Treating Juvenile Arthritis

Juvenile arthritis is not one specific condition; it refers to a number of (mostly autoimmune) conditions that result in joint inflammation in children. Out of all the conditions, juvenile idiopathic arthritis (JIA) is the most common. An autoimmune condition is one in which the body’s immune system, which is supposed to protect the body, attacks its own healthy cells. When this happens, the joints in the body get inflamed and painful, swollen joints result.

Juvenile idiopathic arthritis can be further classified into 6 subtypes:

• Oligoarthritis – This typically affects only a few joints with the ankle and knees being the commonly involved joints. An eye condition called uveitis is associated with this type of JIA. Half the number of children who are diagnosed with JIA have oligoarthritis.
• Polyarticular – This affects girls more often. The condition can affect 5 or more joints with both small and large joints getting affected. If the children affected with this condition test positive for rheumatoid factor, their symptoms will be more pronounced and more intense treatment will be required.
• Systemic – This type will have at least one joint being painful and swollen. Internal organs might be affected and the child will have persistent high fever for more than 2 weeks. Prompt treatment is required.
• Enthesitis Related – In this, along with joint pain, tendons and ligaments are also affected. As the spine is usually affected, children may complain of back pain along with joint pain. This condition might be seen in boys aged 6 years and older.
• Juvenile Psoriatic – Children with this type show symptoms for psoriasis and arthritis. Fingers and toes may be visibly swollen. The number and type of joints affected varies. The nails too will be affected and will tend to split.
• Undifferentiated – Here, the symptoms will not fall under any of the above-mentioned sub types or will show symptoms from more than one subtype.

Signs Parents should watch out for:

• Small children may not be vocal about the pain but they might limp while walking after a period of rest (e.g., when they wake up in the morning).
• The joints, especially the bigger ones, will be swollen.
• Due to stiffness or rigidity of joints, the child may seem off-balance. This is also more pronounced after a period of rest.
• Depending on the type of JIA, the child might have high fever, enlarged lymph nodes, etc.

The symptoms won’t be present at all times. There will be a period during which the symptoms are active followed by periods of remission.

Diagnosing JIA:

The child’s pediatrician may be able to identify the symptoms but for treatment the child will be referred to an orthopedic doctor.

• The doctor will want to know the child’s medical history in detail.
• A thorough physical examination to check eyes, skin and joint mobility will be done.
• Blood tests to check ESR level (inflammation in the body), rheumatoid factor, etc. will be done.
• Imaging tests may be done to exclude other possible causes of joint pain like tumors.
• Regular imaging may be done after diagnosing the condition to keep an eye on the affected joint.

Treatment Options for Juvenile Arthritis:

Treatment centers around giving the child as normal a childhood as possible. So, to manage the symptoms, a number of options may be tried. The aim is to reduce pain, keep the joints mobile and prevent any aggravation in the condition.

• In the initial stages, the doctor will prescribe NSAIDs (non-steroidal anti-inflammatory drugs) which will help with pain and swelling management.
  • The drugs may cause side effects like indigestion and if taken for a long period, may possibly affect the kidneys.
  • It is important to follow the dosage given by the doctor and to inform him about any side-effects experienced.
• Disease modifying anti-rheumatic drugs (DMARDs) will be given if the child does not experience relief with NSAIDs.
• DMARDs work by containing the immune system’s action against the healthy cells and thus help slow down the disease progression.
• In some cases, DMARDs will be prescribed with NSAIDs.
• Biologic agents are drugs derived from living organisms which work to control inflammation.
• While they have been shown to be very effective, the drawback is that they work by controlling the body’s immune response and hence the patient is more susceptible to other infections.
• Corticosteroid injections may also be given if the pain is too bad to help manage it till other drugs take effect. Though they are fast acting, these injections should be used only when absolutely necessary.
• Exercises taught by a physiotherapist go a long way in helping to manage the condition. They will help with both mobility and pain. On days when the pain is bad, it is important to give enough rest and not carry on with the usual exercise plan.
• An occupational therapist can help children by teaching them the easiest way to carry on with daily activities.

Home Remedies

• Eating a healthy diet rich in fibre and calcium is recommended. Processed food or any food containing sugar is best avoided as it may contribute to further inflammation.
• A warm or a cold compress will help kids handle pain and will also help with flexibility. While a warm compress is likely to help after a period of rest, a cold compress might be soothing after an activity.
• Stick-on patches are available which when stuck on the inflamed joint will help bring down the pain.

How Family Members Can Help

Children with JIA might feel angry and upset with their condition and this is to be expected. Support from family plays a huge role in helping them come to terms with the condition.

• Parents are encouraged to treat a child with JIA as normally as possible.
• Make it clear to the child that the condition is not because of something he/she did wrong.
• If the child is interested in sports in school, ask the doctor for an opinion on whether he/she can go ahead with it.
• Talk to the teachers in school so that they too are aware of what the child is going through.
• If the child shows signs of depression, it is best to get him professional help on how to handle the condition.