Juvenile Arthritis (Childhood Arthritis) - Causes, Types, Symptoms, Diagnosis, and Treatment

What Does Juvenile Arthritis Mean?

Some children complain about pain in the knee joint, small joints in the fingers, shoulder joint, etc., due to various causes. But, if your kid's joints are red and painful continuously for more than six weeks or longer, it can be juvenile arthritis (JA).

Joints that get affected by juvenile arthritis can become painful, swollen, and stiff. Juvenile idiopathic arthritis, which is arthritis due to unknown causes, is the most common type.

This type of arthritis, like others, is long-lasting in children too. It is an autoimmune disease, meaning the body attacks the healthy cells in the joints. In serious juvenile arthritis cases, the joints can progressively become deformed, as it causes problems with bone growth and development.

Sometimes, the symptoms of juvenile arthritis do not progress and remain mild. It was believed that the majority of children affected by juvenile arthritis usually outgrow it. But, now, it has been established that almost 50 % of such children continue to have arthritis symptoms even after 10 years of diagnosis. This can be prevented by aggressive treatment to control pain and inflammation and avoid damage.

What Causes Juvenile Arthritis?

Juvenile arthritis is believed to be the result of the immune system attacking healthy cells in the body (autoimmune reaction), causing inflammation in the joints and other organs.

What Are the Types of Juvenile Arthritis?

The following are the main types of childhood or juvenile arthritis:

1. Oligoarthritis or Pauciarticular Juvenile Rheumatoid Arthritis - This type of childhood arthritis affects less than five joints, most commonly the knees, ankles, and wrists, in the first six months of the disease onset. The eyes are also affected sometimes, resulting in the inflammation of the iris called uveitis or iritis. Girls are more commonly affected by oligoarthritis, and in most, the condition goes away on its own by the time children grow old.

2. Polyarthritis or Polyarticular Juvenile Idiopathic Arthritis - Here, five or more joints, often the same joints on either side of the body, are affected within the first six months of the disease onset. Joints in the jaw, neck, arms, and legs are commonly affected. Girls are again more commonly affected than boys.

3. Systemic Arthritis or Still's Disease - The entire body or many systems of the body can get affected. Systemic juvenile arthritis generally results in a high fever and rashes, which are commonly seen in the arms, legs, and trunks. Internal organs like the heart, spleen, lymph nodes, and liver can also get affected by juvenile systemic arthritis. This type affects boys and girls equally.

4. Psoriatic Arthritis - This type of arthritis affects children who have psoriasis, where the skin has red bumpy patches covered with white scales. Either of the diseases can occur before the other one develops years after. Pitted fingernails (tiny dents) are a common finding in such kids.

5. Enthesitis-Related Arthritis - This type of arthritis usually affects the entheses (the area where tendons attach to bones), hips, spine, and eyes. It is commonly seen in boys (8 years or older). Generally, a male member of the child's family has a history of ankylosing spondylitis (arthritis of the spine).

6. Undifferentiated Arthritis - The child might show symptoms of two or more types of arthritis.

What Are the Common Signs and Symptoms of Juvenile Arthritis?

Some children with juvenile arthritis might show no symptoms, while in others, the symptoms vary depending on the type and severity of inflammation. The following are some commonly seen symptoms of juvenile arthritis:

• Joint pain, tenderness, and swelling.

• Joint stiffness, mostly in the morning.

• Limping.

• Tiredness.

• Irritability.

• Recurrent fever.

• Skin rash.

• Weight loss.

• Eye pain or redness.

• Blurred vision.

How Is Juvenile Arthritis Diagnosed?

The doctor will perform the following tests if your child has persistent joint pain and other symptoms of juvenile arthritis:

1. Erythrocyte Sedimentation Rate (ESR) - ESR is the rate at which the RBCs (red blood cells) settle at the bottom of a tube containing blood. Inflammation will result in elevated ESR.

2. C-Reactive Protein (CRP) - CRP is produced by the liver in response to inflammation. The test is done to detect the presence of this protein.

3. Rheumatoid Factor - The rheumatoid factor is an antibody produced by the immune system. The test that detects the presence of this antibody is done to diagnose a rheumatic disease.

4. Antinuclear Antibody - This is also a type of antibody produced by the immune system and is found in people with an autoimmune disease. The antinuclear antibody test is conducted to detect this antibody.

5. Cyclic Citrullinated Peptide (CCP) - This is also another antibody that might be present in the blood of children with juvenile arthritis.

6. HLA-B27 - The human leukocyte antigen B27 is a protein found in people with some autoimmune conditions. The presence of this antigen is associated with enthesitis-related juvenile arthritis.

7. Imaging Tests - X-ray or MRI is done to rule out infections, fractures, or other conditions that can cause joint pain and redness.

How Is Juvenile Arthritis Treated?

Juvenile arthritis treatment focuses on maintaining the child's normal level of physical and social activities. For this, the following treatment options are available:

1) Home Remedies:

• Regular exercises that do not put too much stress on the knees, such as swimming, are important to enhance muscle strength and joint flexibility.

• Cold packs or hot packs can help with joint stiffness.

• A well-balanced diet is important to maintain proper weight.

• Calcium supplements are a must for maintaining bone strength.

2) Medications:

• Painkillers - Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Ibuprofen and Naproxen Sodium, are used to relieve pain and swelling.

• Disease-Modifying Antirheumatic Drugs (DMARDs) - When NSAIDs do not relieve symptoms, the doctor might prescribe DMARDs, such as Methotrexate and Sulfasalazine.

• Biologic Response Modifiers - These drugs prevent joint damage and reduce inflammation. Examples include Etanercept, Adalimumab, and Infliximab. Some biologic agents like Rituximab and Tocilizumab work by suppressing the immune system differently.

• Corticosteroids - Steroids like Prednisone may be used to treat inflammation.

3) Physical Therapy:

A physical therapist will help the child perform exercises to keep the joints flexible and maintain muscle tone. An occupational therapist will also be needed to help the child use splints to protect the joints.

4) Surgery:

Rarely surgery might be needed for juvenile arthritis.

What Are the Possible Complications of Juvenile Arthritis?

If left untreated, juvenile arthritis can lead to:

1. Anemia.

2. Joint damage.

3. Uneven limbs.

4. Inflammation around the heart (pericarditis).

5. Severe and long-lasting pain.

6. Stunted growth.

7. Vision changes.

Conclusion:

Most children with juvenile arthritis go into remission after a few years. But in some cases, the child might experience frequent flare-ups, and the possibility of inflammation spreading to other joints and organs increases. For more information, consult a doctor online.