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, where an individual's immune system may attack its own healthy tissues and cells. [1] [2]

Contents

Juvenile arthritis may last for a few months, years, or becomes a lifelong disease that requires treatment as the child becomes an adult. [3]

Signs and symptoms

Several types of childhood arthritis exist, including juvenile idiopathic arthritis, juvenile myositis, juvenile lupus, juvenile scleroderma, vasculitis, and fibromyalgia. [4]

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)) [5] 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] [6]

  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] [6] [7] [8] 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] [7]
  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] [6] [7] 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] [6] Girls younger than eight are more likely to develop this type of arthritis. [5] </ref> [6]
  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] [7] 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]
  4. Oligoarticular (aka pauciarticular) arthritis: This type can be early or late onset and affects about 50% of children with juvenile arthritis. It typically affects fewer than four joints, usually the large joints such as knees, ankles, or wrists. It may cause eye inflammation, particularly in girls with positive anti-nuclear antibodies (ANA). Girls younger than eight are more likely to develop this type of arthritis. [9]

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. [10] [6] 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. [6] The underlying cause in the malfunction of the autoimmune system is unknown, however it is common to see an imbalance or abnormality in regulatory T cell levels in a majority of juvenile arthritis cases. [11] Additionally, dietary habits and emotional state seem to have no effect on the disease. [5] [3]

Diagnosis

Early diagnosis and treatment by a pediatric rheumatologist or a rheumatologist can help manage inflammation, relieve pain, and prevent joint damage. [1] [6] However, it is difficult for doctors to diagnose the disease [12] [5] because there is not a single test that doctors can use to diagnose this disease. [3] Physical exams [3] , laboratory tests (blood and urine), and various forms of imaging like X-rays may be some of the tests conducted by a doctor. [1] [6] Doctors may perform some of the following tests to diagnose the condition [12]

Treatment

Clinical guidelines provide treatment recommendations dependent on the clinical characteristics. [16] The treatment of most types of juvenile arthritis include medications, physical therapy, splints and in severe cases surgery. [6] The type and intensity of the treatment is largely based upon the subtype and severity of damage of the disease. [17] Guideline-informed pharmacological include intraarticular glucocorticoids, scheduled non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs, and interleukin inhibitors, depending on macrophage involvement and if symptoms are localized or systemic. [16] 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] [8] Consistent exercise can reduce both pain and immobility, while also improving life quality. [18] Exercise helps to improve symptoms that one with childhood arthritis might be experiencing, by significantly improving the extent to which the body's joints can move and be flexible. [2]

Epidemiology

In the US it affects about 250,000-294,000 children making it one of the most common groups of childhood diseases. [6]

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">Rheumatoid arthritis</span> Type of autoimmune arthritis

Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are involved, with the same joints typically involved on both sides of the body. The disease may also affect other parts of the body, including skin, eyes, lungs, heart, nerves, and blood. This may result in a low red blood cell count, inflammation around the lungs, and inflammation around the heart. Fever and low energy may also be present. Often, symptoms come on gradually over weeks to months.

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">Ankylosing spondylitis</span> Type of arthritis of the spine

Ankylosing spondylitis (AS) is a type of arthritis characterized by long-term inflammation of the joints of the spine, typically where the spine joins the pelvis. With AS, eye and bowel problems—as well as back pain—may occur. Joint mobility in the affected areas sometimes worsens over time. Ankylosing spondylitis is believed to involve a combination of genetic and environmental factors. More than 90% of people affected in the UK have a specific human leukocyte antigen known as the HLA-B27 antigen. The underlying mechanism is believed to be autoimmune or autoinflammatory. Diagnosis is based on symptoms with support from medical imaging and blood tests. AS is a type of seronegative spondyloarthropathy, meaning that tests show no presence of rheumatoid factor (RF) antibodies.

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).

<span class="mw-page-title-main">Rheumatism</span> Medical conditions affecting the joints or connective tissue

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> Long-term inflammatory disorder of the skin and muscles

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.

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

Myositis is a rarely-encountered medical condition characterized by inflammation affecting the muscles. The manifestations of this condition may include skin issues, muscle weakness, and the potential involvement of other organs. Additionally, systemic symptoms like weight loss, fatigue, and low-grade fever can manifest in individuals with myositis.

Mixed connective tissue disease, commonly abbreviated as MCTD, is an autoimmune disease characterized by the presence of elevated blood levels of a specific autoantibody, now called anti-U1 ribonucleoprotein (RNP), together with a mix of symptoms of systemic lupus erythematosus (SLE), scleroderma, and polymyositis. The idea behind the "mixed" disease is that this specific autoantibody is also present in other autoimmune diseases such as systemic lupus erythematosus, polymyositis, scleroderma, etc. MCTD was characterized as an individual disease in 1972 by Sharp et al., and the term was introduced by Leroy in 1980.

Palindromic rheumatism (PR) is a syndrome characterised by recurrent, self-resolving inflammatory attacks in and around the joints, and consists of arthritis or periarticular soft tissue inflammation. The course is often acute onset, with sudden and rapidly developing attacks or flares. There is pain, redness, swelling, and disability of one or multiple joints. The interval between recurrent palindromic attacks and the length of an attack is extremely variable from few hours to days. Attacks may become more frequent with time but there is no joint damage after attacks. It is thought to be an autoimmune disease, possibly an abortive form of rheumatoid arthritis.

