The greatest gift we can give in our lifetime is the gift of LIFE! We find great joy in the birth of a child. Most of the time we give birth to healthy children with all ten fingers and toes. Sometimes the birth of a child brings challenges that we never imagined we would have to face. Does this mean we love them any less? Absolutely not! We love our children no matter what.
Throughout life, we find many things that seem unfair. Children can get cancer, down syndrome, autism, and other diseases that we can not truly understand why. July brings to the table one disease that strikes our children without any reason as to why. July is Juvenile Arthritis Awareness Month. There is no cure for Juvenile Arthritis. Let us take a look at the diagnosis and treatment options that you have if your child suffers from this disease.
Juvenile Arthritis Explained – What is JA?
First let us start off by explaining what is Juvenile Arthritis, and the six different forms of Juvenile Arthritis (JA).
Juvenile Arthritis affects approximately 300,000 children worldwide, and that number includes 50,000 just in the United States. When looking at the total number affected by this disease, we have to remember that this number does not include children that are never diagnosed. Thousands of children go through their life with the thought “Oh, it is just growing pains” or “You need to stretch more.”
JA is an autoimmune disease that affects the joints of children. Diagnosis of JA in children happens before the age of 16. As adults, we get Arthritis, but in the case of children we diagnose them with Juvenile Arthritis. They get a form of arthritis that can be debilitating. As of right now there is no cure for the disease. JA is a chronic disorder that can last from weeks to years. The reason why some children get the disease is unknown, and as far as we can see there is no hereditary link.
There are six different types of JA:
- Juvenile Idiopathc Arthritis -This is the most common Juvenile Arthritis. This is broken up into 6 categories:
- Oligoarthritis – The most common in children, and the mildest form of the disease. This can affect up to four joints within the first six months of onset of symptoms. The two types are oligoarticular- persistent and oligoarticular-extended
- Polyarthritis – This form affects 5 or more joints in children 10 years or older. Small and Large joints can be affected. Doctors note that this performs like adult Rheumatoid Arthritis (RA) which is why it has two types Rheumatoid-factor Positive and Rheumatoid-factor Negative.
- Systemic – The rarest form of the disease to affect children. Being systemic means that it can affect the entire body. Symptoms include, but not limited too, high fevers, rash, and joint pain.
- Enthesitis-Related – This form of the disease affects the enthesitis site. It is arthritis, but causes inflammation at the enthesitis site which is the place where the ligament, joint capsule or tendon connect to the bone.
- Juvenile Psoriatic Arthritis – Form of JA that causes inflammation and swelling of the joints. This form can affect the eyes where it will cause eye inflammation. This affects a small portion of the children with JA which is about 6% of the cases diagnosed.
- Undifferentiated– This category is for anyone that does not fit into one of the above types of JA.
- Juvenile Myositis – These rare forms affect the muscles within the body. Along with the inflammation, and pain comes muscle weakness. Two types of Myositis are: 1. Juvenile Polymyositis (JPM) which affects many muscles within the body. JPM attacks the muscle fibers causing inflammation, pain, and weakness. 2. Juvenile Dermatomyositis (JDM) which attacks the skin of the child. A characteristic of JDM is a rash can develop on the eyelids and knuckles of the body.
- Juvenile Scleroderma – This is a rare disease that has no known cure, and also no known cause. When a child gets Scleroderma that body attacks itself, which makes this an autoimmune disorder. The body makes too much collagen in the skin and connective tissues causing a “hardening” of the skin. The patient tends for feel a burning sensation, kinda like they are burning from the inside out. This burning sensation is the nerves endings dying within the skin. Once the skin has been affect it will look like leather, and will become very tight. The degree of disease can vary from small patches to the entire body known as localized. Scleroderma can also affect the organs which is called Systemic.
- Juvenile Lupus – This Autoimmune disease is also known as Juvenile Systemic Lupus erythematosus (Juvenile SLE). With Juvenile SLE it causes the body to attack the cells within the body. This can be very painful as it causes inflammation, and because it is systemic it attacks the organs within the body. Many organs can be affected from the skin, joints, heart, kidneys, lungs, and even the nervous system. There is no cure for this autoimmune disease.
- Juvenile Vasculitis – Vasculitis is an extremely rare disease in children under the age of 17. Inflammation occurs within the wall of the blood vessels causing pain, and discomfort. There are more than a dozen forms of this disorder, but the two main forms are Kawasaki disease and Henoch-Schonlein purpura (HCP).
- Juvenile Fibromyalgia – Fibromyalgia is a chronic disease that can affect children. Children will have musculoskeletal pain, and several areas of joint pain which gets worse on palpation of the area. Along with pain the child may have episodes of fatigue, insomnia, headaches/migraines, and bowel issues.
Symptoms – How is it Diagnosed?
One of the first things you should be on the look out for is for your child to have symptoms. Most kids grow up having aches and pains. They are in the process of growing, and we may just brush them off as growing pains. This is also one of the reasons why the diagnosis rate is low. Many children may never get diagnosed until they are well into their adult years. Some of the main signs and symptoms to look for are:
- Joint pain – Joints may be swollen and stiff, and possibly have redness in the area. Because of this it will be painful, tender, and warm to the touch. Symptoms may be increased in the morning or if they maintain a single position for a long period of time.
