EXPERT ADVICE: Can my child have arthritis?

Babies as young as 3 months can show signs of the condition, known as Juvenile Idiopathic Arthritis, or JIA.

Joint pain and swelling ― such arthritis symptoms are usually experience by the elderly.

It’s no wonder then that one mum was shocked when she found out that her 3-month-old baby suffers from arthritis (read her story here).

Juvenile Idiopathic Arthritis (JIA) is a chronic condition that causes joint inflammation in the body of a child under age 16, explains Dr Elizabeth Ang, a paediatric consultant at the Division of Allergy, Immunology and Rheumatology at the National University Hospital.

Here are details about this condition.

Dr Ang, what exactly causes JIA?
We don’t know the exact cause of arthritis, and scientists are still looking for the causes of juvenile arthritis. But it’s most likely an autoimmune disease. This means that the body’s immune system, which is meant to fight off infections, starts to attack its own healthy cells and tissues. The immune system is meant to defend ourselves by causing inflammation and swelling. In juvenile arthritis, the body creates an inflammation in the joints, meaning that the white blood cells produce chemicals that harm the lining of the joint. There is no proof that diet, allergies, stress or vitamin deficiencies cause JIA. There is a genetic predisposition to the condition, but genetic markers alone cannot predict who will get arthritis. Scientists believe that a trigger, like a virus, can set off the disease process in children with the genetic tendency.

There is no proof that diet, allergies, stress or vitamin deficiencies cause JIA.

How common is this condition?
JIA is the most common form of chronic arthritis in kids. There are about 500 children with JIA in Singapore. NUH sees about 70 to 80 active patients in total. That said, the number of children going to Paediatric Rheumatology Clinics for evaluation of joint pain is about twice as many as those with JIA.

What are the signs and symptoms and how do parents know when to send their child to a doctor to be checked out?
The most common symptoms of juvenile arthritis are joint swelling, pain and stiffness of the joint. Any joint may be affected, but the knees, hands, feet are most commonly affected. The symptoms are usually worse in the morning, after prolonged sitting or a nap. Not all children with juvenile arthritis will have the same symptoms. Some symptoms are specific to a subtype of JIA. Symptoms may change from day to day, or even within the same day. Sometimes, the symptoms go away or get worse.

Signs may include:

* Limping in the morning.

* Clumsiness, reduced physical activity.

* High fever and skin rash.

* Swelling in the lymph nodes and other parts of the body.

* The affected joint may feel warm.

 

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How severe can the pain and swelling get? Is medical treatment always necessary?
The severity of arthritis varies between patients, and within the same patient from day to day or even in the same day. When severe, it can cause a child to refuse to move the affected joint, which then can affect his mobility and may even affect his mood. Usually, because of its chronic nature, the pain is not severe enough to make them cry, but it can still be a distressing pain that affects their activity and mood. The younger child may have no way of communicating this and appear unwilling to move, and are sometimes labelled as “lazy”.

Could the pain be due to something other than arthritis?
Yes, it’s important to remember that not all pain around the joints is due to arthritis. It’s important to discuss with the child’s doctor to see if pain is from JIA, or an injury or a different illness. Families and doctors can then start the process of monitoring symptoms to establish a pattern. Arthritis affects each child differently. It’s vital to recognise each child’s signs to make an accurate diagnosis to ensure the best outcome.

Could the arthritis be inked to any other illnesses?
JIA may be linked to an inflammation in the eye called uveitis. Some subtypes of JIA are associated with a skin condition called psoriasis.

Children may have arthritis as part of other autoimmune or inflammatory disease like lupus, or an inflammatory bowel disease. But if the arthritis in the child is caused by another condition, it is not called “JIA”.

What treatment options are there?
Non-steroidal anti-inflammatory drugs like ibuprofen naproxen are used in arthritis for their anti-inflammatory effect, and the reduction of pain is one indication that the inflammation is subsiding. Many new drugs, known as biologics, have been developed in the past 15 years which allow children to get good control of their arthritis with fewer side effects.

If the condition goes undetected and the joint is not used, the bone and muscle near it will become smaller and weaker.

Can you prevent juvenile arthritis?
Unfortunately, no. But there are many ways to maintain healthy joints in children, which are even more important to those affected with JIA. This includes maintaining a healthy weight, physical activity and exercise.

Can a child with arthritis be affected socially and emotionally?
As arthritis causes pain and swelling, the child would not want to use the joint or joints that hurt. If the condition goes undetected and the joint is not used, the bone and muscle near it will become smaller and weaker. Juvenile arthritis can also cause limb-length discrepancy in children or impair the growth of the joint in general. Inflammation that starts earlier has a longer chance of causing damage, compared to if the inflammation started later in life in a joint that has finished growing and developing.

Movement and activity are vital to a child’s development, whether in the area of the brain, motor, muscle, coordination and balance. This in turn affects a child’s confidence and social skills.

Can you recover from juvenile arthritis? What can parents of children with arthritis expect?
Many medicines ― which may be eaten, or injected ― are available to treat arthritis. Injection medicine can be given directly into the affected joint (usually if a few joints are affected), or into the muscle or just under the skin. The latter method is usually used if many joints are affected, if initial oral medicines don’t work, or if the arthritis is very bad.

The CapitaLand-NAF Juvenile Arthritis Fund that was established in 2011 has been used to subsidise treatment for children aged between 6 and 14. An additional S$250,000 has been injected into the Fund this year.

Photos: iStock

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