Juvenile arthritis affects nearly 300,000 children in the U.S., and researchers are just starting to understand more about the diseases and conditions that fall into this category.
July is Juvenile Arthritis Awareness Month, offering a unique opportunity to educate and inform PT and OT practitioners, along with the public, about various forms of juvenile arthritis and how to offer relief to young patients. Using the hashtag #StrongerThanJA, the Arthritis Foundation is working to spread the word that children can get arthritis too, and the need exists for more answers to fight this painful disorder.
What is juvenile arthritis?
Among the most common types of arthritis is juvenile idiopathic arthritis, which begins before age 16 and involves swelling in one or more joints for at least six weeks, according to the Arthritis Foundation. Knowledge of juvenile idiopathic arthritis, formerly known as juvenile rheumatoid arthritis, has shifted recently as researchers have come to understand a difference in the type of arthritis that affects most pediatric patients and arthritis in adults. Only about 10% of children have the disease that resembles adult rheumatoid arthritis.
Another recent shift relates to the belief that juvenile idiopathic arthritis is a group of strictly autoimmune diseases. Some experts are looking at whether one particular form of juvenile idiopathic arthritis — systemic — is autoinflammatory, while others are exploring whether subtypes of juvenile idiopathic arthritis are not “autoimmune or autoinflammatory but caused by something else,” writes author Mary Anne Dunkin on the Arthritis Foundation website KidsGetArthritisToo.org. Such discussions could impact present and future treatment methods of juvenile idiopathic arthritis.
Other types of juvenile arthritis include juvenile dermatomyositis, juvenile lupus, juvenile scleroderma and Kawasaki disease, named after Japanese pediatrician Tomisaku Kawasaki, who observed inflammatory-type symptoms in children, followed in later years by heart conditions.
Know the symptoms, causes of juvenile arthritis
Although pain is an obvious symptom of juvenile idiopathic arthritis, children might not complain of joint pain. Instead, parents might notice their child limping, particularly first thing in the morning or after a nap, according to the Mayo Clinic. Symptoms also include joint swelling, stiffness and fever, swollen lymph nodes and rash. Severe complications can include eye issues, such as inflammation and struggles with growth.
“Juvenile idiopathic arthritis can affect one joint or many,” the Mayo Clinic website states. “There are several different subtypes of juvenile idiopathic arthritis, but the main ones are systemic, oligoarticular and polyarticular. Which type your child has depends on symptoms, the number of joints affected and if a fever and rashes are prominent features.”
Children with juvenile idiopathic arthritis also may display signs such as difficulty dressing, walking, playing or other daily activities, according to the Centers for Disease Control and Prevention.
Experts believe genetics play a significant role in children developing juvenile arthritis, but researchers are continuing to study the combination of genetic and environmental factors that might contribute. According to the Mayo Clinic, juvenile idiopathic arthritis occurs when the body’s immune system attacks its own cells and tissues. Certain gene mutations also can make children more susceptible to environmental conditions, such as viruses.
Author Linda J. Brown writes on KidsGetArthritisToo.org that parents of children with juvenile idiopathic arthritis often are concerned siblings also will be diagnosed. A study conducted by Sampath Prahalad, MD, associate professor of pediatrics and human genetics at Emory University in Atlanta, found siblings are 12 times more likely to get juvenile idiopathic arthritis, Brown writes. Still, the risk is not as severe as one might think.
“With the population prevalence of juvenile idiopathic arthritis at one in 1,000, a 12 times greater risk may sound like a lot but it’s only equal to 1.2%,” Prahalad said. “So, there’s a 98% chance that the family would not have another child with arthritis.”
Modern treatments and physical therapy
In previous years, children with juvenile idiopathic arthritis were treated with non-steroid, anti-inflammatory drugs, according to the U.S. Food and Drug Administration. Other treatments include drugs such as corticosteroids and methotrexate that suppress the body’s immune system response. New treatments also have started to emerge, including biologics, which are manufactured in or from biologic sources.
In a blog post on the FDA website, Nikolay Nikolov, a rheumatologist and clinical team leader at the FDA, wrote that new therapies for juvenile idiopathic arthritis give parents reasons to be optimistic. These therapies moderate the effects and control the disease, helping to prevent significant disability as children get older.
