It’s a common misconception that only elderly people have arthritis. People of all ages, including children, can have this disease. Although it’s mostly a burden in the older population, arthritis in children is more active. It is crucial to note that unlike osteoarthritis and other degenerative disease, which is common in older individuals,
arthritis among children is due to autoimmune causes.
If your child is experiencing persistent joint pain, swelling, stiffness, or difficulty moving their joints, these could be signs of arthritis. Your child may be avoiding certain activities that interest him, looking more fatigued than normal, or struggling to walk. At times the child may also experience fever and even rashes during episodes of joint pains. In case these signs persist for about six weeks, or moreon a child less than. 16 years of age, then the diagnosis of juvenile idiopathic arthritis (JIA) is made after ruling out other causes of arthritis.
The term refers to different subtypes of arthritis affecting children, clinical features of which are not identical to each other, however, each includes persistent arthritis of the joints as a common feature. The severity of arthritis pain that children experience is just as much if not more, than what can be experienced by adults. Expressing pain, or understanding the cause of their pain, can be very distressing for children. The intensity of distress or discomfort can be different for each child and may be more or less on some days or following inactivity. This pain, in some cases, can become long-lasting and affect your child’s temperament, sleep as well as general health.
In the mildest cases, there is the likelihood that your child will have mild discomfort and or joint stiffness on and off especially during the first half of the day. Over time, although still infrequent, the stiffness may last longer with more grinding pain affecting more than one joint. In moderate cases, there may be any of the following symptoms in conjunction with pain and perfect mobility hindrance: inflamed joints with swelling, redness of the skin, warmth of joints. In severe cases, the pain may be constant, joints may become visibly deformed, and your child may struggle with everyday activities.
It is important to note that juvenile arthritis is a disability that has a great impact on all aspects of the child’s day to day activities. As the severity increases, your child may be limited in their ability to walk and climb stairs or even writing and playing. Lack of the physical ability brings about irritation and in the extreme case, your child may even require aid in carrying out simple activities. However, with appropriate treatment and management, many children can continue to lead active lives.
Currently, there isn’t a definitive test to predict the onset of juvenile arthritis before symptoms appear. However, if your child is at high risk due to family history and has symptoms of arthritis, consult a Pediatric Rheumatologist. A thorough history and physical examination is necessary before doing any tests. Based on the clinical picture, your doctor will ask for blood test to look for inflammatory markers and antibodies associated with autoimmune conditions. These tests, combined with imaging studies like X-rays or MRIs, can help in diagnosing arthritis early, even in younger children.
It is especially important in the case of juvenile arthritis to identify the disease at the earliest stage and prevent further damage through early intervention. All children with JIA need their eyes to be checked to look for any silent inflammation in the eyes called uveitis, which if not detected can lead to decreased vision and even blindness.
Upon the diagnosis of juvenile arthritis in a child, doctors generally follow a treatment regime that consists of a course of anti-inflammatory medication, physical activity therapy and often also immune suppressive agents. In cases that do not respond to standard first-line treatment or in some other cases at onset itself, biologic drugs that inhibit only certain pathways of the immune system are given. Physical therapy is as important as medication to preserve joint mobility and should be under the guidance of a trained pediatric physiotherapist. You should always ask your physician’s permission before trying any home treatment.
Juvenile arthritis is a disease that should be considered severe due to its influence on both the physical and emotional aspects of the child being affected. The Pediatric Rheumatologist is the anchor person of your child’s treatment who will liaison with the other specialists such as the Ophthalmologist, physiotherapist, Orthopedic surgeon and General Pediatrician. Regular growth monitoring, immunisation, prevention and treatment of infections, periodic follow-ups for adjusting the medications and even career choices are to be discussed with your doctor. With the right medical care and regular follow-ups, your child can lead a fulfilling life despite the challenges of arthritis. The key is early intervention and ongoing management to reduce pain and prevent joint damage.
(The author, Dr Jyothi Raghuram, is a senior consultant-Pediatrics & Pediatric Rheumatology, at Aster Whitefield Hospital.)
