Children can get arthritis too

Most laypeople fail to understand that arthritis in children exists. Due to the misconception that arthritis can only occur in older adults, many children suffer for months or years before a diagnosis of arthritis is thought of, and proper treatment is sought.

The problem doesn't end there. Children with arthritis often experience difficulty in school because their teachers and schoolmates have no idea what to expect from a child with arthritis, or the nature of the illness.

Childhood arthritis is often referred to as juvenile rheumatoid arthritis or juvenile idiopathic arthritis (JIA). JIA may involve one or multiple joints, and can cause other symptoms such as fever, rash and eye inflammation.

Symptoms can last from several months to many years.

JIA is caused by the malfunctioning of the immune system. This results in the inflammation of the synovial membrane, which is the lining of the joint. Essentially, it is a case where the immune system of the body starts fighting itself, says Dr Amir Azlan Zain, consultant rheumatologist and president of Arthritis Foundation Malaysia. When the inflammation persists, joint damage may occur.

What causes the immune system to malfunction in JIA has yet to be identified. These conditions are not considered to be hereditary, and rarely involve more than one family member.

Current statistics show that about one in every 1,000 children develops some type of juvenile arthritis. This disorder can affect children at any age, although rarely in the first six months of life. Because the causes of JIA are unknown, no one knows how to prevent this condition.

Early detection of the symptoms can however, prevent the problem from getting worse.

The problem is, JIA may be difficult to diagnose because some children may not complain of pain at first, and joint swelling may not be obvious. There is no blood test that can be used to diagnose the condition either.

As such, the diagnosis of JIA very much depends on physical findings and the medical history of the patient. Careful examination is imperative in identifying the signs and symptoms of JIA. Typical symptoms that accompany the condition include limping, difficulty with fine motor activities, and the reluctance to use an arm or a leg.

"JIA often presents itself as some form of a loss of function in the limbs, such as the inability to use an arm properly," Dr Amir explains.

"The pain is often not localised as well. For example, pain in the knee can present itself as pain in the thigh."

Other JIA symptoms parents should look out for include crying out constantly, changes in their child's personality and weight loss.

JIA was one of the central topics at The World Arthritis Day Congress held last Sunday at Sunway Medical Centre, Selangor.

"Not enough people know that arthritis can affect kids. We feel that we need to increase the awareness that this can actually happen so that those who are affected can seek treatment in time," says Dr Amir.

An experienced team of healthcare providers that include a paediatric rheumatologist, physical and occupational therapists, social worker and nurse specialist can help provide optimal care to a child with JIA.

The overall treatment goal is to control symptoms, prevent joint damage, and maintain function of the affected areas.

Medicine is likely to be involved in an arthritic child's treatment, in which case, non-steroidal anti-inflammatory drugs (NSAIDs) are likely to be the first line of treatment to reduce inflammation and pain.

In more severe cases of JIA, a doctor may prescribe medicines referred to as disease-modifying anti-rheumatic drugs (DMARDs). DMARDs are sometimes also known as slow-acting antirheumatic drugs, or SAARDs.

Methotrexate, either alone or in combination with other medicines, is the DMARD that is usually tried first. A type of DMARD called a biologic, such as etanercept, may also be tried.

In all cases, physical exercise plays a crucial part of treatment in JIA. Physical and occupational therapists can teach a patient exercises to prevent contractures (a permanent shortening of a muscle or a joint), and maintain joint range and muscle strength.

Moving a child's arthritic joints regularly through their range of motion also helps prevent stiffening or deformity. While many children with JIA are reluctant to move painful joints, they need to be encouraged to continue with their daily physical therapy to reduce further damage.

"There are forms of JIA that actually get better with time," Dr Amir says. "However, more severe episodes of the disease can leave a child, and subsequent young adult, with long-term damage that will affect them for the rest of their lives if they are not treated in time."

How a JIA patient will respond to treatment depends on the individual. "There is no way of knowing if a child with arthritis is going to be affected for just a few months or for many years to come," Dr Amir adds.

"But hopefully, our ability to predict who gets what, and for how long, will improve over time with ongoing research and development."

Until then, time is of the essence in identifying and treating JIA. "Similar to other forms of arthritis, the earlier we catch JIA, the better we can concentrate on reducing the potential of subsequent problems that may occur. The main promise arises when there is damage to the joints.

"When the damage has occurred, there is not much you can do to reverse the damage and to make joints whole again," he concludes.

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