What types of rheumatic diseases can children get?
Children can get chronic arthritis – called juvenile idiopathic arthritis (JIA), previously known as juvenile rheumatoid arthritis – as well as other rheumatic diseases such as systemic lupus erythematosus (known as lupus or SLE), juvenile dermatomyositis, or vasculitis.
How common are these childhood diseases?
About 1 in 1,000 children have juvenile arthritis. This includes children with juvenile idiopathic arthritis (JIA) and those with other rheumatic or connective tissue diseases. If children with orthopedic and congenital problems that may develop into osteoarthritis in adulthood are included, then an average of one to five children in every elementary school have a chronic rheumatic disease.
What is juvenile idiopathic arthritis?
Juvenile idiopathic arthritis is the newest and preferred terminology to describe chronic arthritis in children. Idiopathic means unknown cause or spontaneous origin. The disease is also sometimes referred to as juvenile arthritis (JA) or juvenile rheumatoid arthritis (JRA). Children under 17 years of age who develop inflammation in a joint (usually with swelling and/or pain and/or morning stiffness) that lasts longer than six weeks usually have JIA. There are seven different types of JIA, and the pattern of arthritis and the short-term and long-term effects of each type are different. We do not know the cause of any of the types of JIA. If the arthritis is associated with another disease such as lupus, dermatomyositis, inflammatory bowel disease or even leukemia, the arthritis is not known as JIA.
Is juvenile idiopathic arthritis the same as rheumatoid arthritis?
JIA is not the same as rheumatoid arthritis! In the United States, some forms of childhood arthritis are still somewhat inaccurately referred to as juvenile rheumatoid arthritis or JRA even though the pattern of arthritis and the short-term and long-term effects of most types of juvenile arthritis are completely different from rheumatoid arthritis in adults. Less than 5% of children with JIA have a subtype of arthritis that resembles rheumatoid arthritis.
What are the warning signs of juvenile arthritis?
A child with arthritis may have an obviously swollen joint, or he/she is stiff when waking up and might walk with a limp, or may have trouble using an arm or leg. Children do not always complain of pain because they may adjust the way they do things so that it hurts less, or they may simply ask to be carried more often. With some of the more serious types of JIA, children may also have a fever, a rash, or feel very weak and fatigued.
How is arthritis diagnosed in children?
Arthritis is diagnosed by examination of the child by a doctor who has specialized training (or experience) in childhood rheumatic diseases. Preliminary evaluation should be by the family doctor or pediatrician, but the final diagnosis is ideally made by a pediatric rheumatologist. There are no blood tests or x-rays to confirm a diagnosis but these tests may be useful to determine the type of arthritis, to assess the severity, or to identify complications.
What is the usual course of juvenile idiopathic arthritis?
This is very difficult to predict at the outset, and to some extent, it depends on the type of JIA. In a small number of children, the disease may last as little as several months to a year and disappear forever. Most children, however, have an up-and–down course with “flares” and “remissions” for many years with about half of them continuing to have problems into adulthood. While there is no cure for juvenile arthritis, current available therapy often prevents the long-term damage and disability that may be left by arthritis even after it has gone.
Is childhood arthritis treated the same as adult-type arthritis?
Children with arthritis are not just kids with an adult disease. Although the drugs and therapies used to treat children are similar, the intensity of treatment and the frequency of follow-ups need to be much greater.
Unlike for adults with arthritis for example, physical growth may be stunted, children may grow one leg longer than the other, or one hand or foot may be smaller. Some children with arthritis can also have associated eye inflammation that can lead to blindness. These changes may be irreversible if there is a delay, or poor follow-up, in treatment. The impact of any chronic illness on psychological development, especially during adolescence, should not be underestimated as it can have lifelong recreational, educational, and career implications.
The best outcome for children with any rheumatic disease will be achieved by the involvement of a multidisciplinary team of health professionals such as those at BC Children’s Hospital. In this setting, children will have access to pediatric rheumatologists; specialized nurses, occupational and physical therapists, and social workers whose jobs are dedicated to treatment of children with rheumatic diseases. Other childhood and adolescent medical specialists are also available.
Where can I get more information?
An excellent book is Your Child with Arthritis: A Family Guide for Caregiving by Dr. Lori B. Tucker, Bethany A. DeNardo, Dr. Judith A. Stebulis, and Dr. Jane G. Schaller.
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