Juvenile arthritis is of different types but the most common is juvenile rheumatoid arthritis.
As many 50,000 children are diagnosed with juvenile arthritis in the US alone each year. And the diagnosis is not easy to arrive at - many kids are undiagnosed for years. There are three different kinds of arthritis which affect kids. These include pauciarticular (less than four joints affected), polyarticular (four or more joints affected), and systemic-onset (inflamed joints with high fevers and rash). They are all different forms of rheumatoid arthritis.
It is commonly referred to as JRA and affects kids below the age of 16 years. Depending on the type of JRA the child has, the treatment is somewhat different. Because of its nature and because exact classification is difficult, it is often referred to as juvenile idiopathic arthritis (JIA). The good news is that many children do 'grow out of it'. The bad news is that drugs taken to treat the arthritis have many side effects which can cause more problems as children are still developmentally growing, physically, mentally and emotionally.
What kind of disease is it? Like all forms of arthritis, it is a disease which affects the joints. Since it affects the joints, it hampers movement. Joints can become swollen and inflamed and a flare-up may be accompanied by fever which goes on and off. In some cases JIA can cause inflammation in the eyes - in the iris - or even result in uveitis. This needs to be diagnosed early as vision problems can be serious and include cataracts, glaucoma and even blindness.
During a flare-up or when there are episodes of unbearable pain, the doctor may restrict activities and advise rest. At other times, whatever range of movements are possible are advised, because physical fitness in children is most important.
Why is it undiagnosed? A slight pain in the hip, leg or any joint which occurs once in a while may be put down to an accidental injury. Youngsters do play sports and get injured, run into objects, fall down and more. So the occasional may be simply ignored by the child or even the parents. It is only when it recurs, becomes chronic or presents worsening symptoms that the child is taken to the doctor.
A doctor, too, may not spot the signs of juvenile arthritis till symptoms keep on recurring or there is painful swelling, accompanied by fever. As JIA has symptoms similar to other diseases, sometimes even doctors find it difficult to diagnose. If you know the symptoms of JIA and suspect that your child may be having this disease, ask the doctor to get the required investigations done.
Tests for JIA Unfortunately there are no definitive tests for JIA. The doctor will have to go through the check list of symptoms, do a complete physical exam and take the complete medical history of the patient. Among the blood tests which are indicative of the disease are complete blood count (CBC) with ESR, anti-nuclear antibody test ANA), RA Factor (RF).
Other tests include X-rays, MRIs, CT scans, bone scans, Dexa (for bone density) but these are usually done one at a time, depending on the findings. Further tests include synovial fluid test or even a synovial biopsy.
Medicines Medicines for treatment of JIA include pain killers and NSAIDs as the first line of treatment. If your child is really fortunate, the JIA can go into remission for a long time, barring an occasional episode. Other medicines include anti-inflammatories, DMARDs, steroids and even stronger medications.
If the disease progresses and the joint/s become deformed, surgery may the only resort left. Most doctors avoid surgery till absolutely necessary. In any case physical therapy is also required and the dietary and nutritional needs of the child have to be taken care of.
