Children are inclined to infections and mishaps. Therefore, fever, swollen and painful joints, rashes, and fatigue can be mistaken as a sign of infection, or a sign of overexertion, or a result of an injury during a game, or so-called growing pains, and so on. Do you know that these simple signs can be due to Juvenile idiopathic arthritis- the most widely recognized arthritis, and one of the most common chronic disease found among toddlers to children below 17 years. Let us try to understand more about this condition, which affects approximately 1 in 1,000 children. An interesting fact is that girls are more likely to develop rheumatoid arthritis than boys at all ages.
What Is Juvenile Idiopathic Arthritis ?
Juvenile Arthritis is a condition which leads to inflammation of the joints, with persistent stiffness, warmth, and torment in the joints. Some children experience arthritis only for a short term, as if a couple of months, while others have arthritis for quite a long while, lasting several years. In rare cases, the condition can last a lifetime.
It is quite different from adult rheumatic fever in the following aspects
- The greater part of the children experiencing juvenile idiopathic arthritis, come out of the illness, while adults generally possess lifelong symptoms
- Juvenile idiopathic arthritis may affect the development of the skeletal system as well as the normal growth of the child. This will not happen in adult rheumatics
- About 70 to 80 percent of all adults with rheumatoid arthritis have a Rheumatic factor in their genes, but fewer than half of all children with juvenile idiopathic arthritis are found to be RF positive. The presence of RF shows the increased possibility of JRA continuing into adulthood
What Are The Causes Of Juvenile Idiopathic Arthritis?
Juvenile idiopathic Arthritis occurs when the body’s immune system attacks its own cells and tissues (autoimmune). It is a mystery why this happens. However, it is believed that both heredity and environment have a part in provoking the immune system. Some experts rely on the theory that it could be because of factors like a virus, which then vanishes from the body after creating a permanent damage. In addition, if any of the family members experience any kind of autoimmune disorder, children of the family have a strong reason to develop Juvenile idiopathic rheumatoid arthritis. This shows the genetic cause behind juvenile idiopathic arthritis.
What Are The Symptoms Of Juvenile Idiopathic Arthritis?
Juvenile idiopathic arthritis can affect the babies who are a few months old to any child who is below 16 years old. If this affects the toddlers, they are too small to explain what is troubling them. Therefore, it is important to recognize these symptoms to get a proper diagnosis from the child’s pediatrician. Early detection and appropriate treatment can prevent acute and perpetual damage to your child’s joints. There are different types of juvenile idiopathic arthritis. The signs and symptoms vary with the type of arthritis the child developed. The most prevalent signs and symptoms of Juvenile idiopathic Arthritis depending on the types are:
- Systemic-onset juvenile idiopathic arthritis
It is responsible for 10-20% of juvenile idiopathic arthritis and affects both boys and girls to the same degree. It causes inflammation in one or more joints (both small and large joints are affected) and is often accompanied by a high fever.
The Symptoms involve:
- High fevers that often increase in the evenings and then suddenly drop to normal
- Inflammation of the outer linings of heart or lungs. This can cause chest pain or shortness of breath among children
- The spleen and lymph nodes become puffed-up
- The child looks pale and anemic
- Rashes may unexpectedly appear and disappear, emerging in one area and then in another
- Gradually many joints get affected, becoming stiff and swollen, generating pain, and eventually making the movements difficult for the child
50 % 0f juvenile idiopathic arthritis cases are of Oligoarticular juvenile idiopathic arthritis. Usually, the large weight-bearing joints such as the ankles, knees and elbows are affected. Hips are not usually affected. However, occasionally, it may also affect the smaller joints like the fingers and toes. It is usually not symmetrical, which means that it affects only one side of the body and the joints rather than both.
The symptoms include:
- Chronic eye inflammations, like uveitis, are the unique sign of Oligoarticular juvenile idiopathic arthritis. This is because of the presence of antinuclear antibody (ANA) which prompts eye inflammations
- Pain, stiffness and swelling in joints
25 % of juvenile idiopathic arthritis cases are that of Polyarticular juvenile idiopathic arthritis. In Polyarticular juvenile idiopathic arthritis, after the onset of the disease, in the initial 6 months, 5 or more joints are affected. This disease usually affects the smaller joints of the fingers and hands. But in some cases, it may affect the weight-bearing joints such as the knees, hips, and ankles. It affects joints on both sides of the body in a more symmetrical manner. Kids with polyarticular juvenile idiopathic arthritis are at a higher risk of joint damage than in the other forms of juvenile idiopathic arthritis. This is because, the Rheumatoid factor (RF), which determines whether arthritis continues to the adulthood of the child may test positive or negative among children in this group.
The symptoms include:
- Swelling or pain in five or more joints
- Recurring low-grade fever
- Bumps or nodules develop in areas of the body, which undergo pressure from sitting or leaning
Juvenile psoriatic arthritis refers to arthritis that occurs in along with a skin disease called psoriasis.
The symptoms include:
- The scaly red rash that can appear behind the ears. It can also appear in belly button area, eyelids, scalp line or even elbows and knees
- Fingernails and toenails might be affected by psoriasis
- Pain and puffiness in one or more than one joints, more often in the wrists, knees, ankles, fingers, and toes
This sort of joint pain regularly influences the legs and spine. In this type of arthritis there is tenderness in the area where the bone connects with a tendon, ligament, or other connective tissue. It most often affects the hips, knees, and feet.
The symptoms involve:
- Pain, puffiness, and rigidness in the joints of the hips, knees, ankles, feet, and lower back
- Lower back or buttock pain that is worse with rest and better with activity
- The child complains heel, foot, or knee pain (with or without swelling)
This type of arthritis occurs when the joint pain does fall under any of the above classifications or if the child shows symptoms of more than one of type of juvenile idiopathic arthritis.
Complications Due To Juvenile Idiopathic Arthritis
Several serious complications can result from juvenile rheumatoid arthritis. Therefore, a careful monitoring of the child’s condition and giving appropriate medical attention as early as possible is necessary to reduce the risk of these complications.
The Potential Complications of Juvenile idiopathic Arthritis include:
- Anemia: Developed due to disturbed iron metabolism
- Long-term recurring pain which restricts the movements of the child eventually
- Joint damage
- Hindered growth
- Uneven limbs as the bones and ligaments get affected
- Serious eye-related complications like uveitis, a condition in which the middle layer of the eye is inflamed. If left untreated, it may bring about cataracts, glaucoma, and even blindness
- Swelling around the heart can result in chest pain and related issues
What Are The Treatment Options For Juvenile Idiopathic Arthritis?
Various treatments will help to manage juvenile idiopathic arthritis effectively and minimize the effects of juvenile idiopathic arthritis. The foremost goal of the treatment is to get rid of pain, swelling, and the destruction of joints, and to maintain movement and strength. To accomplish this, Doctors usually recommend a combination of treatments. The treatment that is effective for a child not necessarily helps another one. Therefore, a physician, rheumatologist, and physical therapist will work jointly to plan the best method of treatment.
- Most of the time, juvenile idiopathic arthritis treatment merges medication, physical therapy, and exercise
- The aim of physical therapy is to keep the joints bendable, enable the range of motions, and improve muscle tone.
- A physical therapist recommends the best exercise
- A therapist may also recommend and train the child to make use of joint supports or splints. This helps to protect the joints and keep them in a good functional position
- In very rare cases, children may require surgical intervention
- In some cases, corticosteroid injections are given into the joint