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Juvenile Arthritis: More Than Just Growing Pains

One of the biggest challenges as a parent is knowing, when your child is truly sick, if he needs to stay home from school and/or see a doctor. If she’s constantly complaining of pain but you just can’t nail down why, when is it time to take the next step? Should you give him Tylenol and hope you don’t get a call from the school nurse in the middle of that big presentation? Is it growing pains or something else entirely?

While arthritis is most commonly known as a condition that primarily affects adults, juvenile arthritis, also known as pediatric rheumatic disease, affects as many as 300,000 children in the United States. The term juvenile arthritis (JA) encompasses the varied autoimmune and inflammatory conditions/diseases that affect children younger than 16.

The most common JA symptoms are pain, joint swelling, redness and warmth, but each type of the disease will present in different ways and can affect various parts of the body, including the musculoskeletal system, eyes, skin, muscles and gastrointestinal tract.

Kwame Ennin, M.D., orthopedist and physician on the medical staff at Texas Health Plano, says parents should talk to their child’s doctor if he or she is experiencing pain or extended symptoms.

“Juvenile arthritis isn’t common, but if a parent suspects it, the first step should be a conversation with the primary care physician or pediatrician to discuss a full workup,” he says. “Children can be misdiagnosed because of the severity and broad range of symptoms, so reaching a diagnosis can be challenging. We rely on first-line doctors to take a multi-disciplinary approach and test for multiple things.”

The Arthritis Foundation categorizes the seven different types of JA as follows:

  • Juvenile idiopathic arthritis: the most common form of juvenile arthritis (previously known as juvenile rheumatoid arthritis), which includes swelling in one or more joints for 6+ weeks, pain, fever and rashes; includes six subtypes of JA
  • Juvenile dermatomyositis: an inflammatory disease that causes muscle weakness and a rash on the eyelids and knuckles
  • Juvenile lupus: an autoimmune disease that can affect the joints, skin, kidneys, blood and other areas of the body
  • Juvenile scleroderma: a group of conditions that cause the skin to tighten and harden
  • Kawasaki disease: a disease which causes blood-vessel inflammation and potential heart complications
  • Mixed connective tissue disease: a disease that may include various features of arthritis, lupus and scleroderma, characterized by extremely high levels of an antinuclear antibody (anti-RNP)
  • Fibromyalgia: a chronic pain syndrome more common in girls that also causes stiffness, fatigue, disrupted sleep and other symptoms

Ennin says national observances like Juvenile Arthritis Awareness month are great opportunities to shed light on diseases and conditions that don’t usually get much attention or are misunderstood.

“This is a tremendous opportunity for a rare disease to get attention, and allows those affected by it to not feel so marginalized,” he explains. “It helps the public to receive better information, increase their knowledge and improve the level of overall understanding. The main misconception is that children shouldn’t have these kinds of issues, but they do. People need to take them seriously and take their pain seriously.

“Earlier diagnosis leads to better treatment so the disease doesn’t just go on uncontrolled, which can lead to greater long-term mechanical issues. Juvenile arthritis is due to an inflammatory process and often affects the auto-immune system, so it’s important to get it properly diagnosed so these kids can get the proper treatment.”

While different types of juvenile arthritis may manifest in varied ways, the most common symptoms of juvenile idiopathic arthritis include pain, stiffness, swelling, fevers, rashes, weight loss and eye problems. These symptoms are common to other childhood injuries and illnesses, but if they persist, further testing should be done to reach a diagnosis and subsequent treatment plan.

“Oftentimes we’ll have young children complaining of pain, fatigue and fevers without a concrete diagnosis and these kids can be mislabeled as lazy or unmotivated when in actuality, they have a medical issue,” Ennin says. “The onset of juvenile arthritis can range from ages one to six. If a doctor does a preliminary workup but doesn’t find anything and the child’s symptoms persist, parents have to be their advocate and push to see a specialist, either a rheumatologist or a pediatric rheumatologist.

“For kids with juvenile arthritis, the most important thing is for family members and friends to take their pain seriously and help ensure that they remain active but pace them to their ability.”

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