What is juvenile arthritis?

Juvenile arthritis refers to all types of arthritis that affect children. However, it is fortunately quite rare. There are three main types of juvenile arthritis:

• Polyarthritis - this type affects five or more joints and is more common in girls. This type commonly affects smaller joints like the hands and feet, though larger joints may also be affected. It often affects the same joint on both sides of the body.
• Pauci-articular juvenile arthritis - this is the most common type and affects four joints or less. This type usually affects larger joints such as the knees or ankles.
• Systemic juvenile arthritis - this type affects both the joints and internal organs, causing rashes and a fever. This type used to be known as Still's disease.

Children's joints can sometimes swell because of another condition, such as chickenpox or German measles. However, if the joints remain inflamed for over two months and no other cause can be found, this is known as juvenile chronic arthritis (JCA). In other parts of the world JCA is sometimes known as juvenile rheumatoid arthritis.

Children can develop JCA at any time, though it usually starts between the ages of one and four.

What causes juvenile arthritis?

Like arthritis in adults the actual cause of juvenile arthritis is unknown. However, like rheumatoid arthritis, research shows that juvenile arthritis is an autoimmune disease, which means the body's immune system reacts to something abnormal in the body and tries to remove it. Juvenile arthritis is not thought to run in families and is not contagious.

What are the symptoms of juvenile arthritis?

Symptoms can vary greatly in every child from mild to severe. The following symptoms may indicate that your child has arthritis:

• Swelling and redness in one or more joints.
• Stiffness around the joints, especially first thing in the morning. You may notice that your child limps in the morning or has trouble using an arm.
• Constant or recurring pain in a joint.
• Sudden difficulty in moving or using a joint.

Systemic juvenile arthritis may also cause a fever, rash and swollen glands. On very rare occasions children with systemic juvenile arthritis may develop inflammation of the coverings of the heart and lungs. A severe complication of pauci-articular arthritis is eye inflammation called chronic iridocyclitis. If your child has arthritis ensure they have their eyes checked regularly.

If your child has severe arthritis a slowing of growth may occur. However, the growth rate will return to normal when the arthritis improves.

How long does juvenile arthritis last?

It is difficult to say how long juvenile arthritis will last. Some children will recover after a few months and some may suffer for years. However, most children will be able to lead a normal life and will go into adulthood fully recovered.

Like rheumatoid arthritis in adults, juvenile arthritis may go into remission (when it looks like the arthritis has gone away) for awhile and then flare up again.

How is juvenile arthritis diagnosed?

Your doctor will suspect arthritis from your child's symptoms and medical history. In many cases arthritis may also be diagnosed from a physical examination of the joints, especially if it's a large joint that is affected. There is no one test that can definitively diagnose juvenile arthritis, so your child may need a number of blood tests and on occasions fluid from the joint may be taken for examination. An x-ray of the affected area will usually be carried out to exclude any other bone disorders or illnesses.

How is juvenile arthritis treated?

Children with arthritis will usually get better over time if they receive proper treatment. Some children may only require a simple, daily exercise program to help ease pain and improve movement in the joint. If the joint is painful and swollen the child will need to rest in bed and may require a splint to prevent the joint from becoming deformed.

There are also many prescription drugs available to relieve pain and reduce inflammation around the joint. The main drugs used are non-steroidal anti-inflammatory drugs (N.S.A.I.D.s) and cortisone injections or tablets. If your child has severe arthritis they may be prescribed disease-modifying drugs to slow down the progress of the disease and reduce inflammation.

Your child may also require an exercise program, which will usually be carried out at a local hospital. These exercises are aimed at strengthening the muscles and helping the muscles to develop. Heat pads can be used before exercise to relieve pain.

What can I do to help my child?

If your child has arthritis treat them as normal as possible and ensure they get regular medical care. Your child should be encouraged to exercise, swimming is an ideal exercise for children with arthritis.

Most children will be able to attend an ordinary school, though you should ensure the teachers at the school are aware that your child has arthritis. Explain to the teachers what arthritis it is and what your child may require.