Rheumatoid arthritis is a chronic and disabling auto immune disorder which can present with host of physical woes. It causes inflammation and destruction of any joints and cartilage in the body. Most of the time people believe that arthritis is a disease of adults. But it not so, children also suffer from this disorder, especially those below the age of 16 years. The other name for rheumatoid arthritis in children is juvenile rheumatoid arthritis.
Generally the joints involved are bilateral and symmetrical. Restriction of growth and inflammation of eyes are few of its complications.Fortunately not everyone who has the disease is severely affected. In many cases it is just a minor ailment. According to one statistic, at least 30000 to 40000 children are suffering from juvenile rheumatoid arthritis in United States.
What Causes Rheumatoid Arthritis In Children?
Medical researchers believe it to be an autoimmune disease, wherein the immune system of the person wrongly destroys the cells which are really meant to protect the body. There is no convincing evidence found yet and the etiology still remains elusive. The child can develop Rheumatoid arthritis in infancy or later years of childhood.
Genetic preponderance and environmental factors including possible infections are considered to trigger the infections. Viruses such as Epstein-Barr, retroviruses, mycobacteria, may trigger the disease. Generally girls are more affected than boys.
Symptoms Of Rheumatoid Arthritis
There are three different types of juvenile rheumatoid arthritis; Systemic juvenile rheumatoid arthritis, polyarticular and pauciarticular JRA. Systemic type is not very common in children; it involves joints and other organs of the body such as lungs, blood vessels, muscles etc. It is considered to be more serious and debilitating of all the three types. The other two are comparatively minor variety.
RA begins insidiously and rarely with an acute onset. The most common symptoms of rheumatoid arthritis in children are pain, swelling, and stiffness. The child may not complain of slow and progressive pain, instead the first sign may be a limping gait. Limping is more prominent after taking rest or waking up in the morning.
Stiffness is another main symptom. It lasts for hours and may involve all the joints rather than the inflamed ones. Swelling of joints is another hallmark symptom of rheumatoid arthritis in children. It is most common in larger joints such as knee joint and hip joint. Pain may worsen upon movement because of inflammation.
Fatigue, weight loss, perspiration, fever, loss of joint function, rashes, and inflammatory changes in eyes are some other symptoms of juvenile rheumatoid arthritis.
The alert signs of early juvenile rheumatoid arthritis are:
- Prolonged morning stiffness for 6 weeks and longer.
- Insidious onset with pain and stiffness in few joints.
- Swelling of the involved joints.
- Slow and progressive pain, tenderness, heat and redness in multiple joints.
- Same joints are involved on both the sides.
Juvenile Rheumatoid Arthritis Treatment
Rheumatoid arthritis in children needs to be treated energetically. The goal of treatment should be:
- Relief of symptoms. (Pain, stiffness, swelling)
- Preservation of joint function.
- Prevention of deformity and damage to the joint and other organs such as eye etc.
- Allowing the child to live a normal life.
The entire above are possible with the help of medication, diet, physiotherapy exercise,
- Medication: today rheumatologists have given up “go slow” and “go low” approach to treat JRA. There is sea change in recent thinking to treat JRA. They believe it is an aggressive disease and it should be tackled aggressively. This is to reduce the deformity, retardation of growth in children. There is a growing belief that NSAID and pain killer are not enough. There is a need of introducing disease modifying anti rheumatic drug (DMARD) early enough to prevent deformities. Medications will depend on the severity of the disease.
- Diet: a balanced diet consisting of vitamins, proteins, minerals helps to boost the immune system and reduce the chances of flaring of symptoms of rheumatoid arthritis in children. Also the child should avoid certain foods.
- Exercise: the child should perform light exercises which will help to preserve joint mobility. Gentle movement of regular exercise is an effective therapy for JRA. Swimming is an excellent activity as it helps to strengthen the muscles and maintain flexibility in the joint. But ultimately the physiotherapist should outline the program. However, when the joint is swollen, warm and painful the child should cut back his activities and take rest for few days.