In rheumatic joint disease, the child has inflammation in one or more joints. It causes the child to get hurt and have difficulty moving. The disease is unusual in children and its cause is usually unknown.

The term pediatric rheumatoid arthritis refers to a group of diseases that cause inflammation in one or more joints. The disease group is also called JIA, juvenile idiopathic arthritis. The disease can mean completely different symptoms and treatments for different children.

The goal of the treatment is to reduce pain and inflammation. In addition, the child’s mobility and strength are trained with the help of physical therapy and occupational therapy. Some children get rid of the disease while others have it at adulthood.

Symptoms of Child Rheumatoid Arthritis

Children with rheumatic joint disease can have several different problems:

  • The child may have pain in the joints.
  • The child may feel stiff, especially in the morning or after being quiet for a long time.
  • The child can get swollen, sore and sometimes hot joints.
  • The child may crawl or walk differently, or have difficulty using hands and arms.
  • The child may have disturbed growth in the skeleton. 
  • The child’s behavior and well-being are affected.

Some forms of the disease not only affect the joints, but can also cause inflammation throughout the body, including fever, rash, and loss of appetite. The child may appear generally ill, depressed or irritated.

Children with the rheumatic joint disease often feel their illness for periods. Sometimes they have no trouble at all.

An inflamed joint becomes swollen, hot and painful

A joint that is inflamed becomes swollen, hot and hurts, especially if it is stressed. Sometimes it is also fluid-filled. The child is not as mobile as usual, and it may be impossible, for example, to completely bend or stretch the joint.

Most of the body’s joints can become stiff and sore. The child may feel stiff in the neck and have difficulty bending and twisting if the small parts of the neck vertebrae are inflamed.

Young children may begin to crawl or walk differently than usual, or may have difficulty using hands and arms as before. In some young children, the disease appears very diffuse at first, with no obvious joint problems.

When and where should I seek care?

If the child is in pain and difficult to move, you can contact a child care center, a care center, a child care center or student health. The same applies if the child has other conceivable symptoms of childhood rheumatic joint disease.

Treatment of Child Rheumatoid Arthritis

The treatment of child rheumatoid arthritis is to alleviate the pain and inflammation with the help of drugs and exercise mobility and strength with the help of physiotherapy and occupational therapy. How the treatment is designed in detail is influenced, among other things, by the child’s age and what kind of illness the child has.

If the child has problems with his feet, it can help with inserts and shoes that provide good support. Discomfort with the hands can be relieved by using supportive bandages.

Children with ongoing inflammation may have cortisone injected into the inflamed joint.

Where is the treatment taking place?

At Pediatric and adolescent clinics there are pediatricians with special responsibility for rheumatic diseases. The child and the family get to meet many different professional groups working together: doctors, nurses, occupational therapists, physical therapists, orthopedics, ophthalmologists, dentists, curators, and psychologists. Sometimes cooperation with a hand surgeon is also needed.

The goal of all treatment for childhood rheumatoid arthritis is for the disease to affect daily life as little as possible. It is important to reduce the pain and to keep the disease down. In addition, it is important to maintain the mobility of the joints and the strength of the muscles.

Physiotherapy and occupational therapy

Many children with a rheumatic joint disease regularly meet with a physiotherapist who checks the function of the joints and provides different types of treatments, advice, and tips. The joints can be strained without being damaged even when they are inflamed if done properly. Therefore, the child receives an individually designed exercise program.

For many children, other types of treatment are soothing, such as massage and relaxation.

If rheumatism is in the hands, wrists, and fingers, it is important for the child to go to an occupational therapist to get advice on training the mobility of the hands and how the pain can be relieved. There, the child can try out support for the wrist in the form of soft or hard bandages.

An occupational therapist also assesses how the environment in the child’s school and home should be adapted to the child’s needs.

Treatment with drugs

There is no medicine that will make the child fully recover from the disease. In contrast, different types of drugs can greatly reduce inflammation and reduce both the hassles and damage to the joints. The child is often allowed to take several different medicines. Some are used to slow down the activity of the immune system, others to reduce inflammation and a few to reduce pain.

It is important to discuss the entire drug treatment with a doctor so that you understand the effect of the different medicines and how they should be combined in the best way.

