Pureocd

Juvenile rheumatoid arthritis is defined as arthritis starting before sixteen years of age, and it is commonly diagnosed between the ages of three and five. The diagnosis is made when the child has painful joints accompanied by inflammation and fever. The symptoms persist for more than six weeks. Movement of the effected joints may be limited.

Other causes have to be excluded, such as injury or infection. The disease is further divided according to how many joints are affected. The disease is often triggered by a seemingly minor illness that triggers the childs own immune system to attack their joints.

If less than five joints are affected the disease is known as oligoarthritis, and if more than five then it is known as polyarthritis. The disease can be chronically disabling for the child in terms of pain and ability to enjoy normal childhood activities.

The initial pain and inflammation may trigger joint damage, leading to deformity and further disability. An early onset of the disease magnifies these problems as the cycle of pain, inflammation and joint damage repeats itself.

Children with joint pain will rest the joint, commonly in a flexed position. This leads to weakness of the opposing muscles, and can lead to joint weakness and instability. Attempting to keep the joint flexed can lead to compensatory ways of walking, leading to limping. If the hands are effected the ability to grasp objects effectively can be lost.

The natural tendency to rest when in pain can exacerbate these weaknesses, leading to an overall loss in fitness reflected in lowered exercise capacity a lowered cardiovascular fitness. The lack of exercise can also lead to osteoporosis; a factor that should be considered as in patients with poor mobility falls will be more likely.

The aim of treatment is to allow the child to live a normal pain free life, and has to follow a multidisciplinary approach.

The active disease should be treated aggressively in an attempt to prevent joint damage and further disability but the drugs used to do this are commonly toxic. Steroids are the treatment of choice to stop active inflammation, but long-term use leads to the stunting of growth and osteoporosis, factors that must be considered with patients that are so young. The disease itself also causes growth retardation.

Pain killers should be used, but long term NSAID’s cause stomach damage and fluid retention that can lead to cardiac disease.

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