Childhood arthritis

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Childhood arthritis
Other namesJuvenile arthritis, Pediatric rheumatic disease
Specialty Rheumatology

Childhood arthritis (juvenile arthritis or pediatric rheumatic disease) is an umbrella term used to describe any rheumatic disease or chronic arthritis-related condition which affects individuals under the age of 16. Most types are autoimmune disorders. [1]

Contents

Signs and symptoms

Several types of childhood arthritis exist, including juvenile idiopathic arthritis, juvenile myositis, juvenile lupus, juvenile scleroderma, vasculitis, and fibromyalgia. [2]


General signs of childhood arthritis disorders include:


The most common type of childhood arthritis, juvenile idiopathic arthritis (previously known as juvenile rheumatoid arthritis (JRA) or juvenile chronic arthritis (JCA)) [3] can be divided into three main forms: The classification is based upon symptoms, number of joints involved and the presence of certain antibodies in the blood. [1] [4]

  1. Polyarticular arthritis is the first type of arthritis, which affects about 30–40% of children with arthritis and is more common in girls than boys. [1] [4] [5] [6] Typically five or more joints are affected (usually smaller joints such as the hands and feet but many also affect the hips, neck, shoulders and jaw). [1] [5]
  2. Oligoarticular (aka pauciarticular) arthritis can be early or late onset and is the second type of arthritis, affecting about 50% of children with juvenile arthritis. [1] [4] [5] This type affects fewer than four joints (usually the large joints such as knees, ankles or wrists) and may cause eye inflammation in girls with positive anti-nuclear antibodies (ANA). [1] [4] Girls younger than eight are more likely to develop this type of arthritis. [7] [4]
  3. Systemic disease is the least common form, with 10–20% of children (boys and girls equally) being affected with limited movement, swelling and pain in at least one joint. [1] [5] A common symptom of this type is a high, spiking fever of 103 °F (39.4 °C) or higher, lasting for weeks or months, and a rash of pale red spots on the chest, thighs or other parts of the body may be visible. [1]

Cause

In most cases, juvenile arthritis is caused by the body attacking its own healthy cells and tissues, i.e. autoimmunity, causing the joint to become inflamed and stiff. [8] [4] Once the joint has become inflamed and stiff, damage is done to the joint and the growth of the joint may by changed or impaired. [4] The underlying cause in the malfunction of the autoimmune system is unknown; dietary habits and emotional state seem to have no effect on the disease. [9] [10]

Diagnosis

Early diagnosis and treatment by a pediatric rheumatologist or a rheumatologist can help manage inflammation, relieve pain, and prevent joint damage. [1] [4] However, it is difficult for doctors to diagnose the disease. [11] [9] Careful examination, laboratory tests (blood and urine), and various forms of imaging like X-rays may be some of the tests conducted by a doctor. [1] [4] Doctors may perform some of the following tests to diagnose the condition [11]

Treatment

The treatment of most types of juvenile arthritis include medications, physical therapy, splints and in severe cases surgery. [4] Methotrexate is commonly prescribed to children with juvenile arthritis. [15] These treatments are focused on reducing swelling, relieving pain and maintaining full movement of joints. [1] Children are encouraged to be involved in extra-curricular activities, physical activity when possible, and to live a "normal" life. [1] [6]

Epidemiology

In the US it affects about 250,000-294,000 children making it one of the most common groups of childhood diseases. [4]

Related Research Articles

<span class="mw-page-title-main">Arthritis</span> Type of joint disorder

Arthritis is a term often used to mean any disorder that affects joints. Symptoms generally include joint pain and stiffness. Other symptoms may include redness, warmth, swelling, and decreased range of motion of the affected joints. In some types of arthritis, other organs are also affected. Onset can be gradual or sudden.

<span class="mw-page-title-main">Systemic scleroderma</span> Medical condition

Systemic scleroderma, or systemic sclerosis, is an autoimmune rheumatic disease characterised by excessive production and accumulation of collagen, called fibrosis, in the skin and internal organs and by injuries to small arteries. There are two major subgroups of systemic sclerosis based on the extent of skin involvement: limited and diffuse. The limited form affects areas below, but not above, the elbows and knees with or without involvement of the face. The diffuse form also affects the skin above the elbows and knees and can also spread to the torso. Visceral organs, including the kidneys, heart, lungs, and gastrointestinal tract can also be affected by the fibrotic process. Prognosis is determined by the form of the disease and the extent of visceral involvement. Patients with limited systemic sclerosis have a better prognosis than those with the diffuse form. Death is most often caused by lung, heart, and kidney involvement. The risk of cancer is increased slightly.

Rheumatology is a branch of medicine devoted to the diagnosis and management of disorders whose common feature is inflammation in the bones, muscles, joints, and internal organs. Rheumatology covers more than 100 different complex diseases, collectively known as rheumatic diseases, which includes many forms of arthritis as well as lupus and Sjögren's syndrome. Doctors who have undergone formal training in rheumatology are called rheumatologists.

