Understanding Chronic Childhood Arthritis (CA)

Understanding chronic childhood arthritis is quite imperative because when most people hear “arthritis,” they think of a condition that primarily affects older adults. However, arthritis can occur in children, too, and statistics highlight its significant prevalence.

Approximately three in every 1,000 Canadian children are affected by chronic childhood arthritis (CA), making it one of the more common chronic diseases in children.

You might be familiar with the medical term juvenile idiopathic arthritis (JIA) and wonder what it means. The word “idiopathic” denotes a condition with no known cause. This term is used when other possible causes of arthritis, such as infections, injuries, or autoimmune diseases, have been ruled out.

Diagnosing Childhood Arthritis

Identifying CA can be challenging. Unlike adults, children with arthritis may not always report pain, which is often a key indicator of joint inflammation.

Signs such as swelling, warmth, and redness of joints may be subtle or absent. A child might only display stiffness upon waking or have difficulty using an arm or leg. In some cases, the only noticeable symptom might be a swollen joint or restricted movement.

Doctors carefully assess for signs like joint swelling or loss of mobility to detect inflammation. Since there is no definitive test for diagnosing CA, the process involves ruling out other potential causes such as infections, injuries, or allergic reactions. This typically includes a combination of blood tests, urine tests, and imaging such as X-rays.

Once CA is diagnosed, ongoing monitoring is essential. Routine tests—including blood work, imaging, and eye exams—are repeated periodically to track the disease’s progression and evaluate the effectiveness of treatments. Your healthcare provider will determine the appropriate testing frequency based on your child’s specific needs.

Patterns and Types of CA

The presentation of CA varies widely. Once a physician suspects chronic childhood arthritis, they usually refer the child to a pediatric rheumatologist—an expert in managing joint, muscle, and bone disorders in children. Determining the exact type of CA is crucial for tailoring the best treatment plan.

There are seven major forms of chronic childhood arthritis, each with unique characteristics:

1. Oligoarticular–Persistent Juvenile Arthritis
2. Oligoarticular–Extended Juvenile Arthritis
3. Polyarticular–RF Negative Juvenile Arthritis
4. Polyarticular–RF Positive Juvenile Arthritis
5. Systemic Juvenile Arthritis (Systemic JA)
6. Enthesitis–Related Arthritis
7. Psoriatic Arthritis

The specific diagnosis often evolves over time, as the pattern of symptoms and disease progression over six to 12 months provides critical information. While treatment can begin before a precise classification is confirmed, identifying the exact form ensures a more targeted and effective management approach.

Exploring the Different Forms of Childhood Arthritis

1. Oligoarticular–Persistent Juvenile Arthritis

This is the most common and mildest form, affecting four or fewer joints beyond six months of diagnosis. It typically involves large joints like the knees, ankles, wrists, and elbows. Early treatment minimizes the risk of permanent joint damage. However, up to 20% of children with this form may develop uveitis (eye inflammation), necessitating regular eye examinations.

2. Oligoarticular–Extended Juvenile Arthritis

This form initially involves four or fewer joints but progresses to affect five or more over time. Both large and small joints may be impacted. Regular eye checks remain critical due to the risk of associated eye disease.

3. Polyarticular–RF Negative Juvenile Arthritis

This type involves five or more joints within six months of diagnosis but does not include rheumatoid factor (RF) in blood tests. It can begin at any age and often affects girls more frequently. Joints in the jaw and neck may also be impacted, potentially affecting chewing or neck movement.

4. Polyarticular–RF Positive Juvenile Arthritis

This form also affects five or more joints early on but is marked by a positive test for rheumatoid factor. It commonly begins in pre-teens or teenagers, with symptoms often resembling adult rheumatoid arthritis. Small and large joints on both sides of the body are affected, and early intervention with strong medications helps prevent severe joint damage.

5. Systemic Juvenile Arthritis (Systemic JA)

Unlike other forms, systemic JA impacts not just the joints but also the entire body, including internal organs. Spiking fevers, a transient rash, and general unwellness are hallmark symptoms. While the course of the disease is unpredictable, newer medications have improved remission rates significantly.

6. Enthesitis–Related Arthritis

This form involves inflammation where tendons attach to bones (entheses) as well as in joints. It often affects boys over the age of 10 and commonly involves the legs, hips, and lower back. In some cases, it may also affect the eyes or intestines. A genetic marker (HLA B-27) can aid in its diagnosis.

