Arthritis can also occur among children. It is known as juvenile or childhood arthritis. It’s the swelling and tenderness of joints. The most frequent one is called juvenile idiopathic arthritis (JIA) or juvenile rheumatoid arthritis. It can cause permanent physical damage to joints. Studies show that approximately three million children and teens have juvenile idiopathic arthritis. It’s also more prevalent among girls. In addition, it’s the most common disorder among patients under 16.
Causes of childhood arthritis
Scientists are yet to uncover the exact cause of childhood arthritis. However, genetic, environmental, and autoimmune factors can increase the risk. Children are diagnosed with juvenile arthritis if it occurs in more than four joints before 16 years of age and over a period of at least 6 weeks.
Environmental exposure in a child with pre-existing genes will be more susceptible to a changed immune response. These genes are known as human leukocyte antigen alleles. Children with HLA alleles are more likely to develop juvenile idiopathic arthritis. There are also single nucleotide polymorphisms—when a DNA sequence is altered—which can lead to certain types of childhood arthritis. Environmental triggers include infection, whereby heat shock protein levels increase. But more studies are needed to confirm this.
1. Joint pain
The most common symptom of childhood arthritis is joint pain. If your child limps first thing in the morning or after waking up from a nap. The joints may also look tender, swollen, or red. Children may also struggle to do simple activities after sitting in one place for too long. Stiffness is also a common problem.
Childhood arthritis can also cause chronic eye inflammation. This manifests as dryness in the eyes, redness, blurred vision, and sensitivity to light.
3. Skin symptoms
There may also be a light red rash, flare-ups across the bridge of the nose and cheeks, or thick hard patches of skin.
4. Other symptoms
Juvenile arthritis also causes:
- Shortness of breath
- Loss of appetite
1. Oligoarticular arthritis
This is when the condition affects four or fewer joints during the first six months. It is classified into two. Persistent oligoarthritis in four or fewer joints during the entire disease. Extended oligoarthritis is when the condition affects five or more joints after the initial six months.
2. RF-negative polyarticular JIA
This is when the condition affects five or more joints during the first six months of the disease with a Rheumatoid Factor (RF) negative test.
3. RF-positive polyarticular JIA
This is arthritis affecting 5 or more joints during the first 6 months of disease, with 2 or more positive tests for RF at least 3 months apart during the first 6 months of disease.
4. Systemic arthritis
This is when the condition is in one or more joints. A fever occurs three days daily for at least two weeks. It also comes with a rash, lymph node enlargement, or serositis.
5. Psoriatic arthritis
When arthritis and psoriasis are accompanied by dactylitis- swelling of joints in the fingers and toes, nail pitting, and first-degree psoriasis.
6. Enthesitis-related arthritis
Arthritis and enthesitis occur with joint tenderness, presence of HLA-B27 antigen, arthritis in a boy over six, inflammation in the eye, or inflammatory bowel disease.
7. Undifferentiated arthritis
This is when the condition doesn’t meet any of the categories.
Untreated arthritis can lead to disfigurement and severe disability. Ultimately, treatment should aim for remission, prevent joint damage and improve quality of life. Medical treatment includes non-steroidal anti-inflammatory painkillers (NSAIDs), intravenous corticosteroids, and disease-modifying anti-rheumatic drugs (DMARDs). Doctors select the type of medication based on how long the type of juvenile arthritis and symptoms exhibited.
NSAIDs are frequently used if the arthritis isn’t severe. Doctors escalate to corticosteroids if more joints are affected, and the NSAIDs are ineffective. These are anti-inflammatory steroid medications that mimic cortisol. The steroids are injected directly into the affected joints. Younger children will need to take steroid shots under anaesthesia.
Doctors can move on to DMARDs to prevent further escalation of the condition. These are specialised for peripheral joint arthritis. Alternatively, doctors can use anti-TNF therapy. TNF is Tumor Necrosis Factor, a pro-inflammatory protein that plays a role in cell survival, spread, differentiation, and death. Anti-TNF therapy can be effective for patients with moderate to severe disease activity.
Surgery is also an option when medical therapy isn’t working. Joint replacement can help reduce the risk of further disability, severe pain, or damage.
Physical exercise is also key in helping manage joint stiffness and pain. Low-impact exercises like walking, yoga, or swimming may be the safest options. However, if juvenile arthritis isn’t severe, kids can still participate in any activity. The exercises necessary for better joint pain management should include strength training, improving flexibility, improving balance, and showing patients how to use assistive devices like canes and braces.
Changing to a diet rich in fruits, vegetables, lean meats, and healthy fats can also help reduce inflammation.
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