Juvenile Arthritis

GENERAL INFORMATION:

What is juvenile arthritis? 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 may affect any joint, including the joints of the hands, wrists, ankles, feet, and knees. JA is also called juvenile idiopathic arthritis (JIA), juvenile chronic arthritis (JCA), or juvenile rheumatoid arthritis (JRA).

What causes juvenile arthritis? Juvenile arthritis is thought to be caused by a defect in the immune system. The immune system is the part of your body that fights infection. With JA, the immune system mistakenly attacks healthy cells and tissues, especially the joints. Some believe that JA may be triggered by stress, trauma to a joint, or infection. No one knows for sure what causes this disease.

What are the types of juvenile arthritis? There are different types of JA. You may have any of the following types of JA:

• Oligoarthritis: This is also called pauciarticular arthritis. Oligoarthritis is arthritis in less than five joints during the first six months of the disease. Six months after the start of the disease, oligoarthritis may be either persistent or extended. Persistent oligoarthritis is when the number of joints involved remains less than five. Extended oligoarthritis happens when the joints involved increases to five or more. Oligoarthritis tends to occur in large joints of the lower limbs, such as the knees and ankles.
  
  
• Polyarthritis: This type of JA is when five or more joints are affected within the first six months of the disease. This may occur in very young children or adolescents. The large and small joints of the hands and feet are often affected. Sometimes, your child's neck bones and the joints of his jaw may also be involved.
  
  
• Systemic arthritis: This is where many parts of the body, other than the joints, are affected. Fever and rash are often present. Your child's heart, lungs, liver or other abdominal (belly) organs, and lymph nodes may also be affected. The arthritis usually involves many joints and may affect both large and small joints.
  
  
• Enthesitis-related arthritis: Other conditions, such as juvenile ankylosing spondylitis and arthritis associated with inflammatory bowel disease (IBD), are included in this type. This arthritis often occurs in the lower limb joints and places where tendons attach to a bone. A tendon is a cord of tough tissue that connects your child's muscles to his bones. After some time, your child's hips and spine (back bone) may also be affected.
  
  
• Psoriatic arthritis: This type of JA includes arthritis of the joints and a skin condition called psoriasis. This often affects one of the knees or ankles, and the small joints. It also commonly causes inflammation of the sheath (cover) of a tendon.
  
  
• Other arthritis: This type is considered if your child's arthritis falls into more than one type of JA. It may also be considered if your child's signs and symptoms are hard to classify into any one specific type.

What are the signs and symptoms of juvenile arthritis? Signs and symptoms of JA may come and go. They may be present in your child for a time, disappear for a while, and start up again. Your child may have joint pain or stiffness, fever, loss of appetite, weight loss, and growth problems. He may feel very weak or more tired than usual. Other signs and symptoms may include any of the following:

• Abdominal pain or diarrhea (loose bowel movement).
  
  
• Bent or crooked fingers. Sometimes, the toes or fingers may become shaped like a sausage.
  
  
• Eye pain or headache.
  
  
• Firm, round growths on or around the joints.
  
  
• Muscle weakness.
  
  
• Nail changes, such as a change in color, pitting (little dents), and a loosening of the nail from the nail bed.
  
  
• Skin rash. This rash may appear as round, flat, salmon-pink spots. Stress or a warm bath may worsen the rash. Streaks (straight lines) may be seen when the skin is scratched. It does not usually itch.

How is juvenile arthritis diagnosed? Caregivers may check your child's health history, including other diseases and medicines he is taking. Caregivers will also need to know when the joint problems and other symptoms started. Your child may also have any of the following tests:

• Blood tests: Your child may need blood taken for tests. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV. Blood tests can give caregivers more information about your child's health condition. Your child may need to have blood drawn more than once.
  
  
• Joint x-ray: This is a picture of the bones and tissues in your child's joints. Your child may be given dye as a shot into the joint before the x-ray. This dye will help your child's joint show up better on the x-ray. A joint x-ray with dye is called an arthrogram.
  
  
• MRI: This test is called magnetic resonance imaging. During the MRI, 3-D (three-dimensional) pictures are taken of your child's body. An MRI may be used to look at your child's brain, muscles, joints, bones, or blood vessels. Your child will need to lie still during his MRI. Never enter the MRI room with an oxygen tank, wrist watch, or any other metal objects. This can cause serious injury.

How is juvenile arthritis treated? The overall goal of treatment of JA is to control symptoms, prevent joint damage, and maintain function. Your child may have one or more of the following:

• Medicines: Caregivers may give your child painkillers or steroids to decrease pain and swelling in the joints. There are medicines that may slow the progress of JA and reduce stiffness. Your child may also be given medicines that help the immune system fight off disease. It is important to understand that medicines will not take away your child's symptoms right away.
  
  
• 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.
  
  
• Surgery: Caregivers may suggest surgery when your child's joints become severely affected. Surgery can be done to take out all or part of the joint and replace it with a prosthesis (man-made replacement). This may be done to ease pain and repair the joint. It may also be done if the bones in your child's spine are pressing on the nerves.

Where can I find 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 Academy of Orthopaedic Surgeons
  6300 North River Road
  Rosemont, IL 600184262
  Phone: 1-847-8237186
  Web Address: http://www.aaos.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
  

CARE AGREEMENT:

You have the right to help plan your child's care. To help with this plan, you must learn about your child's health condition and how it may be treated. You can then discuss treatment options with your child's caregivers. Work with them to decide what care may be used to treat your child.

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