Most people are familiar with arthritis as a disease of middle or late life. We associate the term with stiff, swollen joints in the fingers, knees, and hips of a graying population. However, arthritis also occurs in children and infants.
According to the Centers for Disease Control, there are about 300,000 children living with some form rheumatic disease in the US alone. The Arthritis National Research Foundation has designated July “Juvenile Arthritis Awareness Month” to help spread the word about this constellation of diseases and the importance of conducting research to better understand them.
Homaira Rahimi, M.D., M.S., assistant professor of Pediatrics and pediatric rheumatologist at the University of Rochester Medical Center, studies juvenile idiopathic arthritis (JIA). JIA is the most prevalent form of chronic arthritis and currently affects somewhere between 70,000 – 100,000 children in the US. There are seven subsets of JIA, which involve combinations of the following: swelling and pain in one or more joints, rash, fevers, inflammation of other organs – especially the eyes, and periods of remission and flare.
JIA is an autoimmune disease, meaning the body’s immune system attacks its own tissues, causing inflammation. Anti-TNF medications are commonly used to halt inflammation associated with arthritis in adults and children, but nearly forty percent of those populations do not respond to these drugs. While other kinds of drugs exist for adult arthritis patients, many are not approved for use in children. Because of important ethical regulations and practical barriers to performing research studies on children, much of what we know about JIA comes from research in adults, which significantly limits the number of medications that are available to children.
That has led researchers to investigate alternate disease mechanisms and treatment approaches for the many different types of arthritis. For example, drainage of joint fluid via lymphatic vessels is impaired in arthritis. This has led Rahimi to explore whether improving drainage of arthritic joints can help patients who are resistant to anti-TNF medications.
“Maybe patients don't respond to anti-TNF medications because their inflammation is in control at the joint, but they just can’t drain it,” says Rahimi. “If we were to open up the drain, maybe their arthritis would improve.”
She is also starting a new line of investigation into the old adage ‘you are what you eat’. She has just begun probing into the gut microbiome to understand whether certain bacteria in the intestines predispose patients to inflammation in other areas of their bodies – like their joints. She suggests there are “good” and “bad” bacteria that must be kept in balance to combat arthritic inflammation. She is just beginning to test this theory using probiotics, like those touted on yogurt labels.
Rahimi hopes that controlling arthritis with diet may provide parents of arthritic children with natural alternatives in addition to traditional medicines that may carry side effects. However, she warns that diet may minimize the amount of drugs needed, but is not likely to cure the disease on its own.
To learn more about pediatric arthritis and rheumatic diseases, click here.
To test your knowledge about Juvenile Idiopathic Arthritis, click here.