Drugs that relieve the pain and suppress inflammation

The so-called anti-inflammatory pain-relieving drug, NSAID, is a group of drugs that attenuate both the pain and inflammation of the joints. The drugs reduce the body’s production of prostaglandins that are formed by inflammation. A reduced amount of prostaglandins in the body leads to less inflammation, less rigidity, and less pain.

NSAIDs are taken regularly as long as the inflammation remains. The pain-relieving effect comes almost immediately, but it may take several weeks before the inflammation goes down. The child may also receive other pain-relieving drugs if the pain does not pass.

Paracetamol is another substance that helps to relieve pain in children, but without reducing inflammation. There is a prescription to buy and is included in medicines such as Alvedon and Panodil.

cortisone

Cortisone is a hormone that effectively suppresses inflammation. The child can get cortisone syringes directly into inflamed joints and late skis if they have an inflammation of the joints despite other drugs. It quickly reduces the symptoms.

Cortisone can cause side effects such as mental impact, sleep disturbance, swelling, and weight gain. A high dose of cortisone tablets every day for an extended period of time can cause the child to grow worse than expected and the skeleton to be calcified. However, when cortisone is given directly in a joint, such side effects are uncommon.

If cortisone is used properly, it is an important drug that reduces the risk of disease-causing long-term damage.

Drugs that slow the progression of the disease

Anti-rheumatic drugs are used to curb rheumatic inflammation and prevent the disease from becoming more severe, but it often takes a long time for the drugs to work. Usually, methotrexate is used in the medicines Methotrexate, Metoject and Metab. The child is given a low dose once a week, which causes very few side effects.

In some other situations, sulfasalazine is used, which is found, for example, in the drug Salazopyrin. It is also used in the treatment of inflammatory bowel disease.

Biological drugs

Biological preparations are a group of anti-rheumatic drugs that are similar to the body’s own biological substances and are used if other drugs do not help.

Most biological drugs affect the function of so-called cytokines, which is a large group of substances that regulate inflammation in the body. The medications are taken as syringes under the skin or available as a drip at various intervals and usually have a good effect on the disease. Most often, biological drugs are combined with methotrexate.

What does child rheumatoid arthritis cause?

It is not entirely known what causes the disease. Clearly, the immune system, which fights foreign organisms in the body, reacts to the body’s own tissues, causing inflammation. The trail becomes fluid, swollen, tender and warm.

Joints are found in many places in the body where different bones meet. The joint is surrounded by a joint capsule with a retina and contains joint fluid that lubricates the joint. The function of the joints is to bind the skeleton, but at the same time make it movable. When the joint capsule becomes inflamed, the movement of the joint is affected in various ways.

Inherited l right

Heredity plays a certain role in all forms of rheumatic joint disease in children. It is about what kind of immune system you have got, and where many different genes play into it. Some types of disease are more clearly hereditary than others.

What is the pediatric rheumatic joint disease?

Child rheumatoid arthritis is a group of diseases that cause inflammation in one or more joints and cause the child to feel sore and difficult to move. The cause is usually unknown.

The medical name is juvenile idiopathic arthritis, JIA. Juvenile means that children get the disease, arthritis means joint inflammation, and idiopathic means the disease has no known cause.

There are various forms of pediatric rheumatic diseases. Some cause inflammation in a few joints and are called osteoarthritis. If there is inflammation in more than four joints instead, it is called polygonal disease, polyarthritis. These two forms have several different subgroups, and sometimes shapes and subgroups overlap. This means that the diagnosis of JIA can mean completely different symptoms and treatment for different children.

It may take time to get a diagnosis, partly because other causes of joint disease should first be ruled out. In addition, the child knows about the disease for periods and sometimes may not have any problems at all.

The entire body can be affected, and childhood rheumatoid arthritis can cause inflammation of the lung, heartbeat, peritoneum, and eyes, for example.

The disease may disappear during childhood, but it is common to remain in adulthood.

Unusual disease in children

many countries, almost 200 children a year are diagnosed with JIA. The disease can cause various problems depending on the variant the child has, and it is difficult to describe in general how a child feels and is treated. It is common for the child to have pain in one or more joints, and the child becomes stiff in the joints. The child usually alternates between periods of sickness and periods of trouble.

Almost 2000 children and young people in many countries have JIA with varying degrees of difficulty.

