Pediatric Arthritis and Other Rheumatic Diseases
What are pediatric arthritis and other rheumatic diseases?
Arthritis is a group of more than 100 diseases. It’s only one category of rheumatic diseases. Rheumatic diseases can cause pain, stiffness, and swelling in the joints, and bones. Rheumatic diseases can also affect other areas of the body, including organs. Some rheumatic diseases affect connective tissues. These types of tissues include muscles, tendons, and ligaments. The diseases are known as connective tissue diseases. Other types of diseases are caused by the body's immune system attacking its own healthy cells and tissues. These are known as autoimmune disorders.
What causes pediatric arthritis and other rheumatic diseases?
The exact cause of most types of rheumatic diseases is not yet known. In many cases, the cause may vary depending on the type of disease. Researchers think that certain factors may play a part in the one or more types of the diseases. These factors include:
- The immune system
- Genes and family history
- Nervous system problems
- Metabolic problems
- Excessive wear and tear and stress on the body
- Environmental triggers
- The effect of some hormones on the body
Who is at risk for pediatric arthritis and other rheumatic diseases?
Arthritis and rheumatic diseases can affect any child. They can occur at any age in any race. But some are more common in some children, such as:
Juvenile rheumatoid arthritis (JRA). This condition more often affects children younger than age 15.
Systemic lupus erythematosus (lupus). This occurs more often in girls.
Ankylosing spondylitis (AS). This bone disease is more common in boys.
What are the symptoms of pediatric arthritis and other rheumatic diseases?
Each type of rheumatic diseases has its own set of symptoms. And symptoms can occur a bit differently in each child. But the most common symptoms in all the diseases include:
- Joint pain
- Swelling in one or more joints
- Joint stiffness that lasts for at least one hour in the early morning
- Chronic pain or tenderness in the joint(s)
- Warmth and redness in the joint area
- Limited movement in the affected joint(s)
- Fevers that don't go away, or that come back
The symptoms can be like those of other health conditions. Make sure your child sees his or her health care provider for a diagnosis.
How are pediatric arthritis and other rheumatic diseases diagnosed?
The process starts with a medical history and a physical exam. Tests may also be done. These include blood tests such as:
- Antinuclear antibody (ANA) test, to check the levels of antibodies in the blood
- Complete blood count, to see if white blood cell, red blood cell, and platelet levels are normal
- Creatinine, to check for kidney disease
- Sedimentation rate, to detect inflammation
- Hematocrit, to measure the number of red blood cells
- Rheumatoid factor test, to see if rheumatoid factor is present in the blood
- White blood cell count, to determine the level of white blood cells in the blood
- Uric acid, to help diagnosis gout
Other tests may be done, such as:
Joint aspiration (arthrocentesis). A small sample of the synovial fluid is taken from a joint. It's tested to see if crystals, bacteria, or viruses are present.
X-rays or other imaging tests. These are done look at the extent of damage to a joint.
Urine test. This is done to check for protein and various kinds of blood cells.
HLA tissue typing. This is done to look for genetic markers of ankylosing spondylitis.
Skin biopsy. Tiny pieces of tissue are taken to check under a microscope. This helps to diagnose a type of arthritis that involves the skin, such as lupus or psoriatic arthritis.
Muscle biopsy. Tiny pieces of tissue are taken to check under a microscope. This helps to diagnose conditions that affect muscles. These include polymyositis or vasculitis.
How are pediatric arthritis and other rheumatic diseases treated?
Treatment will depend on your child's symptoms, age, and general health. It will also depend on how what type of disease your child has, and how severe the condition is. A treatment plan is tailored to each child with his or her health care team. The health care team will include your child's primary health care provider. It will also include a rheumatologist, orthopedist, physical therapist, and other health care providers.
There is no cure for most pediatric arthritis and other rheumatic diseases. The goal of treatment is often to limit pain and inflammation, and help ensure joint function. Certain organs, such as the eyes and heart, are also checked often for problems. Treatment plans often use both short-term and long-term methods.
Short-term treatments include:
Medicines. Short-term relief for pain and inflammation may include pain relievers such as acetaminophen, ibuprofen, or other nonsteroidal anti-inflammatory medicines. Talk with your child's healthcare provider before giving any of these medicines to your child.
Heat and cold. Pain may be eased by using moist heat (warm bath or shower) or dry heat (heating pad) on the joint. Pain and swelling may be eased with cold (ice pack wrapped in a towel) on the joint.
Joint immobilization. The use of a splint or brace can help a joint rest and protect it from further injury.
Massage. The light massage of painful muscles may increase blood flow and bring warmth to the muscle.
Long-term treatments include:
Disease-modifying antirheumatic drugs (DMARDs). These medicines may slow down the disease and treat any immune system problems linked to the disease. Examples of these medicines include methotrexate, penicillamine, and gold injections.
Corticosteroids. These medicines, such as prednisone, reduce inflammation and swelling. They can be taken orally or as an injection.
Biologics. These are medicines to help stop the inflammation process in the body. These include etanercept, golimumab, infliximab, and others.
Weight loss. Extra weight puts more stress on joints such as the hips and knees.
Exercise. Certain exercises may help reduce joint pain and stiffness. These include swimming, walking, low-impact aerobic exercise, and range-of-motion exercises. Stretching may also help keep the joints flexible.
Use of assistive devices. Canes, crutches, and walkers can help to keep stress off certain joints and to improve balance.
Surgery. In severe cases of disease, surgery may be needed to repair or replace a joint. There are two main types of surgery: repair and replacement. Surgery to repair a damaged joint may include removing debris in the joint, fusing bones, or correcting a bone deformity. If a joint is too damaged for repair, it may need to be replaced with an artificial joint.
What are the complications of pediatric arthritis and other rheumatic diseases?
If only a few joints are affected, arthritis may cause little or no joint damage. Other children may have chronic pain and disability. Other complications include slowed growth, anemia, and problems with the eyes or heart.
Helping your child live with pediatric arthritis and other rheumatic diseases
Help your child manage his or her symptoms by sticking to the treatment plan. Encourage exercise and physical therapy. Find ways to make it fun. Work with your child’s school to make sure your child has help as needed. Work with other caregivers to help your child take part as much possible in school, social, and physical activities. Your child may also qualify for special help under Section 504 of the Rehabilitation Act of 1973. You can also help your child find a support group to be around with other children with similar health conditions.
When should I call my child’s healthcare provider?
If your child’s symptoms get worse or he or she has new symptoms, let the healthcare provider know.
Key points about pediatric arthritis and other rheumatic diseases
- Pediatric arthritis is one type of a rheumatic disease. Arthritis affects joints, muscles, tendons, ligaments, and bones. Rheumatic diseases can affect other body parts. These include organs such as the heart and eyes.
- Common symptoms include joint pain, swelling, stiffness, and warmth.
- Treatment is often done with a health care team.
- Treatment options include medicines, heat and cold, massage, exercise, physical therapy, and surgery.
Tips to help you get the most from a visit to your child’s health care provider:
- Before your visit, write down questions you want answered.
- At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
- Foster, Sara, RN, MPH
- Freeborn, Donna, PhD, CNM, FNP