Arthritis In Children: Types, Causes, Symptoms And Treatment

Arthritis in children is called juvenile arthritis (JA) or juvenile idiopathic arthritis. Although arthritis is a common problem in older people, some children below 16 years can have arthritis. In most cases, it is idiopathic, meaning it has no known causes.

Children with arthritis may experience pain, stiffness, and swelling in their joints due to inflammation. While children may have swollen and painful joints for various reasons, arthritis may cause these symptoms to last for more than six months. In some cases, the symptoms may resolve completely in adolescence, while some may only find temporary relief with treatment.

Read on to know the types, symptoms, causes, and treatment for arthritis in children.

Types Of Juvenile Arthritis 

There are five types of juvenile arthritis.

1. Systemic onset JIA: Also known as Still’s disease, this type of arthritis causes inflammation of the joints as well as internal organs. The symptoms begin with fever as high as 103°F, followed by salmon-colored rashes on the trunk, arms, and legs. Anemia and elevated white blood cell count are the other symptoms. Both boys and girls are equally affetcted.

2. Oligoarticular JA: It is found in half of the children with arthritis and can extend into adulthood. It affects fewer than five joints during the initial stages, and the joints near the knee, ankle, and wrist are generally affected. This type of arthritis can also affect the eyes, causing an inflammatory eye problem known as iritis or uveitis. Oligoarticular JA is more prevalent in girls than in boys.

3. Polyarticular JA: Also known as polyarthritis, it affects five or more joints in the first six months. It usually affects the joints in the fingers and hands as well as the knees and joints of the jaw. Children diagnosed with polyarticular JA may have the adult form of rheumatoid arthritis at an earlier-than-usual age.

4. Psoriatic JA: This type is commonly found in children with psoriasis or a family history of psoriasis. Some of the symptoms include pitted fingernails and swelling of the toes or fingers.

5. Enthesitis-related JA: Also known as spondyloarthritis, it affects the ligaments and spine. Along with joint pains and swelling, other symptoms such as back pain and stiffness are noticed(1) There is often a family history of arthritis of the back (called ankylosing spondylitis) among the child’s male relatives.

Symptoms Of Juvenile Arthritis 

The symptoms of JA vary among children. The following are some of the common symptoms of juvenile arthritis:

1. One of the early symptoms includes painful joints in the morning that tend to improve by afternoon. You might find your child suddenly limping in the morning because of an affected knee. Sometimes, the hands and feet may also hurt.

2. The joints may also look inflamed and swollen. Children may not complain of pain, but they may feel irritated and show no interest in any physical activity.

3. The inflamed joints may be warm to touch.

4. Symptoms such as high fever and salmon-colored rash may come and go.

5. In some children, JA might affect the joints’ growth; the joints might either grow too fast or too slow, causing uneven arms and legs (2)

6. Some children might find difficulty in performing daily activities, such as walking, dressing, and playing.

7. The inflammation and sore joints may affect the child’s sleep and appetite, resulting in weight loss and fatigue.

8. Juvenile arthritis can also affect the eyes, causing redness, pain, and sensitivity to light. If left untreated, it can cause permanent damage to the eyes.

9. Sometimes, the lymph nodes on the neck and other parts of the body may appear swollen. Internal organs such as the liver, spleen, and heart and the tissues around the organs can also get inflamed.

In the case of chronic conditions, the symptoms might last for six weeks to three months. In some children, these symptoms might go away temporarily with treatment, which is known as remission. This remission may last for months or years. In other children, the symptoms might go away permanently as they enter adolescence (3).

Causes Of Juvenile Arthritis 

The exact cause for JA is not known. Some studies say that it could be due to an autoimmune disease wherein the body’s immune system starts to attack the joints, resulting in inflammation (4).

Sometimes, arthritis can also be a result of an infection known as septic arthritis, which is characterized by swollen, red, and painful joints and fever (5).

Diagnosis Of Juvenile Arthritis 

JA could be hard to diagnose as the symptoms can be caused by other factors. If the joint pains and swelling do not subside even after six months, it is best to take your child to the doctor.

The doctor would carry out a physical examination, X-rays (to rule out fractures of the bone), and complete blood count. Unlike adults, children will have a negative result for rheumatoid factor. So, a physical examination is the best way to diagnose JA in children (1)

Treatment For Juvenile Arthritis 

Although there is no permanent cure for juvenile arthritis, there are various treatment options available to minimize the severity of the symptoms and help your child lead a normal life.

• Medications: Your child’s doctor will prescribe the appropriate medicine to keep the symptoms at bay. Medications play an important role in treating juvenile arthritis, so always follow the doctor’s advice on when to take or stop the medications.

The doctor might prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) as the first line of treatment. These help in reducing inflammation and pain in the joints.

Disease-modifying-rheumatic drugs (DMARDs) are the second line of treatment if the NSAIDs do not work. These medicines may take weeks or months to show effect.

In chronic cases, biologic agents and corticosteroids may also be used to reduce the severity of the symptoms. Corticosteroids are administered in pill or injection form; however, these may have side effects, such as stunted growth, weight gain, weakened bones, and a weak immune system.

• Physical therapy: Another important option for treating juvenile arthritis is therapy. It helps in preserving the function and range of motion in the joints. Although the pain may prevent children from being physically active, it is advised they do some light exercises without putting much weight on the joints.

Swimming is recommended as it involves many joints and muscles. Consult a physical therapist on the type of exercises that might suit your child.

• Splints: If the doctor suspects a deformation of the joint, they might advise the use of splints to reduce the inflammation and prevent further deformation (2)

Surgical treatments are rarely required for juvenile arthritis. In a case of severe joint deformation that cannot be corrected through splints, your doctor might recommend surgery to correct the joint position.

Along with your doctor’s recommendations, you may also give your child warm baths to soothe the inflammation. 

Living With Juvenile Arthritis 

As the exact cause for arthritis is not known, it cannot be prevented. However, with medications and therapy, the symptoms can be managed, and your child can lead a normal life. As long as the condition is under remission, your child can participate in all physical activities.

References

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Reviewer

Dr. Rana ChanchalMD, DCH, PGPN

     

Dr. Rana Chanchal is currently working as a senior consultant and head of the Department of Pediatrics and Neonatology at Charak Hospital and Research Center, Lucknow. He has completed under graduation and post-graduation in Pediatrics from King George's Medical University, Lucknow following which he completed a two-year fellowship in Neonatology from Manchester, UK.

Read full bio of Dr. Rana Chanchal