Juvenile Arthritis

WHAT YOU SHOULD KNOW:

• Juvenile (JU-ve-nil) arthritis (arth-REYE-tis), or JA, is a chronic (long term) disease that begins before the age of 16. It is marked by inflammation (swelling and pain) of one or more joints for at least six weeks. Joints are parts of the body where bones meet. JA is also called juvenile idiopathic arthritis (JIA), juvenile chronic arthritis (JCA), or juvenile rheumatoid arthritis (JRA). There are many types of JA. Oligoarthritis is arthritis in less than five joints in the first six months of the disease. Polyarthritis is arthritis in five or more joints in the first six months of the disease. Systemic arthritis affects many parts of the body, including organs, such as the heart, and lymph nodes. Enthesitis-related arthritis may affect your child's hips and spine (back bone). Psoriatic arthritis is arthritis that also includes a skin condition called psoriasis. Your child may also have a type of arthritis that includes more than one type of JA.
  
  
• No one knows for sure what causes this disease. Some believe that JA may be caused by problems with the immune system. JA is also thought to be triggered by stress, trauma, or infection. Joint pain or stiffness, fever, loss of appetite, weight loss, and deformity of the joints are common signs and symptoms. JA may affect other areas of the body and may also cause weakness, weight loss, or a skin rash. A detailed health history, with information on when the symptoms started, may be needed to diagnose the disease. Blood tests, joint x-rays, or MRI may also be done. Treatment aims at preventing joint damage, maintaining joint function, and decreasing pain. With treatment, such as medicines and therapy, symptoms of JA may be relieved and quality of life improved.

AFTER YOU LEAVE:

Medicines:

• Keep a list of your child's medicines: Keep a written list of the medicines your child takes, the amounts, and when and why they are taken. Bring the list of your child's medicines or the medicine bottles when you visit your child's caregivers. Ask your child's caregiver for more information about the medicines. Do not give any medicines to your child without first asking your child's caregiver. This includes prescriptions, over-the-counter drugs, vitamins, herbs, or food supplements.
  
  
• Give your child's medicine as directed: Always give your child's medicine as directed by his caregivers. Call your child's caregiver if you think your child's medicines are not helping. Call if you feel your child is having side effects. Do not quit giving the medicines to your child until you discuss it with your child's caregiver.
  
  
• Do not give aspirin to children under 18 years of age: Giving aspirin to your child when he is ill may cause a very serious illness called Reye's Syndrome. This could lead to brain and liver damage. Read medicine labels to see if your child's medicine has aspirin in it.

Ask your child's caregiver when to return for a follow-up visit. Keep all appointments. Write down any questions you and your child may have. This way you will remember to ask these questions during your child's next visit.

Activity:

• Rest is important if your child's joints are very painful. Your child should limit his activities until his symptoms improve. He may be given splints for his hands to help the joints rest and decrease inflammation (swelling).
  
  
• Your child may gradually return to his normal activities when he can do them without pain. Movements and activities that cause strain on the joints, such as heavy exercise and lifting, should be avoided.

Child care:

• Eye checks: Your child should have a complete eye exam regularly. This includes tests that may help learn about your child's vision and check for other eye problems. Depending on your child's caregiver, eye checks may be done every 3 to 4 months, 6 months, or 12 months. Ask your child's caregiver for more information about eye checks.
  
  
• Therapies: Your child may need any of the following therapies:
  
  
  • Physical therapy: A physical therapist helps your child with special exercises. These exercises help make his bones and muscles stronger.
    
    
  • Occupational therapy: Occupational therapy, or OT, uses work, self-care, and play activities to help your child in his daily life. There are many ways occupational therapy may help him become better able to take care of himself. Your child may be taught special skills for daily living. An occupational therapist may help your child choose equipment that will help him get things done at home or school.
    
    
  • Cognitive behavioral therapy: This is therapy to help your child recognize unhelpful patterns of thinking and reacting to stressful situations, such as pain. Your child will also learn how to replace these patterns with more helpful ones. Therapists may help your child learn different ways of coping with pain.
  
  
• Vaccinations: Take your child to his caregiver for vaccinations (shots) against the flu or pneumonia. Depending on your child's caregiver, other shots may also be needed. Ask your child's caregiver for information about vaccinations and which ones are right for your child.

Daily diary: Your child's day to day mood and activities may affect his daily symptoms. A diary of information about his JA may help in the treatment of his disease. Have your child write down what he was doing when the symptoms occurred and what day they occurred. If pain was felt, include information on what the pain felt like, how bad it was, and where it was felt. How long the pain lasted, what time the pain happened, and what your child was doing may also be included. Having your child write down his symptoms may also help caregivers check if his treatment is helping him.

Diet:

• Healthy foods: Offer your child healthy food from all of the five food groups: fruits, vegetables, breads, dairy products, meats, and fish. Ask your caregiver how many servings of fats, oils and sweets should be included in your child's diet. Eating healthy foods may help your child feel better and have more energy. Ask your child's caregiver if your child should follow a special diet.
  
  
• Foods rich in calcium and vitamin D: Calcium and vitamin D are important for growing strong bones. Give your child foods that contain a lot of calcium, such as milk, cheese, broccoli, and tofu. Vitamin D may be found in vegetables and fortified milk, cereal, and bread. Ask your child's caregiver if your child needs extra vitamins and minerals, especially calcium and vitamin D.

Helping your child feel better:

• A massage of the affected joints and muscles may help your child relax.
  
  
• Cold treatments, such as ice or cold packs and iced water, may decrease pain.
  
  
• Sleeping on a waterbed and in warm clothes may keep your child comfortable and warm. Have your child sleep in a position that follows the natural curves of his body, such as on his side. Ask your child's caregiver if your child needs to sleep in certain positions for more comfort.
  
  
• You may use heat to decrease pain and swelling. It may also help relax your child's muscles. Heat treatment includes hot packs, heat lamps, and warm baths or showers. Be sure to check that the temperature is not too hot. Do not use heat treatment if your child has a rash unless his caregiver says it is OK.

For support and more information: Having a child with juvenile arthritis may be life-changing for you and your family. Accepting that your child has JA may be hard. You and your family may feel sad, angry, or frightened. These feelings are normal. You may want to join a support group. This is a group of people who may also have children with juvenile arthritis. Contact the following for more information:

• American College of Rheumatology
  1800 Century Place, Suite 250
  Atlanta, GA 30345
  Phone: 1-404-6333777
  Web Address: http://www.rheumatology.org
  

• Arthritis Foundation
  P.O. Box 7669
  Atlanta, GA 30357-0669
  Phone: 1-404-872-7100
  Phone: 1-800-568-4045
  Web Address: http://www.arthritis.org
  

• National Institute of Arthritis and Musculoskeletal and Skin Disease
  Information Clearinghouse
  National Institutes of Health
  1 AMS Circle
  Bethesda, MD 20892-3675
  Phone: 1-301-495-4484
  Phone: 1-877-226-4267
  Web Address: http://www.niams.nih.gov
  

CONTACT A CAREGIVER IF:

• Your child has a fever (increased body temperature).
  
  
• You child has problems eating or you feel he is not getting enough to eat.
  
  
• Your child begins to lose weight, thinks more slowly, or seems sad most of the time.
  
  
• Your child has a severe headache or pain around the eyes.
  
  
• You have questions or concerns about your child's disease, treatment, or care.

SEEK CARE IMMEDIATELY IF:

• Your child has trouble breathing all of a sudden.
  
  
• Your child is throwing up and is not able to eat or drink.
  
  
• Your child is having a seizure (convulsion).
  
  
• Your child's pain does not go away or becomes worse.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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