Diseases & Conditions
A group of more than 100 different diseases that is considered to be one category of rheumatic diseases. Rheumatic diseases may cause pain, stiffness, and swelling in the joints and other supporting body structures, such as muscles, tendons, ligaments, and bones. However, rheumatic diseases also can affect other areas of the body, including internal organs. When the immune system does not function properly, it leaves the body susceptible to an array of diseases, including juvenile rheumatoid arthritis.
Arthritis and rheumatic disease can affect anyone, at any age, or of any race. There are nearly 300,000 children in America with some form of arthritis or rheumatic disease. Juvenile rheumatoid arthritis affects children between two and 16 years of age more frequently. Septic arthritis is diagnosed in 6.5 percent of all pediatric arthritis cases and occurs at a slightly higher rate in boys.
The impact of arthritis on school, social life, family relationships, dating, sports, and almost every other aspect of an active, growing child’s life raises special concerns. New coping skills for living with the everyday challenges of arthritis must be learned.
Pain and stiffness over a joint is the primary symptom. Many children experience a period of stiffness when they get up each day. This morning stiffness can be one of the best measures of disease activity; the longer the stiffness lasts, the more active the disease. Taking a hot bath or shower, sleeping in a sleeping bag or water bed, doing range-of-motion exercises, or using a hot or cold pack can help relieve pain. Although most children do better with warmth, there are a few who respond to cold.
The cause of most types of arthritis remains unknown and, in many cases, varies depending on the type of disease present. However, researchers believe that some or all of the following may play a role in the development or aggravation of one or more types of rheumatic diseases:
• genetics and family history (i.e., inherited cartilage weakness)
• brain disturbances
• metabolic disturbances
• excessive wear and tear and stress on a joint(s)
• environmental triggers
Treatment Exercise Getting plenty of exercise is a very important part of treatment for juvenile arthritis. For children with arthritis, exercise helps to keep joints mobile, keep muscles strong, regain lost motion or strength in a joint or muscle, make everyday activities like walking or dressing easier, and improve general ﬁtness and endurance. While medications reduce pain and inﬂammation, only therapeutic exercise can restore lost motion in a joint. These exercises can make it easier for children to walk and perform other activities of daily living such as walking, eating, and writing. Range-of-motion exercises keep joints ﬂexible and are especially important for children who have lost motion in a joint, or whose joints have become ﬁxed in a bent position. Strengthening exercises build muscles. Strong muscles and joint protection are the keys to participating in sports. Although contact sports are never recommended, even aggressive sports such as soccer and basketball may not be off limits. Special exercises and protective equipment can further reduce the risk of injury and help children with arthritis play sports. Splints Splints can help keep joints in the correct position and relieve pain. If a joint is becoming deformed, a splint may help stretch that joint gradually back to its normal position. Commonly used splints include knee extension splints, wrist extension splints, and ring splints for the ﬁngers. An occupational or physical therapist usually makes the splint, which can be adjusted as the child grows. Arm and hand splints are made from plastic; leg splints are sometimes made of cast material. Medication Prescribing and administering medication for children with arthritis can be completely different from prescribing medication to adults with arthritis. Children will most likely require different dosages of medication, and they may have different or additional side effects to the same drug.
Surgery An operation is rarely used to treat juvenile arthritis in the early course of the disease, but it can be used to ease pain, release joint malformation, or replace a damaged joint. The latter procedure is used primarily with older children who have stopped growing and whose joints have been badly damaged by arthritis. This operation, which is usually used to replace the hip, knee, or jaw joints, can reduce pain and improve function.
Instead of replacement, soft tissue release may sometimes help to improve the position of a joint. In this operation, the surgeon cuts and repairs the tight tissues that caused the initial contracture, allowing the joint to return to a normal position. (See also ARTHRITIS, JUVENILE PSORIATIC; ARTHRITIS, JUVENILE RHEUMATOID.)