Who would first come to your mind when you hear the word arthritis?
A 50-year-old or a four-year-old?
The answer, unfortunately, is obvious. But that doesn’t make juvenile arthritis any less of a reality.
According to American College of Rheumatology, about 1 child in every 1,000 develops some type of chronic arthritis. Children of all ages could be affected, although it is rare in the first six months of life. While genetic predisposition and family history may have a small role to play, there is no definite cause to the disease and it could happen to anybody.
What is Juvenile Arthritis?
Arthritis is the name given to a group of diseases that concern the joints. The National Health Portal of India mentions different types of arthritis: osteoarthitis, rheumatoid arthritis, juvenile arthritis, infectious arthritis and gout.
Juvenile arthritis, in particular, is an umbrella term for many autoimmune and inflammatory conditions that could develop in children under the age of 16.
Arthritis Foundation discusses several kinds of juvenile arthritis, among which juvenile idiopathic arthritis (JIA) is the most common, and in fact, the two are often used interchangeably. JIA is not contagious.
Dr Puneet Mashru, Director of Rheumatology at Jaslok Hospital and Research Centre, explains,
"“Juvenile idiopathic arthritis affects children below the ages of 16. It is a group of autoimmune diseases, where the immune system attacks the lining of the joints, causing inflammation. If not treated on time, it could even become life-threatening.”" - Dr Puneet Mashru
Dr Naval Mendiratta, Consultant, Rheumatology, Fortis, Gurugram, explains that JIA is a blanket term for at least six different subtypes, “Kids as young as two or three years of age get arthritis. There are many types of juvenile idiopathic arthritis: systematic, oligaorticular, polyarticular, juvenile, enthesitis-related JIA and undifferentiated arthritis.”
As elaborated by Arthritis Foundation, this is what each of the subtype means:
- Systematic JIA: It causes inflammation in one or more joints and is often accompanied by high fever that may last around 2 weeks.
- Oligoarticular JIA: It causes inflammation in four or fewer joints, usually the large ones such as the knees, ankles and elbows. This could also lead to chronic eye inflammation.
- Polyarticular JIA: It causes inflammation in five or more joints, usually the small ones such as the fingers and hands.
- Juvenile Psoriatic Arthritis: In this, arthritis may be accompanied with a skin disorder like psoriasis, wherein the skin problems may appear years before the joint symptoms like pain and swelling. Symptoms include a red rash commonly behind the ears, on the eyelids, elbows and knees, at the scalp line, or in the belly button.
- Enthesitis-related JIA: This causes tenderness where the bone meets a tendon, ligament or other connective tissue. It most often affects the hips, knees and feet. Inflammation may also be observed in parts other than the joints.
- Undifferentiated arthritis: This category is to accommodate any such cases which do not fit into any of the above types, or that may fall into more than one.
Why Juvenile Arthritis Is a Cause for Concern
According to Dr Mendiratta, the condition becomes more complicated with children, simply because they might not realize what they are going through. They may not complain, and the diagnosis and treatment could get delayed.
"“Since children might not be able to comprehend their physical experiences, parents need to be alert. Obvious signs could be swelling of joints. But evident swelling may take 2-3 months to show up. Before that, if any alteration in daily activities, morning stiffness, or an inability to cope with daily routine is observed, a doctor must be consulted. Be watchful for any basic changes.”" - Dr Naval Mendiratta
In cases where there is family history of arthritis, more altertness is needed.
Dr Mashru also discussed that a major way in which the disease may affect children and adults differently is that the former set is still growing.
"“When kids are affected with the disease and not treated on time, growth abnormality, permanent joint deformities, disabilities, or stunted height could also accompany inflammation.”" - Dr Puneet Mashru
Therefore, timely diagnosis and treatment becomes crucial, and is not possible if parents aren’t aware of the signs and symptoms. Look out for these signs in the children:
- Morning stiffness that lasts 20-40 minutes
- Fever that refuses to subside for more than ten days
- Swelling and pain in the joint
- Alteration in daily activity
- Inability or discomfort in sitting cross-legged, or in running and playing
- Unexplained skin rashes
- Family history of another autoimmune disease
While the doctors do not unnecessarily restrict physical activity among these children (unless it’s dire), they acknowledge that special care and attention might be needed in these cases as compared to adult ones.
“When they reach around 8-10 years of age, they become more aware. Some counseling may be needed to help them understand what their body is going through, and to give them assurance that the right treatment could help them recover and feel better,” Dr Mendiratta explained.
Diagnosis, Treatment and What Follows
Doctors explained that the diagnosis is mostly clinical. The child needs to be taken to a rheumatologist, who will examine him/her thoroughly, go through their medical history and then advice some tests.
"“The treatment is usually the same as adults. But the dosage differs according to body weight. Steroids are avoided as much as possible because they can stunt the kid’s growth.”" - Dr Naval Mendiratta
Dr Mashru adds that the treatment depends on exactly what we are dealing with, but steroids are only prescribed for a short duration to control the disease. Their side-effects on children have to be mitigated.
"“There is no permanent cure. But you generally treat them for a minimum of two years and then try to taper and stop the medication. It all depends on the condition. In many cases, there is remission and the problems subside with time. In others, the medication may be needed even in adulthood.”" - Dr Puneet Mashru
Nothing in particular could be done to prevent it. Alertness, awareness, and timely diagnosis is key.
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