Adult-onset Still's disease (AOSD) is a form of Still's disease, a rare systemic autoinflammatory disease characterized by the classic triad of fevers, joint pain, and a distinctive salmon-colored bumpy rash. The disease is considered a diagnosis of exclusion. Levels of the iron-binding protein ferritin may be extremely elevated with this disorder. AOSD may present in a similar manner to other inflammatory diseases and to autoimmune diseases, which must be ruled out before making the diagnosis.

<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">Lupus</span> Autoimmune disease in which the immune system attacks healthy tissue

Lupus, technically known as systemic lupus erythematosus (SLE), is an autoimmune disease in which the body's immune system mistakenly attacks healthy tissue in many parts of the body. Symptoms vary among people and may be mild to severe. Common symptoms include painful and swollen joints, fever, chest pain, hair loss, mouth ulcers, swollen lymph nodes, feeling tired, and a red rash which is most commonly on the face. Often there are periods of illness, called flares, and periods of remission during which there are few symptoms.

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 does not correspond to any criterion of specific autoimmune disease. 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.

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

Enteropathic arthropathy commonly referred to as enteropathic arthritis, is a type of arthritis linked to Crohn's disease, ulcerative colitis, and chronic inflammatory bowel diseases.

<span class="mw-page-title-main">Systemic-onset juvenile idiopathic arthritis</span> Medical condition

Systemic-onset juvenile idiopathic arthritis (sJIA), also known as Still disease, Still's disease, and systemic juvenile idiopathic arthritis, is a subtype of juvenile idiopathic arthritis (JIA) that is distinguished by arthritis, a characteristic erythematous skin rash, and remitting fever. Fever is a common symptom in patients with sJIA, characterized by sudden temperature rise above 39C and then a sudden drop. Over 80% of patients have a salmon-colored macular or maculopapular rash, which can be migratory and nonpruritic. Arthritis can develop weeks, months, or even years after onset and can affect various joints. SJIA is characterized by splenic and lymph node enlargements, with prominent symmetrical lymphadenopathy. Pericardial involvement is common, with 81% of children with active systemic symptoms having abnormal echocardiographic findings and 36% having an effusion or pericardial thickening. Around one-third of children with sJIA have occult macrophage activation syndrome (MAS), a potentially fatal illness causing T cells and macrophages to rapidly multiply and activate, resulting in a "cytokine storm."

<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 "Juvenile Arthritis Facts". Arthritis Foundation. 2012. Archived from the original on 7 March 2012. Retrieved 22 March 2012.
  2. 1 2 Nancy Garrick DD (2017-04-07). "Juvenile Arthritis". National Institute of Arthritis and Musculoskeletal and Skin Diseases. Retrieved 2024-07-25.
  3. 1 2 3 4 NIAMS Science Communications and Outreach Branch (2017-04-07). "Juvenile Idiopathic Arthritis (JIA)". National Institute of Arthritis and Musculoskeletal and Skin Diseases. Retrieved 2024-07-23.
  4. 1 2 3 4 5 6 "Juvenile Arthritis". Arthritis Foundation. Retrieved 2020-10-26.
  5. 1 2 3 4 "Juvenile Arthritis". American College of Rheumatology. Retrieved 2022-11-18.
  6. 1 2 3 4 5 6 7 8 9 10 11 "Orthoinfo". American Academy of Orthopaedic Surgeons. 2012. Retrieved 21 March 2012.
  7. 1 2 3 4 "Arthritis". U.S. Centers for Disease Control and Prevention. 2011. Retrieved 20 March 2012.
  8. 1 2 "Practice Management". American College of Rheumatology. 2011. Retrieved 20 March 2012.
  9. ↑ "Juvenile Idiopathic Arthritis (JIA) | Arthritis Foundation". www.arthritis.org. Retrieved 2024-07-25.
  10. ↑ "Autoimmune Diseases". MedlinePlus. U.S. National Library of Medicine. Retrieved 2020-10-29.
  11. ↑ Thatayatikom A, Modica R, De Leucio A (2024), "Juvenile Idiopathic Arthritis", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   32119492 , retrieved 2024-07-25
  12. 1 2 "Juvenile Arthritis". MedlinePlus. U.S. National Library of Medicine. Retrieved 2022-11-18.
  13. ↑ "ANA (Antinuclear Antibody) Test". MedlinePlus. U.S. National Library of Medicine. Retrieved 2022-11-18.
  14. ↑ "Joint Aspiration (Arthrocentesis) (for Parents)". Nemours KidsHealth. Retrieved 2022-11-18.
  15. ↑ "Rheumatoid Factor (RF) Test". MedlinePlus. U.S. National Library of Medicine. Retrieved 2022-11-18.
  16. 1 2 Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, et al. (April 2022) [2022-03-01]. "2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis". Arthritis & Rheumatology. 74 (4): 553–569. doi:10.1002/art.42037. PMC   10161784 . PMID   35233993.
  17. ↑ Thatayatikom A, Modica R, De Leucio A (2024), "Juvenile Idiopathic Arthritis", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID   32119492 , retrieved 2024-07-25
  18. ↑ Nijhof LN, Nap-van der Vlist MM, van de Putte EM, van Royen-Kerkhof A, Nijhof SL (November 2018). "Non-pharmacological options for managing chronic musculoskeletal pain in children with pediatric rheumatic disease: a systematic review". Rheumatology International. 38 (11): 2015–2025. doi:10.1007/s00296-018-4136-8. PMC   6208689 . PMID   30155667.
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