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Juvenile Rheumatoid Arthritis

Posted by on Saturday, March 5, 2011, 5:45
This news item was posted in Children, J, R category and has 0 Comments so far.

Juvenile rheumatoid arthritis, also known as juvenile idiopathic arthritis, is the most common type of arthritis in children under the age of 16.

Juvenile rheumatoid arthritis causes persistent joint pain, swelling and stiffness. Some children may experience symptoms for only a few months, while others have symptoms for the rest of their lives.

Juvenile Rheumatoid Arthritis
Juvenile Rheumatoid Arthritis

The number of joints affected
The signs and symptoms
The results of blood tests
Some types of juvenile rheumatoid arthritis can cause serious complications, such as growth problems and eye inflammation. Treatment of juvenile rheumatoid arthritis focuses on controlling pain, improving function and preventing joint damage.

Symptoms:

Pain. While your child might not complain of joint pain, you may notice that he or she limps — especially first thing in the morning or after a nap.
Swelling. This sign is most often seen in the knees, but the small joints of the hands and feet also can be affected.
Stiffness. You might notice that your child appears more clumsy than usual.
There are three main types of juvenile rheumatoid arthritis:

Oligoarthritis. This variety affects fewer than five joints during the first six months of the disease. It also is the variety most likely to feature eye inflammation, which can cause blindness in rare cases.
Polyarthritis. This variety affects five or more joints during the first six months of the disease. Signs and symptoms are usually confined to the joints.
Systemic. Formerly known as Still’s disease, this type can feature swollen lymph nodes, rashes and fever — which may come and go quickly. It can also cause inflammation of internal organs.
Like other forms of arthritis, juvenile rheumatoid arthritis is characterized by times when symptoms flare up and times when symptoms disappear.

When to see a doctor
Take your child to the doctor if he or she has joint pain, swelling or stiffness for more than a few weeks — especially if your child also has a fever.

Causes:

Doctors believe that juvenile rheumatoid arthritis is an autoimmune disorder. This means that the body’s immune system attacks its own cells and tissues. It’s unknown why this happens, but both heredity and environment seem to play a role. Certain gene mutations may make a person more susceptible to environmental factors — such as viruses — that may trigger the disease.

Complications:

Several serious complications can result from juvenile rheumatoid arthritis. But keeping a careful watch on your child’s condition and seeking appropriate medical attention can greatly reduce the risk of these complications:

Eye problems. Some forms of juvenile rheumatoid arthritis can cause eye inflammation. If this condition is left untreated, it may result in cataracts, glaucoma and even blindness. Eye inflammation frequently occurs without symptoms, so it’s important for children with juvenile rheumatoid arthritis to be examined regularly by an ophthalmologist.
Growth interference. Juvenile rheumatoid arthritis can interfere with the development of your child’s bones and growth. Some medications used to treat juvenile rheumatoid arthritis, mainly corticosteroids, also can inhibit growth.

Diagnosis:

Diagnosis of juvenile rheumatoid arthritis can be difficult because joint pain can be caused by many different types of problems. No single test can confirm a diagnosis, but tests can help rule out some other conditions that produce similar signs and symptoms.

Blood tests
Some of the most common blood tests for suspected cases of juvenile rheumatoid arthritis include:

Erythrocyte sedimentation (sed) rate. Sedimentation rate is the speed at which your red blood cells settle to the bottom of a tube. An elevated rate can indicate inflammation. Measuring the sed rate may be used to rule out other conditions, to help classify the type of juvenile rheumatoid arthritis and to determine the degree of inflammation.
Anti-nuclear antibody. Anti-nuclear antibodies are proteins commonly produced by the immune systems of people with certain autoimmune diseases, including arthritis.
Rheumatoid factor. This antibody is commonly found in the blood of adults who have rheumatoid arthritis.
In many children with juvenile rheumatoid arthritis, no significant abnormality will be found in these blood tests.

Imaging scans
X-rays may be taken to exclude other conditions, such as:

Fractures
Tumors
Infection
Congenital defects
X-rays may also be used from time to time after the diagnosis to monitor bone development and to detect joint damage.

Treatments:

Treatment for juvenile rheumatoid arthritis focuses on helping your child maintain a normal level of physical and social activity. To accomplish this, doctors may use a combination of strategies to relieve pain and swelling, maintain full movement and strength, and prevent complications.

Medications
For some children pain relievers may be the only medication needed. Others may need help from medications designed to limit the progression of the disease. Typical medications used include:

Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve), reduce pain and swelling. Because children can develop side effects such as bleeding and liver and stomach problems, be sure to use these medications under a doctor’s supervision.
Disease-modifying antirheumatic drugs (DMARDs). Doctors use these medications when NSAIDs alone fail to relieve symptoms of joint pain and swelling. They may be taken in combination with NSAIDs and are used to slow the progress of juvenile rheumatoid arthritis. Commonly used DMARDs for children include methotrexate (Rheumatrex) and sulfasalazine (Azulfidine). Side effects may include nausea and liver problems.
Tumor necrosis factor (TNF) blockers. TNF blockers — such as etanercept (Enbrel) and infliximab (Remicade) — can help reduce pain, morning stiffness and swollen joints. But these types of drugs increase the risk of infections, particularly in the lungs — and even cancers, such as lymphoma.
Corticosteroids. These prescription medications are for children with more severe juvenile rheumatoid arthritis. They’re used to control symptoms until a DMARD takes effect or to prevent complications, such as inflammation of the sac around the heart (pericarditis). Corticosteroids, such as prednisone, may be administered by mouth or by injection. But they can interfere with normal growth and increase susceptibility to infection, and generally should be used for the shortest possible duration. Stopping long-term use of corticosteroids suddenly can be dangerous, so it’s important to follow a doctor’s instructions on usage.
Therapies
Your doctor may recommend that your child work with a physical therapist to help keep joints flexible and maintain range of motion and muscle tone. A physical therapist or an occupational therapist may make additional recommendations regarding the best exercise and protective equipment for your child. A therapist may also recommend that your child make use of special supports or splints to help protect joints and keep them in a good functional position.

Surgery
In very severe cases of juvenile rheumatoid arthritis, surgery may be needed to improve the position of a joint.

Home Remedies:

Caregivers can help children learn self-care techniques that help limit the effects of juvenile rheumatoid arthritis. Techniques include:

Getting regular exercise. Exercise is important because it promotes both muscle strength and joint flexibility. Swimming is an excellent choice because it places minimal stress on joints.
Applying cold or heat. Stiffness affects many children with juvenile rheumatoid arthritis, particularly in the morning. Although some children respond well to cold packs, most children prefer a hot pack or a hot bath or shower.
Eating well. Some children with arthritis have poor appetites. Others may gain excess weight due to medications or physical inactivity. A balanced diet can help maintain an appropriate body weight. Adequate calcium in the diet is important because children with juvenile rheumatoid arthritis are at risk of developing weak bones (osteoporosis) due to the disease, the use of corticosteroids, and decreased physical activity and weight bearing.

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