According to usvsukenglish.com, Juvenile idiopathic arthritis is a chronic joint disease that belongs to the rheumatic group. It occurs before the age of 16 and lasts at least six weeks.
What is Juvenile Idiopathic Arthritis?
The children suffer from pain in the cervical spine, which initially occurs mainly when the head is turned. After a few weeks or months, the small and large joints also become inflamed.
Juvenile idiopathic arthritis, also known as Still’s disease, is also known under the synonym juvenile rheumatoid arthritis. It is abbreviated to JIA or JRA. It is a chronic inflammatory joint disease, a so-called arthritis. The disease belongs to the rheumatic group and occurs in childhood. The disease belongs to the specialty of pediatric rheumatology.
Children’s rheumatism and childhood rheumatism are common collective terms for diseases in the field of pediatric rheumatology. In general, childhood rheumatic diseases and thus also JIA belong to the autoimmune diseases. The incidence of JIA is four to five cases per 100,000 children. Around 1,000 children are newly diagnosed every year.
The cause of JIA is not yet clear. This is also indicated by the “idiopathic” in the name of the disease. The term idiopathy is used for diseases where no cause can be identified. Presumably, various autoimmune mechanisms in an existing genetic disposition favor the onset of the disease. Infection or trauma may play a role.
Infections with the parvovirus B19 in particular are suspected of being able to promote the development of JIA. It is believed that the body forms antibodies against the virus, which ultimately target the body’s own tissues. This is possibly due to the fact that the surface structure of the pathogen is similar to the surface structure of certain body tissues. Thus, the antibodies not only damage the virus, but also the body’s own tissue.
Symptoms, Ailments & Signs
Depending on the symptoms, age, gender and family history, different forms of JIA are distinguished. Systemic juvenile idiopathic arthritis is the most severe form of childhood rheumatism. The disease begins with a high fever. A patchy, salmon-colored rash develops on the trunk, thighs, and upper arms. This can also itch.
The children suffer from pain in the cervical spine, which initially occurs mainly when the head is turned. After a few weeks or months, the small and large joints also become inflamed. In addition to the joints, the lining of the lungs, the pericardium and the peritoneum can also become inflamed.
Rheumatoid factor-positive juvenile polyarthritis has an onset similar to adult chronic polyarthritis. First of all, the wrists, the finger joints and the toe joints are affected by the inflammation. The inflammation occurs symmetrically. Some irreversible damage can occur within a few months. Rheumatoid nodules can appear on the extensor sides of arms and legs.
The disease may be accompanied by vascular inflammation. The small and medium-sized arteries can be affected. In addition, there are general symptoms such as growth arrest or growth retardation, weight loss, poor performance or instability. Liver and spleen may be swollen.
Rheumatoid factor negative juvenile polyarthritis begins with subfebrile temperatures, stunted growth, and weight loss over several months. The joints are moderately swollen and slightly overheated. The children are restricted in their mobility. Typically, the finger joints, toe joints, and wrists are affected symmetrically. The jaw joints and the joints of the cervical spine can also show functional deficits.
The knee joint is most commonly affected in juvenile idiopathic oligoarthritis. Affected joints are swollen and overheated. The pain only occurs when the joint is moved through its full range of motion. Chronic iridocyclitis develops in 20 percent of patients. Overall, however, the symptoms are rather unspecific, making it difficult to diagnose.
Juvenile psoriatic arthritis is a combination of arthritis and psoriasis. The psoriasis can develop years before the arthritis or the arthritis develops a long time before the psoriasis. Typical locations for psoriasis are the navel region, the extensor sides of the joints and the hairline. Arthritis can affect any joint here. However, initial involvement of the hip joints is typical.
Diagnosis & course of disease
A detailed anamnesis and a detailed clinical examination are fundamental for an adequate diagnosis. CRP, ESR, rheumatoid factors, ANA and HLA-B27 are determined in the blood laboratory. Imaging methods are used to rule out other diseases. Juvenile idiopathic arthritis must be differentiated from secondary arthritis.
During the course of the disease, regular examinations by the ophthalmologist must be carried out. Anterior uveitis should be ruled out. Anterior uveitis is inflammation of the iris in the eye. It occurs in 10 to 25 percent of all patients with juvenile idiopathic arthritis.
This disease primarily causes the patient to have a relatively high fever. A rash can also form on the patient’s skin, which in many cases is also associated with itching. If the person concerned scratches the rash, the itching can usually become worse. It is not uncommon for inflammation to occur in various parts of the body.
The heart and lungs are particularly affected, so that this inflammation can be life-threatening for the patient. Furthermore, the affected person loses weight and also suffers from swelling of the spleen and liver. The patient’s quality of life is significantly reduced and limited by this disease. The joints are also swollen, so that it is not uncommon for the patient’s movement to be restricted.
Children also suffer from growth disorders. The treatment of this disease takes place mainly with the help of medication and can limit the symptoms relatively well. There are no other complications. However, if the treatment is unsuccessful, surgical intervention may be necessary. As a rule, it cannot be universally predicted whether there will be a reduction in life expectancy.
