A child cannot outgrow it but with early detection, the disease can be managed, writes Kasmiah Mustapha.
ARTHRITIS is not only associated with the elderly, even children as young as a year old are at risk of the disease. In children, it is known as juvenile idiopathic arthritis, and it causes joint swelling and stiffness. It is the most common type of arthritis in children under the age of 16 and can affect one or more joints.
Prince Court Medical Centre rheumatology specialist Datuk Dr Mohammed Shahdan Shahid says the term “idiopathic” is used as the mechanisms of the disease are known but its causes unknown. Although extensive research has been done, the specific causes of the inflammation are still undetermined.
While local statistics are unavailable, the American College of Rheumatology states that approximately one in every 1,000 children in the US develops some type of chronic arthritis.
“Patients may experience morning stiffness for more than half an hour, develop a skin rash, fever, back pain and fatigue,” says Dr Mohammed Shahdan.
To understand juvenile idiopathic arthritis better, he explains further its impact on a patient’s life.
Q: IS JUVENILE IDIOPATHIC ARTHRITIS GENETIC?
A: It may run in the family. There is no concrete evidence but I have treated two families that may suggest a link. In the first family, it was the grandmother who had arthritis initially, followed by the mother and her siblings, and then two grandchildren. In the other family, the grandchildren were diagnosed first, followed by their mother and grandmother.
Q: WHAT IS THE EFFECT OF INFLAMMATION OF THE JOINTS?
A: All joints have a synovial lining which is responsible for producing joint fluid. In an inflamed joint, the synovial lining proliferates. This leads to the production of a chemical known as interleukin, which can damage the joints, bones and joint capsules. That is why in severe cases, it can result in ruptured tendons and deformed fingers and knees.
The pain is due to the increase in pressure in the joints. In the morning, the joints will be stiff upon movement and it can take between two and three hours, or even up till midday for the patient to feel better.
If the pain persists, the patient needs to see a doctor to remove excess fluid to alleviate pain.
Q: CAN A CHILD OUTGROW THE DISEASE?
A: Unfortunately, the child cannot outgrow it but with early detection, the disease can be managed. With proper treatment and rehabilitation by a specialist, it can be controlled and detrimental effects minimised.
Q: WHAT ARE THE SERIOUS IMPACTS OF JUVENILE IDIOPATHIC ARTHRITIS?
A: Some patients require surgery. I have been treating a patient since she was 15. She is 32 now and has had four knee joint replacements. In such cases, the disease is very active and erodes the bones to the point where the joints are deformed and the patient finds it difficult to move. In order to improve mobility and alleviate pain, surgery is needed.
Post-surgery, the patient is advised not to overuse the artificial joint as it has a lifespan of 10 to 15 years, after which revision surgery is needed.
Patients will often be referred to ophthalmologists as they may develop eye problems — either from the disease itself or medication used to treat it. The most common eye problem is inflammation of the uvea known as uveitis. If uveitis is severe, it can cause cataracts and even blindness.
Q: WHAT ARE THE TREATMENTS FOR JUVENILE IDIOPATHIC ARTHRITIS?
A: Once diagnosed, they will be prescribed nonsteroidal anti-inflammatory drugs. If the medication does not control pain, the patient will then be prescribed hydrocortisone (a steroid). People often misunderstand the use of steroids in children but rest assured, they are only prescribed in low dosages and for a short period of time. The aim is to make the patient feel as comfortable as possible.
The next option is a disease-modifying drug that helps to suppress synovial cells from proliferating. It is given in a very small dosage and the benefits are usually seen after two to six weeks — which is why it is used in tandem with nonsteroidal anti-inflammatory drugs and hydrocortisone.
A better alternative is biologic, which is also a disease-modifying drug. However, it does affect the immune system, which means the patient is prone to infections. That said, the results are fantastic.
On top of medication, it is also important for doctors to work hand-in-hand with a physiotherapist and psychological counsellor. During an acute phase, the patient will need to see a physiotherapist once or twice a week. Once they get used to the movements prescribed, they can do them at home. An occupational therapist will help those with deformities to function and offer lifestyle modification tips.
Q: ARE THERE ANY RESTRICTIONS FOR CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS?
A: They shouldn’t get involved with contact sports, and avoid jumping — trampolines are especially hazardous for the knees, elbows and ankles. If there are no problems with the hips, running should be fine. However, light exercise such as swimming does help. There are no restrictions on food.
Q: HOW CAN PARENTS HELP CHILDREN WITH THis DISEASE?
A: If your child, especially if he is not talking yet, consistently cries in the middle of the night and touches his joints such as knees or elbows, take him to a paediatrician or specialist immediately, not a general practitioner.
Certain modifications should only be done if you notice your child is handicapped. For example, if your child has knee problems and is unable to squat, the toilet seat has to be modified. If they have problems with their hands, the taps at home should not be of the kind that require twisting. There are also other contraptions that can be bought online such as bigger utensils or stationery to help with grip.
The important thing is to treat your child normally. Many children with this disease are able to engage in activities; there are children with the disease who have climbed mountains. However, when they have flares — which means the disease is active and their joints are stiff — they must listen to their body and rest.