Written by Dr. Sagar Bhattad
Most of us are aware of arthritis – the disease that causes swelling of joints resulting in a lot of pain and restriction in movements. But children? Did you know arthritis can affect children too? This is not rare and is classified as an autoimmune disease.
So, why does this happen? Joint pains are synonymous with old age. Young children are supposed to have joints like springs, which can bounce back from any kind of use and injury. Being this the case, what causes arthritis in teenagers? How can you know it is arthritis and not just some injury? Come, let’s dig deeper to know all about this autoimmune disease that is affecting the lives of many children.
Arthritis is a disease that causes the synovium (tissues lining the joints) to swell. When this disease affects children below the age of 16, it is called Juvenile Arthritis. It is an autoimmune disease, meaning the body’s immune system attacks the body instead of protecting it.
Juvenile Arthritis is also known as Juvenile Idiopathic Arthritis (JIA). Idiopathic means the cause is unknown. This was formerly known as Juvenile Rheumatoid Arthritis.
JIA comprises various chronic inflammation disorders. It is the most common type of arthritis that affects children. Some of the types of JIA in teenagers are:
This affects about 20-50% of the children with JIA. This causes swelling and restricts motion in at least one joint. Such children often have high fevers and rashes over the body.
This type of arthritis affects only a few joints. It is also more likely to affect girls below the age of 8. These children have a significant risk of uveitis and need periodic eye check-ups.
About 30% of the children diagnosed with JIA suffer from this type. It is more common among girls than boys.
This affects children with both arthritis and psoriasis (skin disorder). One illness develops ahead of the other one. It can cause pitted fingernails in children.
This is more common in boys above the age of 8. It is mostly genetic. It can affect the spine, eyes, enthesis, and joints.
So, what causes this juvenile arthritis in children? How can you determine the cause of your teenager’s joint aches and pains?
As mentioned earlier, JIA is idiopathic, meaning the cause is unknown. However, some of the possible causes for arthritis in teenagers are:
Arthritis doesn’t happen overnight. It is a slow process that happens over four steps:
In some cases, you can notice these signs at very early stages. In most cases, however, diagnosis happens very late. This is because sometimes arthritis progresses very slowly in a growing child and can be missed.
It is very natural for parents to discard children’s joint pains as aches related to playing rough or straining certain parts of the body. You won’t have parents rushing to the doctor panicking when their child complains of knee pain.
When the joint swells and remains that way for more than a month, parents get worried. This is not normal. The swelling should have gone down by now, restoring the range of actions to what it was before.
Sometimes it can be just a casual injury that is taking time to heal. Sometimes it can be juvenile arthritis. How can you know one from the other? How can you guess your child has something more serious than just a pulled knee?
Here are some signs and symptoms to watch out for:
When they wake up in the morning, the joints can be stiff enough to make them limp when they get out of bed. It will ease away as they start moving around and the body warms up. Some children might experience stiffness in the hands and feet as well.
This condition accompanies pain or swelling that may not be very visible. A child might not be able to express this discomfort. Instead, they might feel very irritable and might avoid a lot of physical activities, which is not common for their age.
Children will have difficulty in walking or handling things normally when the inflammation is high and is affecting many parts of the body. This can cause the child to limp – even during the day and not just in the morning. If hands are affected, they may not be able to hold or lift heavy items.
Sometimes inflammation may reach other organs and cause inflammation there too. The child can also develop a very high fever.
A mild pink rash might appear and go away in some time. This symptom often happens with many other conditions and can be a source of confusion for parents and doctors.
A once healthy child might suddenly start losing weight.
The inflamed joints can make it difficult for the child to move around, resulting in fatigue and tiredness.
Children may not be able to express their pain and discomfort. They might be very irritable.
Few children experience eye problems called iridocyclitis. The presence of this issue can help confirm JIA. If left untreated, this can result in damage to the eye.
In some rare cases, some joints may not grow or grow faster than other joints. This can result in uneven growth of the limbs or even slow down the overall growth of the child.
JIA can be easily missed as in many cases, there is hardly any progress in the damage to the tissues. Only in some cases, where the progress is fast, the child might suffer severe pain and growth-related issues.
Sadly, there is no proper test to confirm this condition. A doctor will have to assess the symptoms presented and rule out other diseases that may have similar symptoms. Only then can they confirm juvenile arthritis. A consult from a Pediatric Rheumatologist would be of great help in this situation.
Once you give your doctor enough reason to suspect your teenager might have JIA, the doctor will:
A). Perform a physical exam to check all the limbs, joints, areas that ache and also to check for atrophy (shrinkage).
B). Get a medical history of the family to ascertain if it could be something hereditary.
C). Ask for an X-ray of the joints to check for inflammation (if necessary).
