Arthritis is an inflammation of the joints that produces swelling, redness, heat, and pain. Although it is typically thought of as a disease of the elderly, some children also have this condition. The four most common forms of childhood arthritis are as follows:
Transient Synovitis (Inflammation) of the Hip
This is the most common form of arthritis in children. It can develop suddenly between two and ten years of age and then disappear after a short time, with no serious lasting effects. The most common cause is a virus, so it is frequently seen after an upper respiratory infection. Treatment is rest and anti-inflammatory medication (such as ibuprofen), which may make the symptoms go away quicker.
Bacterial Infection of the Joint
When a joint becomes infected with bacteria, it causes pain. This pain makes the child walk with a limp or refuse to bear weight on that limb or decreased movement if in an upper extremity. Since this is a bacterial infection, the child also will typically have a fever. Notify your pediatrician immediately if these signs or symptoms appear. If an infection involves the hip, it can be a serious condition and needs to be properly diagnosed and treated by a specialist (usually an orthopedist). Treatment can include a needle aspiration of the hip joint, surgical drainage, and intravenous (IV) use of antibiotics.
An infection transmitted by the deer tick can cause a form of arthritis known as Lyme disease. (It’s called this because it was first diagnosed in a child in Old Lyme, Connecticut.) This infection often starts with a red mark that is surrounded by a light ring or halo, which occurs on the skin at the site where your child was bitten by the tick. Later, a rash may appear on other areas of the body. The child also may develop flulike symptoms such as headache, fever, swollen glands, fatigue, and muscular aches and pain. Then arthritis may develop weeks to months after the skin rash.
If the arthritis is severe, medications may be prescribed to control the inflammation and pain until the condition gradually disappears on its own. If the joint is involved, Lyme disease is treated with antibiotics. However, the American Academy of Pediatrics does not recommend routinely taking antibiotics after a tick bite in an effort to prevent Lyme disease.
This is because of the fact that most tick bites do not transmit the germ that causes Lyme disease, possible side effects of the medication, its cost, and the risk of antibioticresistant bacteria. The Academy also does not recommend testing your child’s blood for Lyme disease shortly after a tick bite, since it can take quite a while to show up in the blood. To prevent Lyme disease, your child should avoid tick-infested areas such as wooded regions, high grasses, or marshes. Children also can protect themselves from ticks by wearing long-sleeved shirts, tucking their pants into their socks, and using an insect repellent that has DEET as an active ingredient.
Almost all cases of Lyme disease can be readily treated with antibiotics, even if arthritis develops.
Juvenile Idiopathic Arthritis (JIA)
Juvenile idiopathic arthritis (JIA) has previously been referred to as juvenile rheumatoid arthritis or juvenile chronic arthritis. This is the most common chronic form of joint inflammation in children. JIA is a puzzling disease that is often difficult to diagnose and for parents to understand. Common symptoms are persistent joint stiffness and swelling of one or multiple joints, pain, and unexplained fever. If your child has any of these symptoms—and/or an unusual pattern of walking, especially in the morning or after naps, call your pediatrician. Surprisingly, many and perhaps even most children with JIA do not complain of pain when they first develop symptoms of the disease.
JIA occurs most often in children between the ages of three and six years or around the time of puberty. It is unusual for JIA to begin under one year of age or after age sixteen. Although this condition can be disabling, with proper treatment many children fully recover by the time of puberty.
The exact cause of JIA is still unknown. Researchers believe that JIA may be triggered by or perhaps is related to a viral infection in children who have an abnormality in their immune (disease-resistance) system. In some children the virus causes only a mild illness. But for others, the virus causes the immune system to overreact and trigger inflammation, joint swelling, and pain.
The signs, symptoms, and longterm effects can vary depending on the type of JIA. A form of JIA known as systemic JIA causes not only fever and painful joints, but also may damage internal organs. When systemic JIA strikes the internal organs, the child can develop either pericarditis (an inflammation of the outer covering of the heart), myocarditis (an inflammation of the heart muscle), pleuritis (an inflammation of the lining of the lungs), or pneumonitis (an inflammation of the lung tissue itself).
Inflammation can also occur in the brain and its lining; this condition is called meningoencephalitis, but it is less common than the other conditions described above. There are two other types of JIA—pauciarticular JIA (affecting one or more joints) and polyarticular (affecting many joints). Pauciarticular JIA can be associated with inflammation of the eye, which in turn can cause glaucoma or cataracts. Pauciarticular JIA is the most common form, most often affecting young girls. It also has the best prognosis relative to disability and ultimate outcome.
Great strides are being made in treating JIA and other forms of arthritis. Treatment varies depending on the type of arthritis a child has, and often includes medication, exercise, physical therapy, and possibly splints. It is important to follow the treatment recommended by your doctor to ensure the best outcome for the child.
For JIA, therapy aims to reduce inflammation. Aspirin may be used initially in children with mild disease since it decreases joint inflammation and pain. Aspirin is also fairly inexpensive and easy to give. In some children, however, aspirin can have some undesirable side effects, such as stomach upset. In addition, aspirin therapy must be stopped if the child has chickenpox or flulike illnesses, related to a disease called Reye syndrome. If aspirin is not working or produces unacceptable side effects, your pediatrician may recommend the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Like aspirin, these are rapid-acting drugs, but less likely to cause side effects.
Particularly for children with many joints affected by arthritis, it is becoming increasingly common to turn to medications that stop the rapid overgrowth of the joint-lining tissue, or reduce inflammation. If the JIA is severe and is not getting better with first-line treatment, your pediatrician may refer your child to a pediatric rheumatologist for this type of treatment. Such medications require careful monitoring but can greatly improve the lives of children with arthritis.
Other therapies also are available and have been shown to help children with inflammation in one or two joints. For example, an antiinflammatory steroid medication can be injected directly into the affected joints, and can rapidly restore your child’s function in even severely affected joints.
Although there is no way to prevent JIA, it is possible to slow the disease’s progression. Exercise plays an important role in slowing the progression of JIA and preventing the joints from getting too stiff. Although it may be uncomfortable at times, especially when a child’s joints are already sore, it is important for parents to help their child work through the discomfort for the long-term benefits.
Living with JIA requires a great deal of adjustment, not only for the ill child but also for her parents and other family members. But working as a team will help decrease the risk of the child having long-term problems or consequences. Your pediatrician can recommend arthritis organizations that can provide useful information about this complex disease.