It is a common misconception that arthritis affects only older people and not children. In this article, we will discuss a condition called juvenile idiopathic arthritis (JIA) which affects children under 16 years of age.
The child will have pain, swelling and morning stiffness in various joints of the body like knee, ankle, wrist and hands for more than 6 weeks. The pain usually improves as the day passes. The child can have other manifestations like fever, rashes, vision loss, pain in tummy depending on the type of arthritis.
Pathological changes in juvenile arthritic joint
Let’s try to understand what JIA means. The word juvenile means relating to children, while the word ‘idiopathic’ means no known cause and word ‘arthritis’ means involvement of joints. Hence, the disease is self-explanatory in the sense that it occurs in children and involves the joints. This disease is thought to result from an auto-immune inflammatory response of the body to an unknown cause.
JIA is classified into three types namely, Pauciarticular, Polyarticular, and systemic. The pauciarticular as the name denotes involves less than 5 joints. It usually involves large joints such as the knee, ankle. It is usually asymmetrical meaning only one side is affected. It can have other manifestations like the involvement of eyes. The next type is polyarticular which means that it involves more than 5 joints. They usually involve hand and wrist joints. They are symmetrical meaning that they affect both sides (right and left) in the same manner. If not treated early, this can lead to deformities in the hand and wrist joints. It usually has the best prognosis among the three. The third type is a systemic type which means it affects other body organs besides joints like liver, spleen heart. It has the worst prognosis among the three.
When to show your child to a pediatric orthopaedic surgeon: If your child has painful and swollen joints for more than 6 weeks along with fever, skin rash, loss of eyesight, pain in the abdomen.
The child will be examined clinically to look for swelling and pain in joints and will be advised blood tests and X-rays depending on the clinical manifestations.
The good thing about JIA is that if diagnosed and treated early, the patient usually does not end up with long term complications or deformities. There are various treatment options available in the form of DMARDS (disease-modifying anti-rheumatic drugs). With an improvement in understanding of the disease, new biologicals have been developed which have better efficacy against JIA. Splints can be useful to reduce joint swellings and prevent joint contractures. Of course, muscle stretching exercises and strengthening exercises help a lot in this type of situation. Sometimes, if the patient does not improve with medicines, surgeries like Synovectomy, Osteotomy, Arthrodesis, or Arthroplasty are the only way left to improve a patient’s quality of life.
Take home message:
The overall aim is to diagnose these patients early and treat them aggressively. With newer agents, it is now possible to keep JIA under remission for long durations. The child should try to lead a normal life and should be encouraged to participate in as many sports activities as possible. These children usually need mental support from their parents, teachers, and doctors to progress normally in life.
Dr. Mohit Kumar Arora, Associate Consultant – Pediatric Orthopedics, Narayana Superspeciality Hospital Gurugram