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Can your child get arthritis at an early age?

Contrary to widespread belief, the chronic disease does not only occur in the elderly, children and teenagers are also susceptible, with the most severe forms occurring in younger people.  Arthritis affects 1 in 5 people in the UAE. 

Arthritis is surrounded by many misconceptions. One of them is that arthritis affects only the elderly. Rheumatoid arthritis (RA) is an autoimmune, inflammatory disease that is commonly diagnosed in early- to mid-adulthood, while children can be diagnosed with juvenile idiopathic arthritis (JIA) as young as 6 months through 16 years of age.

Juvenile idiopathic arthritis is the most common kind of arthritis among kids and teenagers.  ‘Idiopathic’ is a word that we, doctors, use to describe a condition when we don’t know exactly its cause. In JIA, a child’s immune system malfunctions for some reason, attacking the body, especially the joints. It has difficulty telling the difference between the body’s own tissues and external germs or organisms. This confusion makes the immune system attack the body’s healthy tissues. That’s what we call an auto-immune disease and that’s what causes the inflammation characteristic of JIA.

Arthritis is an inflammation of the membrane that lines the joints (like the knees or knuckles) called ‘synovial membrane’. When it becomes inflamed, fluid is produced. The joints become, swollen, painful, stiff and warm to the touch. Over time, inflammation in a joint can cause damage in the cartilage and bone. JIA might affect one, two three or four joints, it is called ‘oligo-articular’ form in this case. When it affects more than 4 joints we call it ‘poly-articular JIA’. This differentiation is important as these different forms of JIA have distinct complications. We know, for example, that children with ‘oligo-articular’ JIA might develop an inflammation of the eye, called uveitis. However, the disease might start as an ‘oligo-articular’ form and evolve into a ploy-articular form over time.

Young kids or teens with JIA may experience joint pain and swelling. They might feel that their joint(s) become stiff, especially in the morning. When the symptoms worsen, it’s known as a “flare” or a “flare-up.” Although JIA is basically an articular disease, it might sometimes affect other organs like eyes, heart, skin, lungs and liver.

There are seven types of JIA:
1. Systemic JIA affects the whole body. This type of JIA is characterised by high spiking fever that often increases in the evenings and then may suddenly drop to normal. During the onset of fever, a child may develop a transient salmon-colored rash. This rash may quickly disappear and then suddenly appear again. The child’s lymph nodes might become enlarged. Eventually, many joints are affected by swelling, pain, and stiffness.

2. Oligoarthritis affects four or fewer joints. Pain, stiffness or swelling often starts in the knee and ankle joints. Sometimes oligoarthritis gives someone an inflammation of an eye that’s known as iritis, or uveitis.

3. Polyarticular arthritis, rheumatoid factor negative is a form of JIA that affects more girls than boys. The small joints of the hands are usually affected in this clinical form. Rheumatoid factor, which is a marker present in an adult form as well, is negative.

4. Polyarticular arthritis, rheumatoid factor positive is the type of JIA that’s most like adult arthritis. This is one of the least common types of JIA, but this the closest form to the adult rheumatoid arthritis. It is known for its elevated risk of joint damage.

5. Psoriatic arthritis is when a person has psoriasis and arthritis together.

6. Enthesitis-related arthritis is a JIA form that affects the lower joints (knees and ankles) and the spine. Kids with this type of arthritis also may have juvenile ankylosing spondylitis if joints of the low back are inflamed. Arthritis that goes along with inflammatory bowel disease (like Crohn’s disease) also falls into this category of JIA.

7. Undifferentiated arthritis is a form of arthritis that doesn’t fit into any of the above categories.

Diagnose
The diagnosis of JIA is not always easy. The condition can manifest in diverse ways. A pediatric rheumatologist, who is an expert that looks after rheumatic diseases in children, will need to rule out other conditions such as infections and malignant diseases before stating JIA as a diagnosis. 

If a doctor suspects that a young patient has JIA, he or she will ask about the patient’s symptoms, enquire about family history of arthritis, and do a complete physical examination to look for joint swelling, eye problems, skin rashes, heart and any lung manifestations. A doctor may do blood tests, ultrasound and X-rays. In some cases, the doctor will need to take a sample of the synovial fluid from the patient’s swollen joint and send it to a laboratory for analysis.

Treatment
Early diagnosis and treatment is the key for better outcomes. While there’s no definite cure, available therapeutics can ease the symptoms of JIA and prevent damage to joints.

For some JIA patients, taking medications like ibuprofen or naproxen are sufficient to reduce inflammation and relieve its symptoms. Some patients need to take a weekly medication called methotrexate. Newer medications called biologics – such as etanercept, adalimumab, abatacept, and tocilizumab – can modulate the immune system and control the disease very efficiently. For flare-ups management, doctors may also use cortisone, also called corticosteroids or steroids (such as prednisone). However, their use should be limited to short use for flares management, because of their multiple side effects, especially growth retardation.

‘Achy joint’ in a child
Very often, a child complaining of on/off achy joints is dismissed as having “growing pains”. However, parents should be aware that symptoms of joint pain need to be taken seriously when they are associated with joint swelling, morning stiffness, fatigue or illness. These symptoms may be early signs of an inflammatory rheumatic disease that requires immediate medical management. 

With thanks to Dr. Ghita Harifi, Rheumatologist, Humeira Badsha Medical Centre.

The annual health awareness event for World Arthritis Day, hosted by the Middle East Arthritis Foundation will be held on Friday 13 October from 9am onwards at Shangri-La Dubai. Entry is free. More information about the event and programme. www.arthritis.ae/wad/