7. Psoriatic Arthritis

This form combines arthritis with psoriasis, a chronic skin condition characterized by red, scaly patches. It can affect both small and large joints and may precede the appearance of skin symptoms. Swollen fingers or toes (dactylitis) are a common feature. A family history of psoriasis can help confirm the diagnosis.

Managing Childhood Arthritis

Each type of CA requires a tailored treatment plan, often involving medications, physical therapy, and regular monitoring. Early diagnosis and intervention are critical for preventing complications, including joint damage or growth delays.

By working closely with healthcare providers, families can help children with CA lead active and fulfilling lives.

Causes of Childhood Arthritis (CA)

The exact cause of childhood arthritis (CA) remains unknown. It is not the result of any disease, infection, or event during pregnancy. Similarly, it is unrelated to dietary choices, and there is no evidence that any specific diet can prevent or cure CA. While some individuals report feeling better in warm and dry climates, no scientific proof links environmental conditions to improvements in CA.

CA may begin after an event that triggers the immune system, such as an ordinary infection or injury. Normally, the immune system combats infections or injuries by creating inflammation. However, in CA, the immune system becomes overactive, resulting in chronic inflammation that affects the joints and, in some cases, the skin and internal organs.

While CA is not generally inherited, it is rare for it to be passed from parent to child. The likelihood of a child with CA transmitting the condition to their offspring is extremely low.

Unique Features of Childhood Arthritis

Growth and Development

The inflammation associated with CA can influence a child’s growth. Affected joints may grow faster due to inflammation, but growth typically normalizes once the arthritis is under control. In cases where inflammation remains poorly managed, growth may slow down.

Medications like steroids, often used to treat severe arthritis, can also temporarily slow overall growth. Growth patterns generally return to normal once the disease is controlled, and steroid use is reduced or discontinued. Regular monitoring by healthcare professionals ensures that any growth concerns are promptly addressed.

Eye Problems and Care

Many forms of chronic childhood arthritis can lead to inflammation inside the eye, known as uveitis. This condition is unique because it often lacks outward symptoms such as redness, pain, or noticeable vision changes. As a result, regular eye exams by a specialist are crucial to detect and manage this condition early.

The frequency of eye exams depends on the child’s risk of developing uveitis, as determined by their healthcare team. Treatment for eye inflammation may involve:

• Steroid eye drops
• Steroid injections behind the eye
• Other systemic medications

If untreated or poorly managed, uveitis can result in severe complications, including vision loss or blindness. Eye inflammation is particularly common in children with CA that affects only a few joints.

Jaw and Dental Health

Arthritis of the jaw can occur in any form of CA. In some cases, symptoms may be subtle or present as recurring ear problems rather than jaw issues. Severe jaw arthritis may interfere with jaw growth, sometimes requiring surgical intervention.

Signs to watch for include:

• Difficulty eating
• Pain while chewing
• Limited jaw movement

Treatment options may include:

• Standard rheumatology medications
• Localized treatments, such as mouth splints
• Collaboration with orthodontists and dentists for specialized care

Orthodontic care may require special attention, as traditional metal braces can interfere with MRI scans. Ceramic braces may be a suitable alternative. Practicing good dental hygiene and regular dental checkups are essential for children with CA.

SEE ALSO: Worst Foods for Rheumatoid Arthritis

Unpredictability of CA

One of the most challenging aspects of CA is its unpredictable nature. In some cases, CA may be active for only a few months to a year before going into remission, seemingly disappearing forever. However, many children experience a fluctuating course over the years, with periods of worsening symptoms (flares) and improvements (remissions).

Flares can be triggered by unknown factors or mild illnesses like the stomach flu. These unpredictable episodes can be distressing for families, particularly when the disease seemed to have stabilized. However, parents should remain optimistic, as advancements in treatment options can help manage flares and improve the child’s quality of life.

By maintaining regular communication with healthcare providers and following treatment plans, families can navigate the ups and downs of CA with hope and confidence.

