Written by Soon Phaikteng
Juvenile arthritis is a group of syndromes in which many autoimmune and inflammatory conditions developed in children below age of 16 and lasts for more than 6 weeks. It is not the same disease but similar to rheumatoid arthritis in adults. This joint inflammation often leads to joint destruction which affects physical disability in children and thereafter impairing their daily life. The prevalence of children with juvenile arthritis in Malaysia is currently not known, but however 34 studies had showed that 0.07-4.01 per 1000 children worldwide is affected.
There are few types of juvenile arthritis which juvenile idiopathic arthritis considered the most common form. It also includes subtypes of oligoarticular juvenile arthritis, polyarthritis and systemic. About 50% of children with juvenile arthritis have the oligoarticular type and girls below 8 years old are likely to develop it. Usually, only one joint (a knee or an ankle) or an eye is involved and symptoms is very mild and will go away over time. On the other hand, around 30% of children with juvenile arthritis developed into polyarticular type which affects five or more smaller joints on both sides of the body like hands and feet. In some cases, children with antibody IgM rheumatoid factor (RF) in their blood tends to have severe form of the disease as the IgM RF antibody attacks body’s own tissue. Doctors believe that it is the same as rheumatoid arthritis in adult. Around 20% of children have the type of systemic juvenile arthritis. Usually, they may have symptoms of rash and inflammation of internal organs such as heart, liver, spleen and lymph nodes. As for enthusiastic-related juvenile arthritis, the child has arthritis as well as enteritis which is a swelling of tissue where bone meets a tendon or ligament. Lastly, there is psoriatic arthritis where the child may have both arthritis and red or silver scaly skin disease termed as psoriasis.
The cause of juvenile arthritis is not known. It is not hereditary but likely due to a combination of genetic factors, environmental exposures (for example virus) and a child’s immune system. Juvenile arthritis affects each kid differently and last for indefinite periods of time. The symptoms may improve or disappear and at times worsen during flare ups.
Symptoms may include
- Painful, swollen, stiff joints in knees, hands, feet, or other joints that occur in the morning or and often improve by afternoon.
- Swelling in the lymph nodes.
- Joints may become inflamed and appear red and warmth to touch.
- Weaken muscles and soft tissues around the joint
- High fever and light pink rash which disappear quickly
- Inability to use one or more joints
- Inflammation of the eye which called iridocyclitis
- Lack of appetite, poor weight gain and overall growth may slow.
Juvenile arthritis may be difficult to be diagnosed and no single test will confirm the disease. Usually tests and scans will be done when the symptoms persists for 6 weeks or longer. Tests such as Antinuclear antibody, complete blood count (CBC), complement test, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Rheumatoid Factor (RF), white blood cell count and so on will be carried out. Besides, doctor will also perform X-rays, CT-scan, MRI, and bone scan for children with juvenile arthritis.
In order to improve quality of life, the aims of treatment in treating children with juvenile arthritis are to control the pain and preserving the range of motion, muscle strength and function. Besides, it is important to ensure normal nutrition, growth, physical and psychological development in these children. Pharmacological treatment include
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen are the first line of treatment to reduce pain and inflammation
- Disease-modifying anti-rheumatic drugs (DMRDs) like methotrexate, sulfasalazine will be used along if NSAIDs do not relieve symptoms.
- Biologic agents
- Corticosteroids will be given by orally or intravenously for severe juvenile arthritis.
Non-pharmacological treatment includes
- Nutritional Therapy such as calcium intake plus vitamin D to increase children with low bone mineral density and preventing osteopenia. Besides, appropriate protein and calorie intake will be considered to ensure normal muscle growth
- Physical activity such as therapeutic exercises, weight bearing exercises and massage to maintain and improve range of motions and strength of the joints.
- Orthotics management like splinting and foot orthotics to help maintaining joint alignment.
- Thermotherapy for instance warm baths, heat packs, deep heat ultrasound to reduce joint rigidity and muscle spasms. Cold packs may be used to cause vasoconstriction and thus reliving joint pain.
- National Institute for Health and Care Excelle (NICE). Systemic juvenile idiopathic arthritis [Internet]. 2014 Mar [cited 2019 Oct 3]. Available from https://www.nice.org.uk/advice/esnm36/chapter/introduction#targetText=Juvenile%20idiopathic%20arthritis%20is%20a,to%20genetic%20and%20environmental%20factors.
- Ping TS. Juvenile Idiopathic Arthritis. [Internet] 2014 Oct 14. [Updated 2019 Oct; cited 2019 Oct 3]. Available from: http://www.myhealth.gov.my/en/juvenile-idiopathic-arthritis-2/
- Femke H M P. Diagnosis and management of juvenile idiopathic arthritis. [internet] British Medical Journal; 2010 Dec 3 [cited 2019 Oct 3];2010;341:c6434. Available from https://www.bmj.com/content/341/bmj.c6434.full
- Pediatric Orthopaedic Society of North America. Juvenile Arthritis. [Internet]. 2018 Jan [cited 2019 Oct 3], Available from: https://orthoinfo.aaos.org/en/diseases–conditions/juvenile-arthritis/
- Standford Children’s Health. Juvenile idiopathic arthritis. [Internet]. [cited 2019 Oct 3] Available from: https://www.stanfordchildrens.org/en/topic/default?id=juvenile-idiopathic-arthritis-90-P01722
- Smith CAM, Karine TP, Jutai JW, and et al. A systematic critical appraisal of clinical practice guidelines in juvenile idiopathic arthritis using the appraisal of guidelines for research and evaluation II (AGREE II) instrument. [internet] PLoS One; 2015 Sep 10. [cited 2019 Oct 3];2015; 10(9): e0137180. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4565560/