Most people today have heard about arthritis and can relate it to joint pain and swelling, particularly due to the rise in prevalence of the disease in the recent years. Arthritis is one of the causes of immobility therefore it is paramount to understand the disease with regard to its causes, signs and symptoms, diagnosis, treatment modalities and prevention measures that can be taken. As opposed to the stereotypical understanding- joint pain in the elderly, arthritis comprises a wide spectrum of conditions from gout, rheumatoid arthritis, osteoarthritis and psoriatic arthritis among others. When the disease affects children aged 16 years and younger, it is termed Juvenile Arthritis (JA).
So what brings about this disease? The commonest form is idiopathic, meaning the specific cause is unknown. It rather occurs as a complex particularly in individuals with a myriad of risk factors, both genetic and environmental. It manifests as an autoimmune illness denoting that the individual’s immune system which is meant to protect them from infections, does the opposite and attacks their body tissues, in this case the joint lining (synovium). In other words, it is a self-destructive disease. There are five different types of Juvenile Arthritis: Oligo-articular, Poly-articular, Systemic, Psoriatic and Enthesitis-related.
Oligo-articular Juvenile Arthritis affects four or less joints during the initial 6 months of the disease, while poly-articular JA affects five or more joints. Systemic Arthritis (Still’s Disease) affects multiple organ systems including the joints, heart or liver. Therefore, the symptoms are usually generalized such as fever and skin rashes on limbs or trunk. Psoriatic arthritis is observed in children with existing skin psoriasis disorder in which the skin multiplies quickly, forming raised red patches with white scales. Enthesitis-related JA is arthritis which affects the regions where muscle tendons attach to bones (entheses) in the children.
Signs and symptoms vary depending on the type of JA the individual has from the above listed forms. Those which cut across all varieties include: swelling of the affected joints, stiffness particularly in the morning or after long periods of inactivity, and pain. The child usually limps making it seem like they lost their recently acquired walking skills. Others include high fever, skin rash on limbs and trunk, and swelling of lymph nodes. The symptoms may worsen over time or dissipate (periods of remission), then flare up once again depending on how effective the administered medication is. If untreated, juvenile arthritis may complicate to involve the eyes and lead to blindness.
Most of the symptoms above are non-specific, meaning that they also occur in different diseases as well. Diagnosis is thus made through a thorough medical history, physical exam and tests to exclude the other conditions. Additional lab tests may be ordered to narrow down on the type of arthritis present. Bone scans can be used to analyze the affected bones and joints. There are different treatment options which can be combined for a better prognosis (outcome) by diminishing the pain, swelling, and joint damage to improve mobility. The dosage regimen may vary from patient to patient based on how aggressive the disease is. The ultimate goal is to prevent disease progression and relieve symptoms. Exercise is also key because it promotes muscle strength and improves joint flexibility.
Given the cause of Juvenile Arthritis, it is somewhat difficult to prevent it entirely in individuals with genetic predispositions. Doctors recommend adequate breastfeeding, regular exercise and avoiding tobacco smoke. For most children with JA, the long-term outlook is good despite the illness lasting for several years, provided they receive treatment. Juvenile Arthritis Awareness Month is a great chance to raise consciousness about the disease, support the afflicted, and shed light on the importance of early diagnosis and treatment to avert complications. Let us take up the responsibility and save lives!
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