Many different diagnoses

Because there are many different forms of the disease in children, it may take a long time, sometimes up to six months or longer, for the physician to provide a safe diagnosis. But the diagnosis can usually be made quickly when the child has a joint inflammation that persists for more than six weeks.

Some forms of the disease cause mild problems while others cause severe problems. Some troubles disappear during childhood, while others remain. Some forms of the disease also cause sequelae.

Because childhood rheumatic joint disease in children is a name for various forms of a disease, the symptoms do not always correspond to what is described here.

Oligoarthritis – joint inflammation with few inflamed joints

The most common form of oligoarthritis occurs between one and six years of age. This form is found in more girls than boys.

As the disease affects a few joints, it is one of the milder forms of childhood rheumatic joint disease, and many become completely healthy before adulthood.

Enthesitis-related arthritis – inflammation of the tendons, muscles, and joints

Enthesitis-related arthritis, ERA, is often a hereditary disease. It usually develops after the age of ten and more boys than girls get the disease.

A child who has enthesitis-related arthritis has both arthritis, which causes inflammation of the joints, and enthesitis, which causes inflammation of the tendon and muscle attachments. The child often gets inflammation in large joints, such as hip and pelvic joints.

Sometimes a child with this form of rheumatism gets Bechterew’s disease later in life.

Joint inflammation in bowel disease

Children with inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis, may also develop inflammation of the joints. Occasionally, joint inflammation may come before bowel disease.

Often it is the pelvic and hip joints that are inflamed. The intestinal disease itself need not be felt in any other way than the child grows less than expected or often has a stomach ache. Joint inflammation in inflammatory bowel disease was previously considered a form of rheumatic joint disease in children.

Polyarthritis – inflammation of the leader

Children can have two forms of multiple-disease. The doctor can determine what form the child has by taking a blood test and examining if the child has a certain antibody in the blood, so-called anti-CCP.

Children who do not have anti-CCP in their blood are more likely to be healthy in adulthood than children who have anti-CCP. The disease can disappear a few years after it occurs.

If the child has anti-CCP in the blood, the disease is the same as that in adults, rheumatoid arthritis. Among children, it is most common in girls in their teens.

Often, the same joints become symmetrically inflamed in both hands and both feet.

Eventually, the child can get inflammation in all joints. The spine joints can become inflamed at an early stage, with the risk of stiffness or sometimes instability. The jaw joints are also usually affected, which can lead to changes in the jaw joint and the lower jaw does not grow as expected.

If the joint inflammation becomes severe, it can also be found in larger joints such as the hip joints. Such inflammation can affect the joint cartilage and cause damage to the joint which makes it difficult for the child to move.

Joint inflammation linked to psoriasis

A form of pediatric rheumatism is associated with psoriasis, although the skin disease sometimes never appears. Both young children and adolescents can get this disease. The skin changes may come later in life or not at all. The suspicion that it is psoriatic arthritis increases if there are close relatives of psoriasis.

Children who get this variant of rheumatism sometimes have only a few inflamed joints, but there are those who get a very active form where many joints are inflamed.

There is also a special form of the disease where the joints hurt and are stiff, although it is not possible to find as much inflammation in the joints. Late skis, usually those in the palm, can become inflamed with reduced ability to stretch and bend fingers. Sometimes a whole finger or toe can be inflamed in the tissue outside the joint and become swollen.

Systemic child rheumatism

Systemic child rheumatism is a disease that affects the entire body. The disease is auto-inflammatory without the immune system developing antibodies, which makes the disease completely different from other rheumatic diseases that are autoimmune. It also makes the treatment to some extent different.

Systemic child rheumatism is found in children of all ages. A variant of the disease is also found in adults.

A common symptom is that the child has fever peaks every day for several weeks and often gets pink-red rashes on the upper body, legs, and arms. The child may feel limp and tired, much like with the flu.

Inflammation is more often found in other membranes than in the joints, and therefore the child may have only slight joint pain. Instead, the child may have inflammation of the heart, lungs or peritoneum.

About half of the children who get systemic child rheumatism become completely healthy within a year. In the second half, the disease turns into a long-term joint disease, often with quite severe symptoms affecting mobility. Cartilage and joints can be destroyed.

When the disease is treated with high dose cortisone for a long time, it is not uncommon for the child to grow worse and get osteoporosis. Treatment with biological drugs can usually make the treatment time with cortisone short.

