Introduction:
Arthritis is a group of conditions in which there is inflammation in the joints of the body and damage to the affected joints. It is a debilitating condition affecting individuals of all ages, genders, and ethnicities. Juvenile spondyloarthritis is one such condition, which is a chronic inflammatory disease that affects mainly the spine, pelvis, and entheses (the site where the tendons and ligaments attach to the bone) in children aged 16 years and younger. The condition is also known to affect a child as young as five. According to studies, children with juvenile spondyloarthritis are weaker healthwise and experience intense pain more frequently. Juvenile spondyloarthritis is more common among boys than girls.
What Are the Causes of Juvenile Spondyloarthritis?
The presence of multiple factors, such as genetics, environment, and the self-attacking nature of the child's immune system, is responsible for the cause or development of juvenile spondyloarthritis. However, the exact pathogenesis of the disease has yet to be understood. Some causes include:
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Genetics - Studies have shown that the human leukocyte antigen B27 (HLA-B27) gene plays a role in developing juvenile spondyloarthritis. However, not all children with the gene develop juvenile spondyloarthritis.
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Environmental Factors - Infections, such as bacterial or viral, exposure to certain toxins, a poor diet mainly consisting of processed foods, and stressed children may make them vulnerable to juvenile spondyloarthritis development.
What Are the Symptoms of Juvenile Spondyloarthritis?
Children with juvenile spondyloarthritis may show varied symptoms depending on the age of onset. Episodes of pain may be intense (a flare), and suddenly, the child may not experience any discomfort (a remission) for a long time. The episodes of flare and remission vary among children throughout life. Some of the most common symptoms are as follows:
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Enthesitis - Inflammation in the site where the tendons and ligaments attach to the bone, causing pain and tenderness in the affected area.
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Uveitis - It is the inflammation in the eye's middle layer, causing redness and swelling of the eye. Children may also be sensitive to light.
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Psoriasis - A skin rash condition that presents red, scaly patches, especially on the joints such as the knees and elbows.
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Bowel Inflammation - It causes abdominal pain, bloody stool, loss of appetite, and weight loss.
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Asymmetrical pain and stiffness, especially in the lower extremities, such as the lower back, hips, and knees, tend to worsen in the morning or with prolonged inactivity.
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Extreme lower back pain causes a child to adapt to a stooped posture (postural kyphosis) for relief from the lower back pain.
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Inflammation on fingers and toes that gives a sausage-like appearance (dactylitis).
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Painful swollen ankles.
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Warm and tender joints.
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Fatigue.
How Is Juvenile Spondyloarthritis Diagnosed?
With frequent episodes of flare and remission, juvenile spondyloarthritis is often diagnosed late or with difficulty. Specific symptoms, like the involvement of the lower back, may occur only later in the disease. Children may present signs of uveitis or psoriasis (dry and itchy patches due to skin cell buildup) reported earlier than spine pain. The diagnosis of juvenile spondyloarthritis is based on a combination of the presence of symptoms, blood tests, and imaging studies, which are as follows:
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Physical Examination - There are painful, tender, and swollen joints, especially lower and peripheral extremities. Enthesitis is a characteristic feature of juvenile spondyloarthritis.
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Family History - A family history of arthritis or spondyloarthritis.
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Blood Tests - The test for the presence of the human leukocyte antigen B27 gene and symptoms of juvenile spondyloarthritis confirms the diagnosis. A higher measuring value of erythrocyte sedimentation rate (ESR) and C-reactive protein indicates inflammation in the body.
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Imaging Studies - X-rays, magnetic resonance imaging (MRI), or ultrasound may be used to detect signs of inflammation and damage in joints, the spine, and the enthesis.
How to Treat Juvenile Spondyloarthritis?
The sooner the treatment is initiated, the better and faster the relief for the child will be. The treatment modalities aim to relieve pain and prevent the progression of the disease, which may cause functional abnormalities due to extensive damage to the joints. The treatment includes medications, physical therapy, and lifestyle modifications.
Medications:
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Usually, non-steroidal anti-inflammatory drugs (NSAIDs, for example, Naproxen) are commonly prescribed drugs for pain relief.
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Disease-modifying antirheumatic drugs (DMARDs, for example, Sulfasalazine and Methotrexate) are also beneficial in treating the symptoms of juvenile spondyloarthritis. Most individuals present side effects when using these medications for a prolonged period; hence, the doctor must closely monitor the child.
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Biologic drugs (for example, Adalimumab and Infliximab) are variants of disease-modifying drugs that individuals better tolerate since they have minimal side effects and are shown to reduce pain and inflammation caused by the disease.
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Studies have shown that steroidal (corticosteroid) injections into severely affected joint spaces, such as the ankle, hip, or knees, showed pain relief and a six-month remission period in some.
Physical Therapy:
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Daily exercise can improve the joints' function and stability, with the added benefit of relief from pain and stiffness. Regular exercise can be done at home or under the supervision of a trainer who knows the symptoms and limitations of juvenile spondyloarthritis.
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Strength training exercises can also help protect and prevent damage to the joints.
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Stooped posture may be corrected naturally for the child with relief from lower back pain. However, if not, it can be fixed with back and shoulder muscle strengthening exercises. A gentle reminder by the parent to the child to make a conscious effort to correct the posture while sitting and standing is also advisable.
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Swimming is a good exercise overall for children, as it helps avoid weight on the tender joints and relieves pain.
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Specialized shoes are available to relieve pain in the ankles and heels while walking.
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Treatment may also involve other specialists, such as an ophthalmologist to treat uveitis (inflammation of the eyes), a gastroenterologist to treat bowel (gastrointestinal) inflammation symptoms, and a dermatologist to treat psoriasis.
Lifestyle Modifications:
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Children with spondyloarthritis commonly seem to be weaker in health. A diet with more fruits and vegetables, whole grains, and fish rich in omega-3 fatty acids (such as sardines and salmon) can help maintain health. Avoid sugary, trans-fat, and processed foods, as studies have shown they negatively affect inflammatory diseases.
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Uninterrupted eight hours of sleep are necessary to help the body heal, especially when on medication, and for the body's overall health.
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Practicing de-stressing exercises such as meditation and yoga can improve the quality of life for children and prevent symptom flares caused by stress.
Conclusion:
Juvenile spondyloarthritis is a rare condition. Children and adolescents who experience joint pain or other disease symptoms need to be evaluated by a healthcare professional with expertise in rheumatology for an early diagnosis of juvenile spondyloarthritis. Early intervention with appropriate treatment measures can prevent joint damage and other disease complications.