<span class="mw-page-title-main">Antinuclear antibody</span> Autoantibody that binds to contents of the cell nucleus

Antinuclear antibodies are autoantibodies that bind to contents of the cell nucleus. In normal individuals, the immune system produces antibodies to foreign proteins (antigens) but not to human proteins (autoantigens). In some cases, antibodies to human antigens are produced.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is one of the institutes and centers that make up the National Institutes of Health, an agency of the United States Department of Health and Human Services (HHS).

Rheumatism or rheumatic disorders are conditions causing chronic, often intermittent pain affecting the joints or connective tissue. Rheumatism does not designate any specific disorder, but covers at least 200 different conditions, including arthritis and "non-articular rheumatism", also known as "regional pain syndrome" or "soft tissue rheumatism". There is a close overlap between the term soft tissue disorder and rheumatism. Sometimes the term "soft tissue rheumatic disorders" is used to describe these conditions.

<span class="mw-page-title-main">Psoriatic arthritis</span> Long-term inflammatory arthritis

Psoriatic arthritis (PsA) is a long-term inflammatory arthritis that occurs in people affected by the autoimmune disease psoriasis. The classic feature of psoriatic arthritis is swelling of entire fingers and toes with a sausage-like appearance. This often happens in association with changes to the nails such as small depressions in the nail (pitting), thickening of the nails, and detachment of the nail from the nailbed. Skin changes consistent with psoriasis frequently occur before the onset of psoriatic arthritis but psoriatic arthritis can precede the rash in 15% of affected individuals. It is classified as a type of seronegative spondyloarthropathy.

<span class="mw-page-title-main">Juvenile idiopathic arthritis</span> Childhood rheumatic disease

Juvenile idiopathic arthritis (JIA), formerly known as juvenile rheumatoid arthritis (JRA), is the most common chronic rheumatic disease of childhood, affecting approximately 3.8 to 400 out of 100,000 children. Juvenile, in this context, refers to disease onset before 16 years of age, while idiopathic refers to a condition with no defined cause, and arthritis is inflammation within the joint.

<span class="mw-page-title-main">Juvenile dermatomyositis</span> Medical condition

Juvenile dermatomyositis (JDM) is an idiopathic inflammatory myopathy (IMM) of presumed autoimmune dysfunction resulting in muscle weakness among other complications. It manifests itself in children; it is the pediatric counterpart of dermatomyositis. In JDM, the body's immune system attacks blood vessels throughout the body, causing inflammation called vasculitis. In the United States, the incidence rate of JDMS is approximately 2-3 cases per million children per year. The UK incidence is believed to be between 2-3 per million children per year, with some difference between ethnic groups. The sex ratio is approximately 2:1. Other Idiopathic inflammatory myopathies include; juvenile polymyositis (PM), which is rare and not as common in children as in adults.

<span class="mw-page-title-main">Dermatomyositis</span> Medical condition

Dermatomyositis (DM) is a long-term inflammatory disorder which affects the skin and the muscles. Its symptoms are generally a skin rash and worsening muscle weakness over time. These may occur suddenly or develop over months. Other symptoms may include weight loss, fever, lung inflammation, or light sensitivity. Complications may include calcium deposits in muscles or skin.

A connective tissue disease (collagenosis) is any disease that has the connective tissues of the body as a target of pathology. Connective tissue is any type of biological tissue with an extensive extracellular matrix that supports, binds together, and protects organs. These tissues form a framework, or matrix, for the body, and are composed of two major structural protein molecules: collagen and elastin. There are many different types of collagen protein in each of the body's tissues. Elastin has the capability of stretching and returning to its original length—like a spring or rubber band. Elastin is the major component of ligaments and skin. In patients with connective tissue disease, it is common for collagen and elastin to become injured by inflammation (ICT). Many connective tissue diseases feature abnormal immune system activity with inflammation in tissues as a result of an immune system that is directed against one's own body tissues (autoimmunity).

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Scleromyositis, is an autoimmune disease. People with scleromyositis have symptoms of both systemic scleroderma and either polymyositis or dermatomyositis, and is therefore considered an overlap syndrome. Although it is a rare disease, it is one of the more common overlap syndromes seen in scleroderma patients, together with MCTD and Antisynthetase syndrome. Autoantibodies often found in these patients are the anti-PM/Scl (anti-exosome) antibodies.

<span class="mw-page-title-main">Autoimmune disease</span> Disorders of adaptive immune system

An autoimmune disease is a condition that results from an anomalous response of the adaptive immune system, wherein it mistakenly targets and attacks healthy, functioning parts of the body as if they were foreign organisms. It is estimated that there are more than 80 recognized autoimmune diseases, with recent scientific evidence suggesting the existence of potentially more than 100 distinct conditions. Nearly any body part can be involved.