Investigations

Most inflammations are not due to rheumatism but may be due, for example, to an infection or injury. Therefore, the doctor first finds out if the child has any other cause of joint inflammation. The child may also have joint pain without inflammation. For the doctor to suspect that the child has a child rheumatic joint disease, the inconvenience must have been present for at least six weeks.

Specialist contact often necessary

Usually, you first meet a general practitioner at a health center, pediatrician or school doctor. You will receive a referral to a pediatric clinic if the doctor suspects a child rheumatoid arthritis, or cannot fully determine what the inconvenience is due to.

There, a body examination and a thorough examination of the child’s joints are done. X-rays, ultrasound or magnetic cameras are also sometimes examined.

Blood tests can provide guidance

There is no blood test that shows that a child has rheumatism. However, some samples in combination with other studies can provide guidance:

  • Measurement of ANA, which is a specific antibody found in the blood of approximately 40 percent of all children with oligoarthritis.
  • Elevated CRP and lowering, which shows if there is inflammation in the body.
  • Elevated platelets, platelets, are often indicative of increased activity in the immune system, which may be due to rheumatic disease.
  • The blood value, which is measured in Hb, is often lowered if the child has a disease that causes inflammation.
  • Measurement of anti-CCP antibodies, an antibody common in adult chronic rheumatoid arthritis.

Complications and sequelae

All forms of the disease can affect the jaw joint and make the lower jaw not grow properly. Therefore, most children with rheumatic joint disease are allowed to have dental exams. If the jaw joint is affected, the child may have a bite. Oral hygiene and dental health can also be worse.

Children with certain types of rheumatism have a greatly increased risk of inflammation of the eye’s iris, the rectum. It usually causes no problems and can be difficult to detect for the child, the parents and the doctor. Therefore, it is important that the child goes for regular eye exams for many years, right up to puberty, even if the joint disease has disappeared.

Orthopedics and surgery

An orthopedic technician adjusts shoes and designs shoe inserts if the joints in the feet are affected. An orthopedic surgeon can help if the child has problems with the growth of curved joints or differences in leg length.

The child can sometimes be operated on if the feet are very affected and they are very sore, but this is unusual.

Children with severe pain in their hands may sometimes need the help of a hand surgeon.

Getting a sick message

A curator provides support for both children and parents. It can be a major upheaval when a child is diagnosed with a disease, especially if it leads to major life changes.

The curator also helps with applications for nursing grants, housing adjustments and other support measures that the community can offer if the child needs it.

Both children and parents can meet a psychologist if the child needs psychological help.

How is the life of child rheumatism affected?

Many children have the disease to a minor degree. A few children become seriously ill and need treatment throughout their lives.

Some children get healthy during childhood and never get the disease back. Many may have suffered minor injuries that affect how long they become as adults, or that cause them to have some impaired function, such as a joint becoming rigid and unable to bend and stretch.

In school

It is important that everyone who meets the child has an understanding of the disease, as the disease is often not visible on the outside. It is also important for the child to feel like other children, and not to be overprotected.

Most children can participate in regular school sports, but sometimes customized activities are required due to the child’s inconvenience.

Some children may need school transfer from time to time. The responsibility for school shootings in the primary school lies with the school and requires medical certificates.

Other pediatric rheumatic diseases

When a child has a child rheumatoid joint disease, the joints are always inflamed. But more common causes of inflammation are various infections that in most cases go by themselves. Common causes of joint problems and joint inflammation are intestinal infections, viral infections, and Velcro infections.

At puberty, many young people have knee pain. This can sometimes be due to inflammation in the tendon attachment below the kneecap, Schlatter’s disease. Younger children may have plant pain in the lower legs.

The child can also have joint pain without any inflammation and then it is not about rheumatism either. There are also various orthopedic problems with joint problems that do not cause inflammation in the joints.

children Rheumatism

Sometimes the term child rheumatism is used. This concept includes, in addition to rheumatic joint diseases in children, several other diseases and conditions. For example, there are inflammatory diseases that cause symptoms throughout the body and sometimes, but not always, in the joints. These are for example:

  • SLE
  • dermatomyositis
  • scleroderma
  • vasculitis.

Ehtisham Nadeem

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