Pain in the joints!

HEALTH ALERT

Juvenile Arthritis (JA) is the most common form of persistent arthritis in children. The word juvenile refers to the onset of arthritis before age 16 and arthritis is the inflammation of the lining of joints. A majority of cases are chronic. Amongst children presented with joint pain to a tertiary hospital in Delhi, 41 per cent were diagnosed to have JA. Juvenile arthritis affects children in the age group of 8 to 150 of every 100,000 children.

JA is by and large under-diagnosed and inadequately treated in India. The level of awareness regarding the disease, among parents and medical practitioners, is low, poor access to healthcare, inadequate numbers of specialists (rheumatologists) to treat chronic joint diseases and myths surrounding joint diseases in children have contributed significantly to the improper treatment of JA.

Symptoms

Symptoms of JA may be non-specific initially, and include lethargy and reduced physical activity. The first manifestation particularly in young children, may be a limp. Children may also fall ill, with flu-like symptoms (fever) that persist despite usual treatment.

The cardinal clinical feature is persistent swelling and pain in the affected joint(s), which commonly include the knee, ankle, wrist and small joints of the hands and feet. A single joint or multiple joints may be affected at the same time. Pain is an important feature of JA, but young children may have difficulty in communicating this symptom. The pain worsens in the morning and may improve later on during the day. Stiffness in the joints especially during morning hours that improves later in the day is also a common feature. Lack of interest in daily activities or playing, poor eating, lethargy may become regular features.

If the disease is not adequately treated in early stages, JA could result in joint contracture (stiff, bent, fixed or immobile joint) and permanent joint damage. This in turn could result in growth retardation of the affected limb.

One particular type of JA called enthesitis-related arthritis predominantly causes back pain in children along with growth retardation of lower limb joints and pain at the site of insertion of tendons and ligaments into bones (eg.heel, front of the knee etc). This is by far the commonest variety of JA in India. The disease presents in children between age 8-14 years and is more commonly seen in boys while the other varieties are seen more in girls with peak age of onset being 1-6 years.

Causes

So far the actual cause of JA remains a mystery. However, the disorder is autoimmune — meaning that one’s own immune system starts to attack and destroy cells and tissues (particularly in the joints) for no apparent reason. It is believed that the immune system is provoked by changes in the environment or perhaps an error in the gene make up. Experimental studies have shown that certain viruses that have mutated may be able to trigger JA.

Complications

JA is a chronic disorder which, if neglected, can lead to complications. Proper follow-up with health professionals can significantly reduce the chance of developing complications.
Juvenile arthritis can also affect the eyes, causing inflammation and redness. Inflamed eyes if left untreated can result in glaucoma, scars, cataracts and even blindness. Often the eye inflammation occurs without symptoms and thus it is important for all children with JA to get regular eye checkups.

Children who delay treatment or do not get in physical therapy can often develop joint deformities of the hand and fingers. Over time hand (joint) function is lost and becomes almost impossible to recover.

Tests

There is no single test that can confirm the diagnosis and most physicians use a combination of blood tests, X rays and a clinical presentation to make an initial diagnosis.

Treatment

The treatment of JA is best undertaken by an experienced team of health professionals, including rheumatologists physiotherapists, and occupational therapists. It is essential that every effort is made to involve the child and his or her family in disease education and balanced treatment decisions.

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