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Children Can Get Arthritis, Too!
When you think about arthritis, an elderly man or woman with chronic knee pain probably comes to mind. Few will associate a young child with this painful disease that is caused by inflammation of the joints and can lead to lifelong disability. Unfortunately, children are susceptible to arthritis, too.
Juvenile idiopathic arthritis (JIA), also known as juvenile rheumatoid arthritis (JRA), is the most common type of chronic arthritis that afflicts children before their 16th birthday. It is an autoimmune disorder. This means that the immune system, which normally helps fight bacteria and viruses, attacks the body’s own healthy cells and tissues.
Symptoms of juvenile idiopathic arthritis include:
- swelling, pain and stiffness in joints, most often in the knees, wrists and ankles (the hips, toes, fingers, elbows, shoulders, neck and jaw can also be affected);
- limping in the morning or after napping, due to joint stiffness;
- high fever;
- skin rash;
- lymph node swelling in the neck and other parts of the body and/or liver and spleen enlargement.
While JIA can be severe, the good news is that timely diagnosis and treatment can enable the child to lead a normal life. However, if treatment is delayed, the child’s growth and development can be impaired permanently.
Different types of juvenile idiopathic arthritis
According to Associate Professor Thaschawee Arkachaisri, Senior Consultant and Head, Rheumatology and Immunology Service, KK Women's and Children's Hospital (KKH), there is little general awareness and understanding about juvenile arthritis in Singapore.
“At KK Women’s and Children’s Hospital, we have seen over 150 patients of JIA over the past two years. Often it is not detected early enough as parents do not realise that something is amiss with their child," says A/Prof Thaschawee.
JIA, which is caused by a combination of factors including genetic predisposition and unknown environmental factors, can attack one or more joints, and can also spread to different organs in its more severe form. Girls have been found to be more prone to JIA than boys.
The three main types of JIA are:
- Oligoarticular: This is the most common and mildest form. It affects one to four joints. There is more risk of eye inflammation in this type of JIA.
- Polyarticular: It affects five or more joints.
- Systemic: This is the least common type of JIA and the most severe, with the disease attacking multiple joints and even spreading to lymph nodes or to organs such as the heart, liver and spleen.
If the arthritis strikes when the child is learning to walk or run, “joint pain and stiffness can interfere with his motor development,” says A/Prof Thaschawee. Treatment shouldn’t be delayed, as “the child can suffer joint deformity, uneven limb length or permanent disability”. A related complication of arthritis is chronic uveitis or inflammation of the eye. If this condition is neglected, the child can lose vision, so regular eye check-ups are advisable, he stresses.
Physical exercise is an essential part of treatment
Long-term treatment for JIA includes non-steroidal anti-inflammatory drugs, anti-rheumatic drugs such as methotrexate, or biologic drugs, as well as physical exercise. Getting the child to move painful joints through their full range of motion might be a challenge but it is important to persist to prevent stiffening and deformity.
For the milder cases, “with effective therapy, in due course of time, the symptoms of JIA will not be noticeable to an onlooker,” says A/Prof Thaschawee. Many JIA patients outgrow the disease and are arthritis-free as adults. In the more severe cases, however, arthritis may be a life-long affliction. |
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