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Childhood arthritis

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Childhood arthritis
Other namesJuvenile arthritis, Pediatric rheumatic disease
SpecialtyRheumatology

Childhood arthritis (juvenile arthritis or pediatric rheumatic disease) is an umbrella term used to describe any rheumatic disease or chronic arthritis-related condition which affects individuals under the age of 16. Most types are autoimmune disorders.[1]

Juvenile arthritis may last for a few months, years, or becomes a lifelong disease that requires treatment as the child becomes an adult.[2]

Signs and symptoms

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Several types of childhood arthritis exist, including juvenile idiopathic arthritis, juvenile myositis, juvenile lupus, juvenile scleroderma, vasculitis, and fibromyalgia.[3]

General signs of childhood arthritis disorders include:

  • Joints: Swollen, stiff, red, warm, and/or painful joints[3]
  • Eyes: Painful/dry eyes, sensitivity to light and/or difficulty seeing caused by uveitis[3]
  • Skin: Scaly red rash (psoriatic), light spotted pink rash (systemic), butterfly shaped rash across the bridge of the nose and cheeks (lupus) or thick, hardened patches of skin (scleroderma)[3]
  • Organs: Digestive tract (diarrhea and bloating), lungs (shortness of breath) and heart[3]
  • Other: Fatigue, appetite loss, and/or high, spiking fever[3]

The most common type of childhood arthritis, juvenile idiopathic arthritis (previously known as juvenile rheumatoid arthritis (JRA) or juvenile chronic arthritis (JCA))[4] can be divided into three main forms: The classification is based upon symptoms, number of joints involved and the presence of certain antibodies in the blood.[1][5]

  1. Polyarticular arthritis is the first type of arthritis, which affects about 30–40% of children with arthritis and is more common in girls than boys.[1][5][6][7] Typically five or more joints are affected (usually smaller joints such as the hands and feet but many also affect the hips, neck, shoulders and jaw).[1][6]
  2. Oligoarticular (aka pauciarticular) arthritis can be early or late onset and is the second type of arthritis, affecting about 50% of children with juvenile arthritis.[1][5][6] This type affects fewer than four joints (usually the large joints such as knees, ankles or wrists) and may cause eye inflammation in girls with positive anti-nuclear antibodies (ANA).[1][5] Girls younger than eight are more likely to develop this type of arthritis.[4]</ref>[5]
  3. Systemic disease is the least common form, with 10–20% of children (boys and girls equally) being affected with limited movement, swelling and pain in at least one joint.[1][6] A common symptom of this type is a high, spiking fever of 103 °F (39.4 °C) or higher, lasting for weeks or months, and a rash of pale red spots on the chest, thighs or other parts of the body may be visible.[1]

Cause

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In most cases, juvenile arthritis is caused by the body attacking its own healthy cells and tissues, i.e. autoimmunity, causing the joint to become inflamed and stiff.[8][5] Once the joint has become inflamed and stiff, damage is done to the joint and the growth of the joint may by changed or impaired.[5] The underlying cause in the malfunction of the autoimmune system is unknown; dietary habits and emotional state seem to have no effect on the disease.[4][2]

Diagnosis

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Early diagnosis and treatment by a pediatric rheumatologist or a rheumatologist can help manage inflammation, relieve pain, and prevent joint damage.[1][5] However, it is difficult for doctors to diagnose the disease[9][4] because there is not a single test that doctors can use to diagnose this disease.[2] Physical exams[2], lboratory tests (blood and urine), and various forms of imaging like X-rays may be some of the tests conducted by a doctor.[1][5] Doctors may perform some of the following tests to diagnose the condition[9]

  • ANA (Antinuclear Antibody) Test[10]
  • Joint Aspiration[11]
  • Rheumatoid Factor (RF) Test[12]

Treatment

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2021 American College of Rheumatology guidelines provide treatment recommendations dependent on the phenotypical presentation.[13] The treatment of most types of juvenile arthritis include medications, physical therapy, splints and in severe cases surgery.[5] Guideline-informed pharmacological include intraarticular glucocorticoids, scheduled non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and interleukin inhibitors, depending on macrophage involvement and if symptoms are localized or systemic.[13] These treatments are focused on reducing swelling, relieving pain and maintaining full movement of joints.[1] Children are encouraged to be involved in extra-curricular activities, physical activity when possible, and to live a "normal" life.[1][7] Consistent exercise can reduce both pain and immobility, while also improving life quality.[14]

Epidemiology

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In the US it affects about 250,000-294,000 children making it one of the most common groups of childhood diseases.[5]

References

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  1. ^ a b c d e f g h i j k l "Juvenile Arthritis Facts". Arthritis Foundation. 2012. Archived from the original on 7 March 2012. Retrieved 22 March 2012.
  2. ^ a b c d NIAMS Science Communications and Outreach Branch (2017-04-07). "Juvenile Idiopathic Arthritis (JIA)". National Institute of Arthritis and Musculoskeletal and Skin Diseases. Retrieved 2024-07-23.
  3. ^ a b c d e f "Juvenile Arthritis". Arthritis Foundation. Retrieved 2020-10-26.
  4. ^ a b c d "Juvenile Arthritis". American College of Rheumatology. Retrieved 2022-11-18.
  5. ^ a b c d e f g h i j k "Orthoinfo". American Academy of Orthopaedic Surgeons. 2012. Retrieved 21 March 2012.
  6. ^ a b c d "Arthritis". U.S. Centers for Disease Control and Prevention. 2011. Retrieved 20 March 2012.
  7. ^ a b "Practice Management". American College of Rheumatology. 2011. Retrieved 20 March 2012.
  8. ^ "Autoimmune Diseases". MedlinePlus. U.S. National Library of Medicine. Retrieved 2020-10-29.
  9. ^ a b "Juvenile Arthritis". MedlinePlus. U.S. National Library of Medicine. Retrieved 2022-11-18.
  10. ^ "ANA (Antinuclear Antibody) Test". MedlinePlus. U.S. National Library of Medicine. Retrieved 2022-11-18.
  11. ^ "Joint Aspiration (Arthrocentesis) (for Parents)". Nemours KidsHealth. Retrieved 2022-11-18.
  12. ^ "Rheumatoid Factor (RF) Test". MedlinePlus. U.S. National Library of Medicine. Retrieved 2022-11-18.
  13. ^ a b Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, et al. (April 2022) [2022-03-01]. "2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis". Arthritis & Rheumatology. 74 (4): 553–569. doi:10.1002/art.42037. PMC 10161784. PMID 35233993.
  14. ^ Nijhof LN, Nap-van der Vlist MM, van de Putte EM, van Royen-Kerkhof A, Nijhof SL (November 2018). "Non-pharmacological options for managing chronic musculoskeletal pain in children with pediatric rheumatic disease: a systematic review". Rheumatology International. 38 (11): 2015–2025. doi:10.1007/s00296-018-4136-8. PMC 6208689. PMID 30155667.
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