It is hard to imagine that children, even infants, can be victims of arthritis. In fact, every 1000th child develop arthritis during the first years of life. Arthritis is usually diagnosed between the ages of one to four years, but can occur at any age.
Arthritis is usually difficult to diagnose in a young child. Often children do not complain directly to the pain, but they are always unhappy, moody and refuse food. Swelling of the joints and can be difficult to detect. Lameness, reluctance to walk or use his hands normally during the game may be the first signs of arthritis. When the joint is inflamed, the diagnosis is easier to place because it is one of the signs of the disease as well as stiffness in the morning.
There are several different types of arthritis that occur in childhood.
Pauciarticular (or oligoarticular), juvenile chronic arthritis
This is the most common form of juvenile chronic arthritis of approximately 50% of all diagnoses. It affects four or fewer joints, may be called monoarticular, juvenile chronic arthritis, if affects only one joint (usually knee). The most frequently sick children under 5 years old, girls, get sick more often than boys. This arthritis is often accompanied by ocular and blood tests are present antibody called antinuclear factor or ANF.
Because this type of disease affects a small number of joints, treatment is usually injections of corticosteroid into the joints and / or oral non-steroidal anti-inflammatory drugs (NSAIDs). The development of the disease is well controlled in 70% of children entering into remission (recovery) after 3-4 years of treatment. The rest of the group progresses in polyarticular defeat.
Polyarticular, juvenile chronic arthritis
This form of the disease affects more than 4 joints. Often in this form are involved joints of the hands and feet, accompanied by pain, swelling and stiffness of joints. Tendons, the flexor muscles of the arms may also become inflamed, resulting in often difficult to write, especially if the involved wrist. The involvement of the joints of the lower extremities can lead to problems with walking.
Children will often feel unwell, especially when the disease is in an active form. As with NSAIDs to control the disease will be used antirheumatic drugs, or immunosuppressants to help prevent serious damage to the joints.
Only a small number of children (about 5%, mostly teenage girls) find a positive rheumatoid factor (RF). This condition is called juvenile rheumatoid arthritis (JRA – juvenile rheumatoid arthritis), and for these children is very important as soon as possible to start taking medication from the group of medicines basic therapy of rheumatic diseases, to prevent damage to the joints.
Systemic juvenile chronic arthritis
The disease is often the most difficult in the diagnosis, the more that arthritis may be absent in early disease. This form of the disease can occur in children of any age but is most common in younger age groups up to 5 years. It usually begins with high fever, more severe at night than during the day. Red, spotty at times, itchy rash often accompanies fever occurs when the temperature rises and falls with the normalization of temperature, usually more noticeable on the hands and feet. It may also increase to meet the glands (inflammation of the tonsils).
There are no specific tests to diagnose systemic juvenile chronic arthritis, but blood tests can rule out other conditions. Treatment will probably include high doses of NSAIDs, corticosteroids, oral or intravenous administration, means the basic treatment of rheumatic diseases, or immunosuppressive drugs needed to control the inflammatory process.
This disease is less than 10% of all diagnoses of juvenile chronic arthritis. Spondylitis affects mostly teenagers, causing arthritis, hip, knee or ankle joints. It may also be inflammation of the tendons at the point where they are attached to bones, such as Achilles tendon in the heel.
This form of the disease is often accompanied by acute inflammation of the eye (iridocyclitis). It may also develop inflammation of the joints and the joints of the sacrum and spine. 90% of children with spondyloarthropathy (spondylitis) are HLA B27 antigen, which can be found in the performance of a special blood test.
Treatment: NSAIDs, injections of corticosteroids into the joints and the administration of drugs to the basic treatment of rheumatic diseases.
To avoid damage to the joints and many other consequences of juvenile chronic arthritis, the treatment should be continued even in a time when the disease does not manifest its activity. Treatment will include medication, physical therapy, exercise therapy, massage, relaxation (spa treatment is recommended during periods of minimum activity or remission) and may also include the use of tires for the temporary immobilization of the joint to help keep the joints in a better position and make possible the movement. Special shoes and insoles help support the leg. Preventing contracture (adhesions) joint – the main goal of physical therapy for juvenile chronic arthritis.
Children should be treated, they should be given support and understanding to cope with the pain and physical disability, trying to maintain a normal life as much as possible.
Complications of therapy
Drugs used for treatment of juvenile chronic arthritis have many side effects. Thus, non-steroidal anti-inflammatory drugs and glucocorticoids increase the oral uptake of the acid function of the stomach and can cause chronic gastritis with the development of erosive and ulcerative process, so they must be taken after meals and preferably drink alkaline drink. If a child suffering from juvenile chronic arthritis and receiving treatment, complained of abdominal pain, an urgent need to show it to your doctor to endoscopic examination of the stomach, so as not to miss serious complication such as perforation of the ulcer.
Juvenile chronic arthritis – a disease for life, but when properly selected and systematic observation of therapy rheumatologist possible long-term remission (recovery) with a satisfactory quality of life (possible training, acquisition of secondary and higher education, working in the profession). If you often recurrent course, systemic manifestations of the disease forecast is more pessimistic – early in the disability occurs, the active life is limited.
Arthritis – a disease that is invisible at the beginning of its development, and can vary from day to day impact of the disease have a huge impact on the normal life of the child.
What can you do?
In all cases, when your child starts to act up, if any active movements, you notice that he was spared a pen or a leg, if the child is able to talk, he complains of pain in your arm or leg, not associated with trauma, or you notice that some of the joints slightly changed (flushed pripuh, changed the shape, the child does not allow you to touch him) should immediately contact a doctor, rheumatologist.
What can a doctor?
Your doctor will do a thorough inspection, appoint the necessary studies and specific laboratory tests that will allow an accurate diagnosis. Given the diagnosis, the child’s age prescribe treatment that will halt the disease, and at best achieve a cure.
Prevention can only be secondary, i.e. prevention of recurrence of juvenile chronic arthritis, and even then only if the patient is constantly monitored by a rheumatologist. Secondary prevention involves continuous monitoring of clinical signs and laboratory parameters of disease. If there are signs of incipient acute need to strengthen drug therapy, reduced physical activity (training at home for school) and, if necessary, to place the patient in a hospital, preferably one where he previously was.