Juvenile Arthritis

Imagine a 3-year-old getting out of bed with legs so stiff their ankles and knees just don’t want to move. It’s easier to crawl for the first half-hour or so than it is to walk. As the day goes on, they may loosen up, run and play like any other child, but the next morning it happens all over again.

    This is a typical presentation of juvenile idiopathic arthritis (JIA), a disease that may affect as many as 400 of every 100,000 children, says Dr. Andrew White, a pediatric rheumatologist with Washington University Physicians and director of rheumatology services at Shriners Hospital for Children. “People might be surprised that kids get arthritis, too,” White says. Researchers don’t know what triggers the disease in children, but it appears to be an autoimmune disorder similar to adult rheumatoid arthritis.

    The most common age range for JIA onset is 1 to 4 years old. Symptoms include joint stiffness and swelling with little or no discomfort, White says. “There are actually several different types of JIA, and the age of onset varies,” he adds.  Twelve- to 16-year-olds who develop the disease may be more likely to carry the symptoms into adulthood, while younger children diagnosed with JIA often experience remission within 10 years.

    “When I tell parents that their child has JIA, I can see the color drain from their face,” White says. “But this isn’t the severe, crippling disease they may imagine. We have treatments that allow kids to enjoy all the normal activities of childhood.” Early diagnosis and aggressive treatment during the first two years of the disease are the keys to preventing complications that may be associated with JIA, such as asymmetrical skeletal development and chronic eye disease, a concern that needs monitoring by an eye doctor. “The first two years of the disease are where the most erosions and joint damage occur,” explains Dr. Terry Moore, a SLUCare rheumatologist on staff at SSM Cardinal Glennon Children’s Medical Center.

    The first line of treatment generally involves anti-inflammatory medications, either available over the counter or by prescription, if stronger doses are needed. “We usually start physical and occupational therapy right away,” Moore says. “Stronger muscles and better range of motion mean less impact on the joints.”

    Physical therapists instruct children in the use of moist heat on the joints, such as hot packs, the importance of rest periods, and how to exercise two to three times per day. Occupational therapy covers posture, body mechanics, improving the performance of daily activities and instructions in joint protection. Moore notes that swimming and cycling are excellent exercise choices for many JIA patients.

    Beyond that, a combination of drug therapies has become the standard of care. New medications are being used successfully, such as anti-rheumatic drugs and new biologic agents. Because some of these drugs may depress the immune system, kids who take them are monitored to make sure they don’t get frequent infections. “One medication is etanercept (Enbrel), which has brought about marked improvement in many patients,” Moore says, “including noticeable decreases in joint swelling, tenderness and fatigue.”

    A team approach is best, Moore adds. Together, “a pediatric rheumatologist, ophthalmologist, and physical and occupational therapists will best benefit the JIA patient for a good long-term outcome.”