Living with
Juvenile Arthritis

What is juvenile arthritis?

Juvenile idiopathic arthritis is the most common type of arthritis in children. This condition was previously known as juvenile rheumatoid arthritis because medical experts know that is similar to rheumatoid arthritis as an autoimmune disease which affects the joints; however, they do not know the exact cause of juvenile rheumatoid arthritis, making the condition idiopathic (or of unknown cause).

While some children may experience symptoms of arthritis for only a few months, others may have them for the rest of their lives, and some types of juvenile idiopathic arthritis can cause serious complications, like growth problems, joint damage and eye inflammation.
Therefore, treatment should not only focus on controlling pain and inflammation but must also aim to improve function by preventing further joint damage.

How do you know you have juvenile arthritis?

Symptoms can affect one or many joints.

There are several different subtypes of juvenile idiopathic arthritis, namely: systemic, oligoarticular and polyarticular. The type of juvenile arthritis your child has will determine which symptoms they experience and to what extent.

The most common signs and symptoms of juvenile idiopathic arthritis in children are:

• Joint pain: You may only notice this in your child because they potentially may limp. The pain is usually worse in the morning and may come about after an injury and worsen over time. Additionally, joint pain of juvenile idiopathic arthritis is usually experienced in both joints, on both sides of the body, equally.
• Chronic and severe inflammation and pain in the eyes.
• Joint swelling and redness: These symptoms are common and are often first noticed in larger joints such as the knee or hip.
• Joint stiffness: The lower back and other joints may become less flexible, with certain movements causing pain. The stiffness is usually worse in the morning or after resting, when your child may appear clumsier than normal.
• Fever and rash: Children with juvenile arthritis often have an unexplained fever and rash, that comes and goes regardless of whether they are sick or not.
• Fatigue: Affected children often experience extreme, chronic exhaustion, regardless of physical activity and whether they have gotten enough sleep the night before.
• Poor appetite and weight loss: A child with juvenile arthritis might stop eating foods they once enjoyed, losing weight.

Like other forms of arthritis, juvenile idiopathic arthritis is typified by times when symptoms flare up and become more severe.

When to see your doctor:
Take your child to the doctor if they have experience any of the above symptoms for a week or longer.

What causes juvenile arthritis?

Most research indicates that juvenile idiopathic arthritis is an autoimmune disease.

The condition occurs when the body’s immune system mistakenly attacks its own joint tissues. However, it is not known why this happens, but both genetics and environmental factors seem to play a role, with some forms of juvenile idiopathic arthritis more prevalent amongst girls.

Additionally, evidence suggests that allergies may also trigger genes causing arthritis, leading to the development of juvenile idiopathic arthritis.

Living and managing

Parents and caregivers can teach children the following lifestyle management tips for their arthritis, including:

• Staying active: Make sure your child stays physically active, as low intensity exercise strengthens the muscles around joints, making joints more stable, and increasing joint flexibility and mobility.
  Your child should try light aerobic activities like walking, swimming or water aerobics, which place minimal stress on joints.
• Eat well for good bone health: It is very important that children with juvenile idiopathic arthritis eat a balanced diet because they are at risk of developing osteoporosis caused either directly by their condition or by the use of corticosteroids for treatment.
  Be sure to include lots of foods rich in calcium in your and your child’s diet. Calcium is a mineral found in dairy products, dark green leafy vegetables like spinach and broccoli, the bones of canned oily fish and in soy products like tofu. Calcium is essential for strong, healthy bones and bone growth.
  See Cooking from the Heart for healthy recipes and to find out more about how to incorporate more foods high in calcium into family meals.
• Apply heat and cold: These can be used to relieve pain and swelling in your child’s affected joints. Your child may prefer a cold- or hot-pack or a shower or bath in the mornings when symptoms are usually most severe.
• Physical therapy: This is an important part of your child’s proper management of their arthritis. A physiotherapist can show your child how to do exercises that help maintain the strength and mobility/flexibility of their joints, and how to take pressure off affected joints.
• Emotional support: Try, as far as possible, to treat your child like any other young person of their age and encourage them to partake in normal activities. Allow them to express their feelings about their condition. You can also talk to their school or other caregivers about any accommodations that need to be made due to their arthritis.

What treatment is available for juvenile arthritis?

Your doctor may prescribe one of the following medications, or a combination of the following medications, to relieve your child’s joint pain and stiffness, improve their mobility and to limit further joint damage:

• Corticosteroids and nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter/Consumer NSAIDs, such as ibuprofen and meloxicam, taken at recommended doses, can reduce inflammation and relieve arthritic pain.
  Courses of corticosteroids, like cortisone, and stronger NSAIDs are available by prescription from your child’s doctor.
  NSAIDs can cause stomach, cardiovascular and bleeding problems, as well as liver and kidney damage – so take care to use these medications correctly and only as indicated when giving them to your child.
• Disease-modifying anti-rheumatic drugs (DMARDs): These medications slow the progression of autoimmune disease, mainly by suppressing the immune response or, in the case of biological agents, by reducing the process of inflammation.
  The most commonly used DMARD for juvenile idiopathic arthritis is methotrexate.

What are the complications of juvenile arthritis?

Your child can suffer several serious complications as a result of juvenile idiopathic arthritis. But by carefully managing your child’s condition and seeking appropriate medical attention, you can greatly reduce the risk of your child developing the following complications:

• Inflammation of the eye (uveitis), which, if left untreated, can cause cataracts, glaucoma and even blindness. Children with juvenile arthritis may experience eye inflammation without other symptoms; therefore, it is important for children with this condition to be examined regularly by an ophthalmologist.
• Stunted growth, as juvenile idiopathic arthritis can interfere with your child’s growth and bone development. This may be caused by the actual disease process itself or by the corticosteroids used in treatment.
• Osteoporosis
• Long-term, recurring or chronic pain.
• Joint destruction, resulting in deformities like uneven limbs.
• Rarely, inflammation of the lining of the heart (pericarditis) if the condition is left untreated.