“As science at the molecular level has advanced, we’ve learned more about what drives arthritis — the mechanism of the disease — and we are able to identify important targets,” Nikolov said.
Although there is no cure for juvenile arthritis, early diagnosis and aggressive treatment are key to remission, according to the Arthritis Foundation. Even with the variety of innovative juvenile idiopathic arthritis medications, physical therapy should still be a significant part of a treatment plan, Brown writes on KidsGetArthritisToo.org. Experts recommend a combination of both for improved outcomes.
“I think establishing and maintaining a good therapeutic exercise program will definitely add to any benefits that medicine can provide,” Greg Shahum, OTR/L, director of rehabilitation at Regency Heights of Stamford in Connecticut, said in Brown’s post.
Celebrities, children raise awareness
With increased awareness of juvenile arthritis and researchers working to find new treatments, more adults are speaking out about their own childhood battles with the condition. These include celebrities such as Claire Foy, who stars in the Netflix series “The Crown.”
“I had juvenile arthritis from the ages of 12 to 15, so I was on crutches,” Foy told The Wall Street Journal in January. “[The arthritis] was extremely painful.”
As part of Juvenile Arthritis Awareness Month, the Arthritis Foundation is inviting families impacted by the condition to share their stories on Arthritis.org. Dozens of stories have been posted so far, with one written by a 7-year-old child.
We offer an Arthritis Management Bundle with courses for PTs that includes:
The Management of Knee Osteoarthritis
(1 contact hr)
All clinical, practicing physical therapists encounter patients with osteoarthritis of the knee or a potential for developing the disease. Osteoarthritis is the leading cause for disability in the general population of the United States. Arthritis of the knee alone afflicts more than 4 million people, and research shows that 14% of individuals aged between 40 and 79 described knee pain with disability on most days of the previous month. Because of the increase in life expectancy within most societies of the western world, the high prevalence of OA is expected to increase further in upcoming years. For example, the number of first-time total knee replacements is expected to skyrocket 673% to 3.48 billion by 2030. Physical therapy is among the treatment options for people who suffer from osteoarthritis and intends to prevent physical impairment and restore functional ability through the use of exercise, physical modalities and patient education.
Back in Action With Joint Replacements, Part 1
(1 contact hr)
More than 7.2 million people in the United States have had hip or knee replacement procedures. The number of people having total knee arthroplasty has increased significantly in the past 25 years, driven in part by an increase in the number of aging persons and by increasing rates of obesity. This two-part continuing education series will educate healthcare providers about total hip arthroplasty and total knee arthroplasty. Part 1 discusses the effects of arthritis on the knee and hip as weight-bearing joints, outlines indications for joint replacement, and reviews joint replacement surgical procedures and patient management by interprofessional healthcare providers.
Back in Action With Joint Replacements, Part 2
(1 contact hr)
This module describes caring for patients who have undergone total hip replacement or knee replacement, stressing the pivotal role of the healthcare professional in educating patients to manage the transition from hospital to home. The module reviews key factors for a successful outcome.
Osteoarthritis of the First CMC Joint
(1 contact hr)
We tend to take our thumbs for granted; that is, until they hurt. The thumb’s important functional role is evident in its 20% whole person impairment rating, which measures the impact of impairment and loss of function on a person’s ability to perform activities of daily living. With a loss of use of a thumb, there is a 20% loss of ability to perform normal activities such as opening lids, tying shoes and even shaking someone’s hand. A painful thumb restricts a person’s independence. Because there is no cure for arthritis, the primary treatment is patient education. Patients need to learn techniques to manage symptoms and perhaps slow the progression of joint changes.
Rheumatoid Arthritis — Living with a Chronic Disease
(1 contact hr)
Rheumatoid arthritis is a chronic autoimmune disorder. The prognosis has improved dramatically for newly diagnosed patients. The focus of this module is to help us understand how RA is diagnosed, how it develops, its characteristic signs and symptoms, treatment strategies, nursing interventions, and non-pharmacologic preventative therapies. The purpose of this module is to educate the healthcare professional team about the development of RA, current treatment approaches, and therapeutic interventions that can help people with RA better manage their disease.