Juvenile arthritis

• Article
• 2021-01-30

Juvenile arthritis is a term that describes arthritis in children. "Arthritis" means joint inflammation. Arthritis refers to a group of diseases that cause pain, swelling, stiffness and loss of movement in the joints. A joint is where two or more bones come together. Juvenile arthritis usually affects the knees and joints in the hands and feet.

There are more than 100 arthritic or rheumatic conditions that can affect the joints, but can also cause pain, swelling, and stiffness in other supportive structures of the body, such as muscles, tendons, ligaments, and bones. Some rheumatic diseases can affect other parts of the body, including various internal organs.

Children can develop almost any type of arthritis that affects adults, but the most common type that affects children is juvenile idiopathic arthritis .

Juvenile idiopathic arthritis is an umbrella term or classification system for all more specific types of chronic or long-term arthritis in children. These conditions used to fall under the term juvenile rheumatoid arthritis, which is no longer used.

Symptoms

The most common symptom of all types of juvenile arthritis is persistent joint swelling, pain, and stiffness that are usually worse in the morning or after a nap. The pain can limit movement of the affected joint, although many children, especially younger ones, will not complain of pain.

One of the first signs of juvenile arthritis can be limping in the morning due to an affected knee.

In addition to joint symptoms, children with systemic juvenile arthritis can:

• High fever that can appear and disappear very quickly.
• A rash that can appear and disappear very quickly.
• Swollen lymph nodes in the neck and other parts of the body.
• Inflammation of internal organs, including the heart (less than half of cases) and lungs (very rare).

Therapy

The main goals of the treatment are:

• Maintain a high level of physical and social functioning.
• Have a good quality of life.

To achieve these goals, doctors recommend treatments that:

• Reduce swelling.
• Maintain full movement in the affected joints.
• Relieves pain.
• Prevent, identify and treat complications.

Most children with juvenile arthritis require a combination of medications and other treatments to achieve these goals.

Medicines

• Non-steroidal anti-inflammatory drugs (NSAIDs). Aspirin, ibuprofen, naproxen and naproxen sodium are examples of NSAIDs. They are often the first type of medication doctors prescribe for juvenile arthritis. All NSAIDs work in the same way by blocking substances called prostaglandins that contribute to inflammation and pain. However, each NSAID is a different chemical and each has a slightly different effect on the body. For reasons unknown, some children seem to respond better to one NSAID than to another. NSAIDs should only be used at the lowest possible dose for the shortest amount of time needed.
  
  You can buy some NSAIDs without a prescription, while several others, including a subclass called COX-2 inhibitors, require a prescription.
  
  All NSAIDs can have significant side effects, so consult your child's doctor before administering them. Your child's doctor should monitor your child if he or she is taking NSAIDs regularly to control juvenile arthritis.
  
  Side effects of NSAIDs include stomach problems; skin rash; high bloodpressure; fluid retention; and liver, kidney and heart problems. The longer a person takes NSAIDs, the more likely they are to experience side effects ranging from mild to serious. Many other drugs cannot be taken if someone is taking NSAIDs, because NSAIDschange the way the body uses or eliminates these other medicines.
• Disease-modifying anti-rheumatic drugs (DMARDs). If NSAIDs don't relieve your child's juvenile arthritis symptoms, the doctor may prescribe this type of medication. DMARDs slow the progression of juvenile arthritis, but because it can take weeks or months to relieve symptoms, they are often taken along with an NSAID. While there are many different types of DMARDs, many doctors prescribe one called methotrexate.
  
  Researchers have learned that methotrexate is safe and effective for some children with juvenile arthritis whose symptoms are not relieved by other medications. Because children only need small doses of methotrexate to relieve arthritis symptoms, potentially dangerous side effects rarely occur. The most serious complication can be liver damage, which a doctor can help prevent with regular blood tests and check-ups. Careful monitoring for side effects is important for people taking methotrexate. When side effects are noticed early, the doctor can reduce the dose and eliminate the side effects.
• Corticosteroids. If your child has very severe juvenile arthritis, stronger medicines may be needed to stop severe symptoms, such as inflammation of the sac around the heart (pericarditis). Corticosteroids, such as prednisone, can be added to the treatment plan to control severe symptoms. This drug can be given by IV (intravenous), mouth, or injection directly into a joint. Corticosteroids are powerful anti-inflammatory drugs. Corticosteroids can interfere with your child's normal growth and cause other side effects, such as a round face, weakened bones and an increased risk of infections. Once the medication has severe symptoms under control, the doctor will gradually lower the dose and stop it completely over time. It can be dangerous to stop taking corticosteroids suddenly. Carefully follow the doctor's instructions on how to take or decrease the dose. For inflammation in one or just a few joints, injecting a corticosteroid compound into the affected joint or joints can often provide quick relief without the systemic side effects of oral or intravenous medications.
• Organic means. If your child has received little relief from other medications, he or she may be given one of a newer class of medications called biological response modifiers or biologics. These are based on compounds made by living cells. Tumor necrosis factor (TNF) inhibitors are biological agents that work by blocking the action of TNF, a naturally occurring protein in the body that helps cause inflammation. Other biological agents block other inflammatory proteins, such as interleukin-1 or immune cells called T cells. Different biologics generally work better for the different subtypes of the disease.

Other treatments

• Physiotherapy.
• Complementary and Alternative Therapies.

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