When should you go to the doctor?
Children suffering from a high fever should be evaluated and given medical attention. If the fever persists for several days, you should consult a doctor. If there are changes in the usual skin appearance, there is reason for concern. A doctor should be consulted in the event of a colored rash, the formation of pustules and unpleasant itching. If open wounds form, sterile wound care is necessary.
If this cannot be guaranteed independently, a doctor must be consulted. Otherwise, in severe cases, there is a risk of blood poisoning and thus the premature death of the child. If existing wounds enlarge, if there is pus formation or pain, a doctor’s visit must be made. A doctor should be consulted in the event of inflammation of the joints, a reduction in physical performance or restricted mobility. Discomfort in the toes, fingers or hands are signs of discrepancies that require clarification.
If the child shows apathy, an increased need for sleep or withdrawal behavior from everyday activities, a check-up is recommended. In the event of a general feeling of illness, inner weakness, malaise, continuous weight loss or growth disorders, comprehensive examinations should be initiated to clarify the cause. Symptoms of the jaw joints and the development of psoriasis are signs of existing diseases that should be presented to a doctor.
Treatment & Therapy
Nonsteroidal anti-inflammatory drugs are the main agents used in JIA. These have an anti-inflammatory and pain-relieving effect and lower the body temperature. In addition, glucocorticoids are administered intra-articularly or systemically. Due to the sometimes serious side effects, systemic prescription should be avoided over a longer period of time. If prolonged administration of glucocorticoids cannot be avoided, osteoporosis prophylaxis should be carried out at the same time.
If this therapy does not improve, disease-modifying antirheumatic drugs such as methotrexate can be used. Methotrexate is also known as MTX. The drug belongs to the cytostatics. In addition, biologicals such as adalimumab or etanercept can be administered. However, some drugs from this group are only approved for children over a certain age. In severe cases, pediatric surgical interventions such as synovectomy may be necessary.
Outlook & Forecast
Juvenile idiopathic arthritis is a type of “anticipated” arthritic disease of the joints and progresses at a young age just as it would in an older patient. The prognosis of a young patient is therefore largely the same as that of an older patient.
Exceptions exist when the juvenile idiopathic arthritis appears in early childhood, because then it may have resolved by puberty. This form is more common in girls than boys. In addition, there are favorable factors in young people, such as a generally better state of health at a young age, often even higher bone density and resilience and, depending on lifestyle, stronger supporting muscles around the joints. The young age of the affected patient can thus ensure that joint wear does not progress as quickly as in a patient of the age at which arthritis usually occurs.
However, this does not completely stop the progression of the disease. However, the prognosis can be positively influenced by a healthy diet and gentle fitness, which is often even more realistic in younger patients than in older people. Because they are usually still healthy and flexible except for the arthritis, they have more opportunities to effectively strengthen their muscles and thus give their joints more stability.
Since the causes of idiopathic juvenile arthritis are still unknown, there is currently no effective prophylaxis.
The aftercare of juvenile idiopathic arthritis is on the one hand about taking the correct medication and on the other hand about the physiotherapeutic and ergotherapeutic aftercare. Exercise therapy aims to relax muscles and relieve pain. Depending on the situation, this can be passive joint mobilization or supportive treatment.
In some cases, the patient’s cooperation is also required to keep the joints flexible and bring about an improvement. Ice packs can also be used to reduce the pain. The patient follows the therapist’s instructions exactly. These measures can easily be carried out at home.
There are often appropriate facilities or courses for special, child-friendly water aerobics. In the course of long-term treatment, the affected children and adolescents learn a lot about the appropriate forms of therapy. In addition to your own participation in physiotherapy, it is also important to use the medication correctly.
Depending on the age of the patient, the responsibility here often lies with the parents. The anti-inflammatory drugs and other drugs are mainly used to relieve pain and promote muscle relaxation. Local heat, massages, exercise baths and electrotherapy are also useful methods for muscular relaxation.
You can do that yourself
In addition to drug therapy, physiotherapeutic and ergotherapeutic treatment also plays an important role. Relaxation and pain relief methods are used as part of physiotherapeutic treatment. Passive or assistive mobilization of the joints and stretching of affected structures lead to improved joint mobility. The targeted activation of the muscles and the use of ice packs to relieve pain are also part of the physiotherapeutic spectrum. Many of the methods used can also be carried out at home with the guidance of an experienced therapist. A child-friendly type of water aerobics to strengthen the muscles is also indicated.
Occupational therapy treatment is appropriate for deficits in the hand-finger area. In this case, a focus of this form of therapy is a playful, functional training. Individual hand splints are also made as part of this therapy and how to use the splints is practiced. Occupational therapy also provides joint protection training and supplies with everyday aids for severely affected children and adolescents. Most of this content can also be carried out at home according to instructions.
Social care is helpful for the whole family. The aim is to integrate the chronically ill into everyday life as well as into school and training. Information on the use of social assistance and compensation for disadvantages is also included in this care. Self-help groups also make a valuable contribution.