Medicine:Childhood arthritis

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Childhood arthritis
Other namesJuvenile arthritis, Pediatric rheumatic disease
SpecialtyRheumatology

Childhood arthritis (juvenile arthritis or pediatric rheumatic disease) is an umbrella term used to describe any rheumatic disease or chronic arthritis-related condition which affects individuals under the age of 16. Most types are autoimmune disorders.[1]

Signs and symptoms

Several types of childhood arthritis exist, including juvenile idiopathic arthritis, juvenile myositis, juvenile lupus, juvenile scleroderma, vasculitis, and fibromyalgia.[2]


General signs of childhood arthritis disorders include:

  • Joints: Swollen, stiff, red, warm, and/or painful joints[2]
  • Eyes: Painful/dry eyes, sensitivity to light and/or difficulty seeing caused by uveitis[2]
  • Skin: Scaly red rash (psoriatic), light spotted pink rash (systemic), butterfly shaped rash across the bridge of the nose and cheeks (lupus) or thick, hardened patches of skin (scleroderma)[2]
  • Organs: Digestive tract (diarrhea and bloating), lungs (shortness of breath) and heart[2]
  • Other: Fatigue, appetite loss, and/or high, spiking fever[2]


The most common type of childhood arthritis, juvenile idiopathic arthritis (previously known as juvenile rheumatoid arthritis (JRA) or juvenile chronic arthritis (JCA))[3] can be divided into three main forms: The classification is based upon symptoms, number of joints involved and the presence of certain antibodies in the blood.[1][4]

  1. Polyarticular arthritis is the first type of arthritis, which affects about 30–40% of children with arthritis and is more common in girls than boys.[1][4][5][6] Typically five or more joints are affected (usually smaller joints such as the hands and feet but many also affect the hips, neck, shoulders and jaw).[1][5]
  2. Oligoarticular (aka pauciarticular) arthritis can be early or late onset and is the second type of arthritis, affecting about 50% of children with juvenile arthritis.[1][4][5] This type affects fewer than four joints (usually the large joints such as knees, ankles or wrists) and may cause eye inflammation in girls with positive anti-nuclear antibodies (ANA).[1][4] Girls younger than eight are more likely to develop this type of arthritis.[7][4]
  3. Systemic disease is the least common form, with 10–20% of children (boys and girls equally) being affected with limited movement, swelling and pain in at least one joint.[1][5] A common symptom of this type is a high, spiking fever of 103 °F (39.4 °C) or higher, lasting for weeks or months, and a rash of pale red spots on the chest, thighs or other parts of the body may be visible.[1]

Cause

In most cases, juvenile arthritis is caused by the body attacking its own healthy cells and tissues, i.e. autoimmunity, causing the joint to become inflamed and stiff.[8][4] Once the joint has become inflamed and stiff, damage is done to the joint and the growth of the joint may by changed or impaired.[4] The underlying cause in the malfunction of the autoimmune system is unknown; dietary habits and emotional state seem to have no effect on the disease.[9][10]

Diagnosis

Early diagnosis and treatment by a pediatric rheumatologist or a rheumatologist can help manage inflammation, relieve pain, and prevent joint damage.[1][4] However, it is difficult for doctors to diagnose the disease.[11][9] Careful examination, laboratory tests (blood and urine), and various forms of imaging like X-rays may be some of the tests conducted by a doctor.[1][4] Doctors may perform some of the following tests to diagnose the condition[11]

  • ANA (Antinuclear Antibody) Test[12]
  • Joint Aspiration[13]
  • Rheumatoid Factor (RF) Test[14]

Treatment

The treatment of most types of juvenile arthritis include medications, physical therapy, splints and in severe cases surgery.[4] Methotrexate is commonly prescribed to children with juvenile arthritis.[15] These treatments are focused on reducing swelling, relieving pain and maintaining full movement of joints.[1] Children are encouraged to be involved in extra-curricular activities, physical activity when possible, and to live a "normal" life.[1][6]

Epidemiology

In the US it affects about 250,000-294,000 children making it one of the most common groups of childhood diseases.[4]

References

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 Arthritis Foundation. (2012). Juvenile Arthritis Face Sheet. Retrieved March 21, 2012, from Arthritis Foundation: "Juvenile Arthritis Facts". Archived from the original on 2012-03-07. https://web.archive.org/web/20120307140005/http://www.arthritis.org/ja-fact-sheet.php. Retrieved 2012-03-22. 
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 "Juvenile Arthritis" (in en). https://www.arthritis.org/diseases/juvenile-arthritis. 
  3. ↑ "Juvenile Arthritis". https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Juvenile-Arthritis. 
  4. ↑ 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 American Academy of Orthopaedic Surgeons. (2012). Orthoinfo. Retrieved March 21, 2012, from American Academy of Orthopaedic Surgeons: http://orthoinfo.aaos.org/topic.cfm?topic=a00075
  5. ↑ 5.0 5.1 5.2 5.3 Centers for Disease Control and Prevention. (2011). Arthritis. Retrieved March 20, 2012, from Centers for Disease Control and Prevention: https://www.cdc.gov/arthritis/basics/childhood.htm
  6. ↑ 6.0 6.1 American College of Rheumatology. (2011). Practice Management. Retrieved March 20, 2012, from American College of Rheumatology:http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/juvenilearthritis.asp
  7. ↑ "Juvenile Arthritis". https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Juvenile-Arthritis. 
  8. ↑ "Autoimmune Diseases". https://medlineplus.gov/autoimmunediseases.html. 
  9. ↑ 9.0 9.1 "Juvenile Arthritis". https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Juvenile-Arthritis. 
  10. ↑ Nancy Garrick, Deputy Director (2017-04-07). "Juvenile Idiopathic Arthritis (JIA)" (in en). https://www.niams.nih.gov/health-topics/juvenile-arthritis. 
  11. ↑ 11.0 11.1 "Juvenile Arthritis". https://medlineplus.gov/juvenilearthritis.html. 
  12. ↑ "ANA (Antinuclear Antibody) Test: MedlinePlus Medical Test" (in en). https://medlineplus.gov/lab-tests/ana-antinuclear-antibody-test/. 
  13. ↑ "Joint Aspiration (Arthrocentesis) (for Parents) - Nemours KidsHealth". https://kidshealth.org/en/parents/arthrocentesis.html. 
  14. ↑ "Rheumatoid Factor (RF) Test: MedlinePlus Medical Test" (in en). https://medlineplus.gov/lab-tests/rheumatoid-factor-rf-test/. 
  15. ↑ Takken, Tim; van der Net, Janjaap J; Helders, Paul PJM (2001-10-23). "Methotrexate for treating juvenile idiopathic arthritis". Cochrane Database of Systematic Reviews 2001 (4): CD003129. doi:10.1002/14651858.cd003129. ISSN 1465-1858. 

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