- Eyes – Redness and dryness may be misdiagnosed as seasonal allergies. If they child has chronic dryness, redness, swelling, visual disturbances or sensitivity to light it may be a good idea to make a trip to the doctor.
- Skin – Most of the symptoms of the skin can point to which form of the disease the doctor may lean towards. Kids get rashes so don’t get too excited if your child has a rash. Take note of the type of rash, and check some of the other signs and symptoms like joint pain, burning sensation of the skin, swelling and redness of joints. The many rashes that can occur with JA are: 1. Red Rash that looks scaly 2. Spotted pink rash (Systemic) 3. Butterfly shaped rash across the nose and cheeks (Lupus) 4. Hard patches of skin (Scleroderma).
- Systemic JA can affect the organs of the body. Things to look for are bowel and bladder changes such as diarrhea or urinating problems which could be a sign of Bowel or Kidneys being affected. Shortness of Breath can be a sign of the lungs being affected. Chest pain or irregular heartbeat can show the heart is affected.
- Other signs and symptoms to look for is unusual fatigue or being excessively tired, high fever, and loss of appetite.
How is JA diagnosed? First you will start off at your pediatrician who will probably get a thorough background history of the child. They will want to known when did the symptoms start? What areas are affected? Family history will be examined even though most of the time JA is not known to be genetic. Bloodwork will be obtained to check for signs of infection or markers for inflammation. Imaging such as Xrays, CT scans, or MRI’s may be performed to check for joint damage or injury to the bones or organs in the body. With all the results your pediatrician may refer you to a rheumatologist. Don’t be alarmed with this because the Rheumatologist is specially trained in diagnosing and treating Arthritis in children and adults. It may take several visits to a year or more to get an appropriate diagnosis.
How Can I Treat this Disease? Is There A Cure?
The treatment of JA can vary depending on which type you have, and can be different for each child. Treatments are to decrease the inflammation, control pain, increase flexibility and range of motion and functions of joints, and preventing severe damage to the joints, skin, and organs of the body. The goal is to try to improve quality of life, and prevent long term damage to the body that can cause severe health problems as they become adults. The disease can be mild in some cases to severe in others.
What are the treatment options for JA? The rheumatologist will decide what is the best treatments for your child. Medication is one of the main treatments. Because this is autoimmune the following medications are considered:
- DMARDS – Disease-motified anti rheumatic drugs such as methotrexate, hydroxychloroquine, and sulfasalazine.
- NSAIDS – Analgesics such as Ibuprofen, Tylenol, Aleve, Narcotics, and Aspirin
Other options that are not drug related include but are not limited to
- Surgery – Joint replacements (Hip, Knee, Shoulder)
- Non-Drug Therapy – Yoga, exercise, swimming, walking, stretching, to help keep joints from becoming stiff and swollen.
- Physical Therapy and Devices – Physical Therapy for strengthening and flexibility, devices such as braces, splints and hand grips.
- Acupuncture – Pain and swelling control
- Massage – To keep muscles loose and help with pain management
- Chiropractic – Help keep the bones and joints in alignment for pain control and swelling.
Self Care – Healthy Diet
Once you have the diagnosis don’t be afraid to start caring for yourself at home. There are many things you can do at home to help with maintaining a healthy outcome. Maintaining a positive mental state is important to control pain and swelling within the body. Here are a few ideas on things you can do at home to help maintain self care:
- Mental Therapies – Meditation, Deep Breathing exercises, Visualization practices encouraging relaxation, and music therapy are proven successful with controlling pain and discomfort.
- Counseling – Going to therapy is very helpful to reduce mental stress and concern. Therapy will help you cope with your new diagnosis.
- Vitamin Supplements – Work with your doctors on this one. You want to make sure you are taking supplements that are safe for you that will not interact with your prescribed medications. Many supplements are on the market to help with inflammation control, digestive control, and energy. Please seek the advice of your doctor before starting this course of treatment.
- Topical Analgesic Cremes – There are many over the counter cremes that can help will pain and inflammation control.
- Hot & Cold Treatments – Ice packs and heat packs can help control pain, swelling, and inflammation. Warm baths and Sitz baths will help with relaxing muscles as well as pain control.
Healthy Diet is also very important to maintain a healthy lifestyle to control the disease. Proper nutrition will go a long way with helping your body control the symptoms of Juvenile Arthritis. Many foods are recommended in your diet such as fatty fish, fruits, vegetables, whole grains, lean high protein meats such as turkey and chicken, and extra virgin olive oils could help keep inflammation at bay. Things to avoid are sugars, processed foods, and high-fatty meats as these can cause inflammation.
A great diet to follow is the Mediterrainean Diet. It is known to have many disease fighting attributes. Amy Paturel put together a great web page that give you a break down of this diet is The Ultimate Arthritis Diet.
Juvenile Arthritis is a rare disease that can be controlled with the right treatments and diet. Working with your healthcare provider is essential. It will take time to get the right drug treatments to work for your child, but with patience you will find the right mix of medications that will give relief to your child’s pain, and piece of mind for yourself. Children feed off of our emotions so if you stay calm, and have faith your child will have low stress, and hopefully as little discomfort as possible. There is no cure for this disease, but many children live long healthy lifestyles. Don’t give up, hug your child tightly, and remember to always tell them you love them because that is always the best medicine….the love of a parent.
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