Treatments for Juvenile or Chronic Childhood Arthritis (JA)

Although there is no cure for Juvenile Arthritis (JA), early diagnosis and proactive treatment can lead to remission, characterized by little or no disease activity and symptoms. The primary goals of JA treatment include:

1. Slowing or halting inflammation to prevent disease progression.
2. Relieving symptoms, managing pain, and improving overall quality of life.
3. Preventing or minimizing joint and organ damage.
4. Preserving joint function and mobility into adulthood.
5. Reducing long-term health complications associated with chronic inflammation.

A comprehensive treatment plan integrates medications, physical activity, complementary therapies (like acupuncture and massage), mind-body techniques, and healthy dietary habits.

Medications

JA treatment involves a range of medications, some targeting the disease’s underlying mechanisms and others focusing on symptom relief.

• Corticosteroids:
  Fast-acting anti-inflammatory drugs, typically administered via injections in a doctor’s office. They help manage disease activity temporarily until other medications take effect. However, they are used cautiously due to potential side effects.
• Disease-Modifying Antirheumatic Drugs (DMARDs):
  These drugs suppress the immune system to prevent it from attacking the joints.
  • Traditional DMARDs: Examples include methotrexate (the most commonly prescribed) and sulfasalazine, usually available in pill form.
  • Biologic DMARDs: Administered through injections or infusions, these target specific immune pathways for more precise treatment.
• Symptom-Relieving Drugs:
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter or prescription medications that reduce inflammation and pain.
  • Analgesics: Pain relievers that ease discomfort but do not affect disease progression.

Treatment is tailored to each child, depending on disease type and severity. Doctors often adopt an aggressive early-treatment approach to minimize joint damage. This might involve starting with biologics or a DMARD-biologic combination rather than a step-by-step method. As the disease is monitored, medications may be adjusted.

Surgical Interventions

Most children with JA will not require surgery. However, in cases of severe joint damage or persistent pain, surgical options, such as joint replacement, may be considered. Many procedures can be performed on an outpatient basis.

Non-Drug Therapies

Exercise

Regular physical activity helps manage joint stiffness and pain while promoting overall health.

• Low-impact activities: Walking, swimming, biking, and yoga are joint-friendly options.
• Children with well-controlled disease may engage in other activities with medical approval.
• On difficult days, balancing light activity with rest is important to protect joints and conserve energy.

Physical Therapy and Assistive Devices

Physical and occupational therapies aim to enhance quality of life by teaching children ways to maintain mobility and perform daily tasks effectively. Therapists can:

• Guide strengthening and flexibility exercises.
• Help improve balance and coordination.
• Perform manual body manipulation.
• Prescribe and train children to use assistive devices like braces, splints, or hand grips.

Self-Care and Complementary Therapies

Healthy Eating

A diet rich in anti-inflammatory foods, such as those found in the Mediterranean diet (fatty fish, fruits, vegetables, whole grains, and olive oil), can help reduce inflammation. Processed, sugary, and high-fat foods should be avoided.

Hot and Cold Therapies

• Heat treatments: Heat pads or warm baths soothe stiff joints and tired muscles.
• Cold treatments: Ice packs can numb painful areas and reduce acute inflammation.

Topical Treatments

Pain-relief creams, gels, and patches can be applied directly to the joints or muscles. Some contain medications similar to oral painkillers, while others use nerve-irritating ingredients to distract from pain.

Mind-Body Therapies

Practices like meditation, deep breathing, and visualization help reduce pain and stress. Distraction techniques, such as listening to music or reading, can also provide comfort during difficult moments.

Massage and Acupuncture

• Massage therapy can relieve muscle tension and promote relaxation.
• Acupuncture involves inserting fine needles at specific points to alleviate pain, while acupressure applies firm pressure for a similar effect.

Supplements

Although less studied in children, certain supplements may provide benefits. Always consult a doctor to ensure safety and avoid interactions with medications.

Stress and Emotional Support

Children with JA are at higher risk for depression and emotional challenges. Counseling, therapy, and peer support programs can help children develop healthy coping strategies. A strong family and social support network can also provide comfort during difficult periods.

Community Support

Participating in programs and events, such as those offered by the Arthritis Foundation, allows children to meet peers facing similar challenges. Initiatives like the iPeer2Peer program pair teens with mentors who have firsthand experience managing JA, fostering encouragement and resilience.

By combining medical care, lifestyle adjustments, and emotional support, children with JA can lead fulfilling lives and manage their condition effectively.

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