<span class="mw-page-title-main">Scleroderma</span> Group of autoimmune diseases resulting in abnormal growth of connective tissue

Scleroderma is a group of autoimmune diseases that may result in changes to the skin, blood vessels, muscles, and internal organs. The disease can be either localized to the skin or involve other organs, as well. Symptoms may include areas of thickened skin, stiffness, feeling tired, and poor blood flow to the fingers or toes with cold exposure. One form of the condition, known as CREST syndrome, classically results in calcium deposits, Raynaud's syndrome, esophageal problems, thickening of the skin of the fingers and toes, and areas of small, dilated blood vessels.

The Undifferentiated connective tissue disease (UCTD) is a disease in which the connective tissues are targeted by the immune system. It is a serological and clinical manifestation of an autoimmune disease. When there is proof of an autoimmune disease, it will be diagnosed as UCTD if the disease doesn't answer to any criterion of specific autoimmune disease. Such as systemic lupus erythematosus (SLE), la scleroderma, mixed connective tissue disease, Sjögren syndrome, systemic sclerosis, polymyositis, dermatomyositis, or the rheumatoid arthritis. This is also the case of major rheumatic diseases whose early phase was defined by LeRoy et al. in 1980 as undifferentiated connective tissue disease. The latent Lupus and the incomplete lupus are alternative terms used to describe this condition.

Systemic juvenile idiopathic arthritis is a type of juvenile idiopathic arthritis (JIA) with extra-articular manifestations like fever and rash apart from arthritis. It was originally called systemic-onset juvenile rheumatoid arthritis or Still's disease.

Ross E. Petty is a Canadian pediatric rheumatologist. He is a professor emeritus in the Department of Pediatrics at the University of British Columbia and a pediatric rheumatologist at BC Children’s Hospital in Vancouver, Canada. He established Canada’s first formal pediatric rheumatology program at the University of Manitoba in 1976, and three years later, he founded a similar program at the University of British Columbia.

<span class="mw-page-title-main">Antiarthritics</span> Drug class

An antiarthritic is any drug used to relieve or prevent arthritic symptoms, such as joint pain or joint stiffness. Depending on the antiarthritic drug class, it is used for managing pain, reducing inflammation or acting as an immunosuppressant. These drugs are typically given orally, topically or through administration by injection. The choice of antiarthritic medication is often determined by the nature of arthritis, the severity of symptoms as well as other factors, such as the tolerability of side effects.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 Arthritis Foundation. (2012). Juvenile Arthritis Face Sheet. Retrieved March 21, 2012, from Arthritis Foundation: "Juvenile Arthritis Facts". Archived from the original on 2012-03-07. Retrieved 2012-03-22.
  2. 1 2 3 4 5 6 "Juvenile Arthritis". www.arthritis.org. Retrieved 2020-10-26.
  3. ↑ "Juvenile Arthritis". www.rheumatology.org. Retrieved 2020-10-26.
  4. 1 2 3 4 5 6 7 8 9 10 11 American Academy of Orthopaedic Surgeons. (2012). Orthoinfo. Retrieved March 21, 2012, from American Academy of Orthopaedic Surgeons: http://orthoinfo.aaos.org/topic.cfm?topic=a00075
  5. 1 2 3 4 Centers for Disease Control and Prevention. (2011). Arthritis. Retrieved March 20, 2012, from Centers for Disease Control and Prevention: https://www.cdc.gov/arthritis/basics/childhood.htm
  6. 1 2 American College of Rheumatology. (2011). Practice Management. Retrieved March 20, 2012, from American College of Rheumatology:http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/juvenilearthritis.asp
  7. ↑ "Juvenile Arthritis". www.rheumatology.org. Retrieved 2020-10-29.
  8. ↑ "Autoimmune Diseases". medlineplus.gov. Retrieved 2020-10-29.
  9. 1 2 "Juvenile Arthritis". www.rheumatology.org. Retrieved 2022-11-18.
  10. ↑ Nancy Garrick, Deputy Director (2017-04-07). "Juvenile Idiopathic Arthritis (JIA)". National Institute of Arthritis and Musculoskeletal and Skin Diseases. Retrieved 2022-11-18.
  11. 1 2 "Juvenile Arthritis". medlineplus.gov. Retrieved 2022-11-18.
  12. ↑ "ANA (Antinuclear Antibody) Test: MedlinePlus Medical Test". medlineplus.gov. Retrieved 2022-11-18.
  13. ↑ "Joint Aspiration (Arthrocentesis) (for Parents) - Nemours KidsHealth". kidshealth.org. Retrieved 2022-11-18.
  14. ↑ "Rheumatoid Factor (RF) Test: MedlinePlus Medical Test". medlineplus.gov. Retrieved 2022-11-18.
  15. ↑ Takken, Tim; van der Net, Janjaap J; Helders, Paul PJM (2001-10-23). "Methotrexate for treating juvenile idiopathic arthritis". Cochrane Database of Systematic Reviews. 2001 (4): CD003129. doi:10.1002/14651858.cd003129. ISSN   1465-1858. PMC   7017300 .
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