and disappear for several days in a row);
- Inflammation of the joints, which usually starts at the same time as systemic symptoms (fever and irritation), but can also start several weeks or months later.
Other possible symptoms of the appearance of this type of arthritis are:
- Inflammation of the heart, lungs or its outer membrane;
- Anaemia (low levels of iron in the blood); and,
- Enlarged lymph nodes, liver or spleen.
In many children, the systemic symptoms of the disease, such as fever, completely disappear. Arthritis may appear and disappear for weeks, but in most cases, it is a chronic disease (of long duration). Uveitis is not common in children with systemic JIA, however, your child’s eyes should be checked once a year.
ARTHRITIS ASSOCIATED WITH ENTHESITIS
This type of disease is characterized by inflammation of the joints and what is known as “enthesis”, that is, the places where the tendons attach to the bone. It often manifests in the joints of the lower extremities, including hips, knees and feet. It can be mild in some children or more severe in others. It could lead to inflammation of the back. It is also referred to as spondyloarthritis and usually begins between 8 and 15 years. It occurs mainly in boys. In general, children with arthritis associated with entheses test positive for the HLA-B27 gene.
JUVENILE PSORIASTIC ARTHRITIS Juvenile
psoriatic arthritis (APJ) is a type of arthritis that affects boys and girls and occurs in association with psoriasis, a condition that affects the skin. However, psoriasis can begin many years before or after the onset of arthritis. Symptoms of psoriasis include a red scaly rash, commonly behind the ears, on the eyelids, elbows and knees and in the line of the scalp or lower belly at the level of the umbilicus. There may be punctate depressions or grooves in the nails of the hands. It is likely that psoriasis is caused by family history and not by the child’s arthritis.
Any arthritis of unknown origin whose symptoms last for at least six weeks and does not meet the criteria of any other type of JIA or whose symptoms encompass two or more types is classified as “undifferentiated arthritis”.
OTHER RHEUMATIC PEDIATRIC DISEASES ASSOCIATED WITH JIA
Lupus is a disease of the immune system that can affect the joints, skin, kidneys, blood and other parts of the body. The most common type of lupus is systemic lupus, or SLE, which can affect various body systems. The majority of individuals who develop lupus are women between 18 and 45 years of age, however, children can also present it. In fact, around 90% of people with lupus are women.
Some of the symptoms of lupus are:
- Skin rash on the cheeks and bridge of the nose, which together resemble a butterfly;
- Scaly, disc-shaped rash on the face, neck, ears, scalp, and chest;
- Sensitivity to sunlight;
- Pain in the joints;
- Chest pain; and,
- Kidney problems.
The word scleroderma means “hard skin” and is the medical term for a group of diseases that can cause the skin to stretch and harden. It affects women more often than men and people of any age, including children. There are two types of scleroderma: localized (which is more common in children) and systemic.
Localized scleroderma is considered a skin disease, but in some cases, it can involve tissues under the skin such as adipose tissue, connective tissue, tendons, muscles and bones. However, it is not a systemic disease, this means that it does not affect internal organs, such as the heart or lungs. Girls who have this disease often develop between 7 and 10 years.
Systemic scleroderma affects several parts of the body, such as the skin, blood vessels, digestive system, heart, lungs, kidneys, muscles, nerves, and joints. Among the most common symptoms of systemic scleroderma we have:
- Changes in the skin, such as hardening;
- Skin that looks shiny, swollen and soft to the touch; Y,
- Changes in skin color.
Most skin changes occur in the fingers, hands, forearms and face.
Juvenile dermatomyositis (DMSJ) is an inflammatory disease that causes muscle weakness and characteristic skin irritation in eyelids and knuckles. About 20 per cent of children with this disease also have arthritis. Skin diseases of the muscles, like arthritis, can be treated with the same treatment. However, because the treatment of DMSJ is different from the treatment of JIA, an accurate diagnosis is important.
Juvenile dermatomyositis is more common in girls and appears more often between 5 and 14 years of age. Muscle weakness affects the muscles of the trunk, shoulders and upper legs. This causes problems in certain activities such as running, climbing stairs or getting up off the floor or a chair. Often, children with DMSJ have muscle pain or tenderness, although it is usually not serious. In most cases, arthritis is moderate and may go unnoticed by the child or the parent.
The word vasculitis means inflammation of the blood vessels. There are several different types of vasculitis, each with unique clinical features that may include arthritis. In addition, vasculitis can occur in children with DMSJ or systemic lupus erythematosus.
Other forms of juvenile vasculitis include:
- Polyarteritis nodosa is a vasculitis of small or medium blood vessels. It can affect any system, but most often involves the skin, kidneys, intestines and joints.
- Cutaneous polyarteritis;
- Granulomatosis with polyangiitis; and
- Behçet syndrome.
NON-INFLAMMATORY YOUTH DISEASES
Non-inflammatory musculoskeletal disorders (such as fibromyalgia) are an important cause of chronic or recurrent muscle or joint pain in children. They can be produced by inheritance, injury or other unknown causes. They do not cause the development of arthritis.
DIAGNOSIS OF YOUTH ARTHRITIS
Your child’s doctor can take many measures to detect if you have any type of juvenile arthritis. Although it can be frustrating, try to be patient. Ask about tests or procedures you do not understand. The diagnosis can include the following steps:
- A complete clinical history that helps to determine the time and characteristics of the symptoms that have been presented, in order to rule out other possible causes, such as trauma or infections, and to know if others members of the family have had arthritis or some related condition.
- A physical examination, to observe joint inflammation, rash, nodules or vision problems, which may suggest the presence of juvenile arthritis or any associated disease.
- Laboratory tests, including the erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA) tests, anti-citrullinated cyclic peptide (anti-ccp), rheumatic factor (RF) test, typing HLA-B27 antigen, complete blood count and urinalysis. Other tests may also be requested, if the doctor deems them necessary.
- X-rays of the joints, to investigate if there are signs of damage in them. Radiology imaging may include an ultrasound, a CT scan, and an MRI, as well as traditional x-rays. Obtaining a diagnosis is a good first step towards developing a plan for the treatment of your child’s arthritis.
TREATMENT OF YOUTH ARTHRITIS
Children with juvenile idiopathic arthritis may achieve a better outcome through early diagnosis and treatment. The treatment of your child will depend on the type of arthritis and its particular symptoms.
All programs for the treatment of juvenile arthritis are aimed at:
- Control inflammation;
- Ease the pain;
- Prevent damage to the joints; and
- Optimize the ability to perform everyday activities.
Your child’s treatment program will include the use of medications, exercises, vision care, dental care and proper nutrition. Occasionally, other treatments, such as surgeries, may be necessary to resolve special long-term complications.
Due to the existence of several treatments for children with AJ, the collaboration of a team of health professionals is often required. These specialists could include a pediatric rheumatologist, a nurse, a physical and occupational therapist, a social worker, a nutritionist, an ophthalmologist, a psychologist, a neurologist, a nephrologist, a cardiologist, a dentist or an orthopaedic surgeon.