Dr. Trevor Davis, MD, Chief of Pediatric Rheumatology, talks to us about the chronic condition that affects approximately 300,000 children, with thousands more diagnosed every year.
Kids can get arthritis
There is nothing worse than seeing your child in chronic pain that prevents him or her from completing even the smallest everyday tasks – especially when the pain can’t be explained. If a child has had more than six weeks of stiff, swollen and/or painful, inflamed joints that can’t be traced back to another disease, Juvenile Idiopathic Arthritis (JIA) could be the culprit.
The exact cause is unknown
The first step is to rule out other diseases or infections that can cause arthritis with a thorough evaluation. Although the exact cause is unknown, it is believed that children with JIA are genetically predisposed to the condition.
A viral infection is a common trigger and can cause acute arthritis in just about anyone. But in these predisposed kids, the inflammation does not turn off properly — leading to a chronic arthritis long after the offending trigger has been removed.
There are several different types of JIA
People are likely familiar with the more well-known adult condition: rheumatoid arthritis. Pediatric arthritis is different and comes in many forms. The most notable is systematic onset JIA, a form of arthritis that includes inflammation of the whole body, accompanied by very high fevers and severe life-threatening illness.
Other types of JIA include:
- Oligoarticular – arthritis in fewer than four joints; most common in the larger joints such as knees or elbows.
- Polyarticular – arthritis in five or more joints; more common in the smaller joints like fingers.
- Enthesitis Related Arthritis – tenderness where the bone meets connective tissue. Usually, this affects the knees, hips and feet.
- Psoriatic Arthritis – arthritis that usually occurs in tandem with the skin condition known as psoriasis.
Receiving a diagnosis
JIA is diagnosed through a careful physical exam, imaging, and lab testing that both document the presence of the arthritis and exclude other diagnoses.
Testing can include lab values that predict risk, like rheumatoid factor (RF) or anti-nuclear antibodies (ANA). However, there is no test that proves or disproves JIA. Evaluation by other specialists, especially ophthalmologists, may be necessary to help diagnosis and to direct treatment.
The first course of action is to decrease the inflammation causing the pain and damage in the first place. Ibuprofen (the NSAID class) is typically recommended. From there, stronger anti-inflammatory and mild immunosuppressive medications and other therapies can be used to resolve the arthritis and bring it into remission. These might include a disease modifying anti-rheumatic drug (DMARD) or other therapies such as:
- Biologic therapy (Injectable anti-TNF medications like Humira or Enbrel)
- Physical therapy
- Occupational therapy
- Analgesic medication or therapy
Growing up with arthritis
Most children with JIA will achieve remission while on medication. Nearly fifty percent of children with JIA will go into adulthood without arthritis, off medication. Many others remain in remission for some time before relapsing. While there isn't a cure, today's medicines have taken a once debilitating, sometimes life-threatening, disease and turned it into one which can be kept under control.
To schedule an appointment with Dr. Trevor Davis, MD, request an appointment online or call our Pediatric Rheumatology department at 617-636-7285.