THE DOCTOR IS IN: Arthritis not just a disease of the old
About 60 percent of the adult population has some form of degenerative arthritis, and 1 percent has an inflammatory, autoimmune form of the disease, known as rheumatoid arthritis.
However, almost 300,000 children in the United States - one in 250 younger than 18 - also have inflammatory arthritis. July was Juvenile Arthritis Awareness Month, and it highlighted the fact that this disease is not just an ailment of the old."Children can develop a form of rheumatoid arthritis, sometimes called Still's disease, juvenile rheumatoid arthritis (JRA) or juvenile idiopathic arthritis (JIA)" says Terry Moore, MD, director of pediatric rheumatology at Saint Louis University Medical Center and director of pediatric rheumatology at SSM Cardinal Glennon Children's Medical Center. "JIA has the same symptoms we see in adult patients: joint swelling, stiffness, pain and restricted movement due to an inflammation of the lining of the joints, but we can also see, at times, fever, rash and other organ involvement in systemic onset."
My colleagues on staff at SSM St. Joseph Health Center often collaborate with pediatric specialists on staff at Cardinal Glennon. As a retired pediatrician, I recall referring patients to pediatric specialists as needed when serious disease issues presented themselves. Working as a team, we provided a coordinated treatment program to address serious childhood illness or injury.
JIA affects some children severely while others may have only occasional symptoms. For kids who have severe cases, growth may be affected. Fortunately, once detected, JIA is treatable, and kids who have the disease can be active and experience a relatively normal childhood.
"There are seven forms of JIA, which present differently and require different treatment strategies," Moore says. In fact, I recall seeing patients who had JIA that presented only with an intermittent very high fever. "We don't consider JIA to be a hereditary disease, and usually there are no relatives who have been diagnosed," Moore notes. We do know that JIA is an autoimmune disease in which the immune system attacks the body's own tissues. The cause is unknown.
To diagnose JIA, physicians conduct a complete examination and order blood tests to rule out any diseases that may cause similar symptoms. The blood tests also can indicate the presence of certain substances that are commonly found in people who have arthritis. Sometimes, X-rays of the joints are taken to determine if there is any bony abnormality or joint damage. And because the inflammation associated with arthritis also can affect children's eyes, an eye exam may be recommended.
Using current drug therapies, we can control JIA, although more than 80 percent of patients experience occasional flare-ups. The specific treatment recommended depends on the subtype of juvenile arthritis present and the degree of inflammation.
Normally, children with JIA take anti-inflammatory medications, most commonly naproxen. However, more involved disease requires drugs such as methotrexate or the newer biologics, such as Enbrel or Humira. These newer medications control the disease in almost 95 percent of patients. Occupational and physical therapy sometimes helps children maintain range of motion and continue participation in physical activities at school and home.
JIAÂ is a serious disease, but Moore offers hope: "Once diagnosed, we can work to control inflammation, relieve pain, prevent joint damage and maximize functional abilities. Kids with JIA don't have to be sidelined due to their illness."
If your child complains of stiff, sore or swollen joints, see your primary care physician. Diagnosis is the first step toward successful treatment and an active and joyful childhood!
Hank Clever, MD, is a well-known pediatrician in the St. Charles community. Since retiring from private practice in 1998, Dr. Clever continues to speak to community groups and organizations about a variety of health-related topics. Send questions for Dr. Clever c/o Public Relations Department, SSM St. Joseph Health Center, 300 First Capitol Drive, St. Charles, MO 63301.
