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House Call: This isn’t your grandparents’ arthritis

Dr. Alisa Hideg

When you hear “arthritis,” your first thoughts are probably of your parents, grandparents or an elderly friend.

But it’s not only older people who get arthritis. Children can develop this condition too. While older adults often have osteoarthritis, caused by wear and tear on joints over time, children – nearly 300,000 of them in the United States – develop other types of arthritis, which are grouped together under the name “juvenile idiopathic arthritis.”

These types of arthritis can appear any time before the age of 16 and, like rheumatoid arthritis in adults, are thought to be caused by autoimmune reactions in the body. This means that the child’s immune system is mistakenly attacking healthy cells. We do not entirely understand why. It does seem to happen more in some families. Infections, stress or other illnesses may also play a role.

Some symptoms of juvenile arthritis are similar to those that a child might also have with a cold or flu, though they will often be prolonged or recurrent:

• Pain: Usually worse right after waking in the morning or from a nap and improves with activity. It is most common for pain to be in the knees, hands, feet, neck and jaw. Acetaminophen or ibuprofen may not help lessen the pain.

• Stiffness: Stiff joints are also more noticeable after waking. A child may show limpness in a limb or hold a limb in one position. In very young children, normal activities, especially ones recently learned, may suddenly become difficult.

• Fever: Frequent fevers without any symptoms of respiratory or gastrointestinal infection. Fevers frequently come and go quite suddenly. Sometimes fevers are seen at the same time every day.

Other symptoms more unique to juvenile arthritis include the following:

• Swelling: Painful joints may swell and become red, sometimes feeling warm to the touch. A joint or several joints commonly feel hot. Swelling from juvenile arthritis will seem to come out of nowhere, unlike swelling from a fall or injury.

• Rash: Faint, pink rash on the knuckles, cheeks, bridge of the nose, trunk, arms or legs can last for days or weeks. Such rashes might not ooze or be itchy.

• Eye problems: Persistent eye redness, eye pain and blurred vision can be associated with juvenile arthritis.

It is often not possible to distinguish between a common childhood ailment (flu or pinkeye) and juvenile arthritis. Most children with these symptoms will not have juvenile arthritis; however, symptoms persisting for weeks, reccurring symptoms and multiple symptoms are all reasons to seek evaluation from your child’s health care provider.

If your child does have a type of juvenile arthritis, the recommendations for treatment will depend on which type of arthritis it is. A rheumatologist (specialist in autoimmune diseases) who cares for children will frequently manage the treatment. Medications such as corticosteroids, non-steroidal anti-inflammatories or biological agents for suppressing the immune system may be needed.

Treatment with medications is meant to stop pain and discomfort, but also prevents damage caused by the disease to joints and other parts of the body. While there is no cure for juvenile arthritis, treatment can allow your child to grow normally and healthily. Early treatment increases good outcomes and in some cases leads to remission.

As with many diseases caused by inflammation in the body, a healthy diet, good sleep and physical activity as tolerated are recommended. Swimming is often suggested because it places minimal stress on joints while strengthening muscles. Working with a physical or occupational therapist can help children recover full use of affected joints.

The Arthritis Foundation has a special website about juvenile arthritis at www.kidsget where you can find more information on juvenile arthritis, treatments, conferences, camps, research, local resources and more.

Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section.
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