It's juvenile

If you thought arthritis afflicted only those into their prime, then think again as it is catching them young and is idiopathic, warns Dr Sagar Bhattad

arthritis

Arthritis is no more an age-related disorder and does not affect only those above 45 years. Toddlers and teens below 16 years of age also suffer from arthritis, thereby posing a major threat to paediatric health.

Juvenile Idiopathic Arthritis (JIA), as it is called, is a special kind of arthritis that mostly occurs among children before their 16th birthday. Given the tender age of those getting afflicted, it has become essential for parents to be aware of this chronic condition, its causes and symptoms and the ways in which it can be tackled. Interestingly, JIA is more common among girls than boys.

Why does it occur?

Although JIA is considered to occur from a combination of genetic and environmental factors, the specific cause of the disorder is still a mystery. The term ‘idiopathic’ denotes that the exact cause behind this issue is yet unknown. However, this condition is the result of excessive inflammation in and around the joints. As per medical terminology, an inflammation occurs when the immune system conveys signalling molecules and white blood cells to a site of injury or disease in order
to facilitate tissue repair and face the microbial invaders.

While among those who have normal body conditions, the inflammatory response pauses after completion of the healing procedure to avoid damage to its own cells and tissues, those with JIA experience a prolonged inflammatory response, specifically in the joints. Several studies show that changes in several genes, particularly the human leukocyte antigen (HLA) complex that helps the body to differentiate between the body’s own proteins and those made by foreign invaders may increase the risk of developing JIA. To simplify, “JIA is an auto-immune disorder, where the body’s immune system fails to differentiate between self and foreign and attacks the joints.”

When must you see a doctor?

Children often complain of pain in their legs in the evening hours and before sleep. These kids are otherwise healthy, active, and playful and do not have swollen joints and are said to have “growing pains”. This condition does not warrant any medication and kids would outgrow this condition as they became older. On the contrary, it is very important for parents to keep a keen eye on several symptoms in their children like painful, swollen or stiff joints, joints that are warm to touch, increased tiredness, a fever
that keeps running and a limp without any injury. These symptoms point towards JIA. One may also notice redness in the eyes of the patients, enlarged glands and liver as well as skin rashes and psoriasis. In case one spots any of these symptoms, it is a must to consult a doctor immediately to further investigate the condition. Depending on these symptoms, JIA can be classified into various kinds including systemic-onset juvenile idiopathic arthritis, oligoarticular juvenile idiopathic arthritis, psoriatic arthritis, enthesitis-related arthritis and undifferentiated arthritis.

Managing JIA

Apart from early detection of the condition, a team-based approach to the treatment of JIA is considered helpful. A multi-disciplinary team involving paediatric rheumatologist, family physician/paediatrician, ophthalmologist, physiotherapist and occupation therapist is essential to provide optimal care to these young suffering souls. Managing JIA may include one or all of these steps like pharmacologic therapy with non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, biologic agents or
intra-articular and oral corticosteroids, psychosocial interventions, steps to improve school performance like academic counselling and encouragement towards increased physical activity, better nutrition, physical therapy and occupational therapy.

Managing the symptoms also forms a vital part of JIA treatment which includes significant lifestyle changes. Adequate exercise and sleep, appropriate diet and refraining from smoking and any other kind of substance abuse can considerably help in keeping the symptoms under control.

Weight-bearing exercise like walking works wonders in preventing symptoms of JIA. Exercise that keeps one’s joints in the neck, spine, arms and legs moving can be of great help. Maintaining a healthy diet is necessary to curb the symptoms. Eating plenty of dairy products like milk, cheese and yoghurt along with lots of fruits, vegetables and high-fibre content are helpful in keeping JIA at bay. Also, it is a must to avoid too much fat. In order to ensure a child’s healthy living and to avoid JIA, it is essential for parents to keep them physically active and their joints more flexible. With a multi-pronged approach supported by positive lifestyle changes, a healthy diet and proper diagnosis of the condition, JIA can be easily combated.

(The author is consultant, Paediatric Immunology and Rheumatology, Aster CMI Hospital)

 

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