D). Ask for a blood test to check for
E). Take samples of the joint fluids for further tests at the lab (only in select cases).
These tests can not only help the doctor confirm the diagnosis, they can also help classify what type of juvenile arthritis it could be.
Juvenile Arthritis is a treatable condition if it is caught at early stages. However, if the inflammation has already set in and started damaging the joints, it will take more time for treatment and recovery.
Once your child is diagnosed with Juvenile arthritis, you must take them to a Pediatric Rheumatologist (a doctor specializing in arthritis and other joint-related issues in children).
The doctor will first assess the extent of swelling and start treatment accordingly. The treatment will aim at reducing the swelling and relieving pain first. Then they will work on restoring full movement in the affected joints.
If there are more damages such as joint contracture, the treatments will differ accordingly.
Not all joint-related problems require surgery. If the damage has not set in and inflammations are still low, it can be treated without any surgery.
Your non-surgical treatment options are:
This is the most basic yet very important part of any arthritis treatment. There are several medicines to help control juvenile arthritis. Your child’s doctor might suggest certain medicines for the short term and certain medicines for the long term, depending on the severity of the illness.
Physical therapy is important to increase the mobility of the joints. As inflammation and pain set in, the child will reduce the usage of that limb. Over time, this will reduce the range of motion and weaken the muscles. It can even cause an imbalance in muscle development.
Physical therapy will help strengthen the joints improve mobility and reduce pain in the process. Therapy will be designed to suit each patient’s needs.
Aqua therapy is one of the most effective therapies used for arthritis. Swimming and water help to increase the motion in the limbs without putting much strain on them. The water’s buoyancy will reduce the strain and weight you put on the joints.
Braces made of plastic or some other material are used to help children suffering from juvenile arthritis. The splints are generally used for arms and hands, at night, to prevent the fingers and wrists’ tissues from tightening. These are used only in cases where deformities are set in.
Warm baths and electric blankets might also be used. Heat can help reduce inflammation and increase movement. If your child has mild pain and joint stiffness, a doctor might suggest warm baths and hot water packs to reduce stiffness.
This is not a regular requirement in treating juvenile arthritis. However, sometimes arthritis might cause severe damage to the limbs or joints. In order to correct this, surgery might be required.
For adults, joint replacement surgeries help treat deformed joints. For children, however, experts do not recommend surgeries. So surgical intervention for juvenile arthritis is extremely rare.
The impact of juvenile arthritis varies from child to child. The timing of diagnosis also plays a vital role. The earlier the diagnosis, the lesser the damage. If arthritis has progressed too far, it could not only cause severe pain and discomfort for the child but can cause mental trauma too.
A child might avoid physical play due to the pain. Over time, this becomes their way of life. Even if arthritis is controlled, there is no guarantee that the child might get back to physical play or be active physically.
Children with juvenile arthritis may have the following limitations
Juvenile arthritis can cause a severe negative impact on the quality of life for the child.
Sadly, no. JIA can neither be avoided nor prevented. If someone in the family has had this condition, you can be vigilant to catch the disease early.
Following an active lifestyle that includes a lot of walking, exercising, etc. can reduce the impact of arthritis and also help in early detection. If the child is not active, juvenile arthritis can reduce mobility and increase joint aches easily. If the child is physically active, the chances of swelling or reduction in mobility will be less.
Juvenile arthritis can be a very unfortunate diagnosis for a child. It can impact them physically and mentally. They require proper medication, treatment, and moral support from family, to combat this difficult phase. If not handled with care, the child might suffer both physically and mentally.
Since there is no permanent cure for this illness, one has to adopt an active lifestyle and make the necessary changes to restore the quality of life. This can again be hard on a teenager who is already going through raging hormones and other changes. It is the parent’s responsibility to reassure and guide them through.
The cause or trigger for juvenile arthritis is still unknown, It is an autoimmune disease and could be due to some genetic factors. It could also be due to environmental factors, lifestyle, etc. Research is still going on to identify the exact cause for JIA.
JIA is a chronic illness. It can last anywhere from weeks to years. However, treatments and medications can suppress arthritis. This can be for years or forever. Better known as remission, your teen can enter partial or full remission with proper treatment and medications.
Juvenile arthritis is nothing but rheumatoid arthritis suffered by children below the age of 16. So, if they do not enter remission, the condition will continue into their adulthood. If your child enters remission, there is no way to predict if they will stay in remission forever or arthritis can surface again in a few years.
Unfortunately, no. There is no cure for juvenile arthritis. However, children are able to continue with a good quality of life and do all physical activities with little treatment. With continuous treatment, some children can get permanent remission. This means, they won’t suffer from JIA and have been effectively “cured” of it.
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