Arthritis not growing pains

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

In the old days, when a child would complain of aches and pains in the joints, these would be attributed to “growing pains.” It is now apparent that these growing pains may actually have been arthritis.

What is unfortunate is that this misconception is still very much alive today. That aches and pains in children are normal and that they’ll outgrow them. Nothing could be further from the truth.

For example...rheumatoid arthritis (RA) is a chronic inflammatory disease that damages and eventually destroys joints. What many people don’t realize is that this disease may affect children... not just adults!

Though inflammation is a normal response of the body’s immune system, in arthritis, the inflammation is uncontrolled and targets normal tissue leading to damage and destruction. The inflammation in the joints causes pain, stiffness, and swelling as well as many other symptoms. The inflammation often affects other organs systems as well.

When rheumatoid arthritis affects children it is referred to as juvenile arthritis or JA. JA is actually a group of diseases. What all these diseases have in common is chronic joint inflammation. Besides this common feature, these diseases are different in their symptoms, their treatments, and their prognoses.

Pauciarticular disease affects only a few joints, fewer than 5. The large joints, such as the shoulder, elbow, hip, and knee, are most likely to be affected. This type of JRA is most common in children younger than 8 years of age. Children who develop this disease have a 20-30% chance of developing inflammatory eye problems and need frequent eye examinations. Children who develop this disease when older than 8 years have a higher-than-normal risk of developing an adult form of arthritis. About 50% of all children with JA have this type.

A variant of pauciarticular disease is axial JA. This type often presents with spinal involvement as well as peripheral joint involvement. Patients are often young boys. many will be positive for the HLA-B27 antigen. A large number of these children will have eye involvement.

Polyarticular disease affects 5 joints or more, sometimes many more. The small joints such as those in the hands and feet are most likely to be affected. This type can begin at any age. In many cases, the disease is identical to adult RA. This type accounts for about 30% of cases of JRA.

Systemic disease is a dreadful disease. Children may have high fevers, skin rashes, and problems caused by inflammation of the internal organs such as the heart, spleen, liver, and other parts of the digestive tract. It usually, but not always, begins in early childhood. Physicians sometime call this Still’s disease. This type accounts for about 20% of cases of JA. Conditions such as systemic lupus erythematosis, polymyosistis, scleroderma,rheumatic fever, Lyme disease, and malignancies such as leukemia and lymphoma must also be considered in the list of conditions to rule out.Still's disease can also affect adults.

Children with JA may experience complications specific to their type of JA.

In addition to complications related to the disease, complications can arise as a result of side-effects of medications taken to treat the disease. An example are the non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin). When taken chronically, these drugs can cause irritation, pain, and bleeding in the stomach and upper intestine. They also can cause problems in the liver and kidneys. There appears to be an increased risk of lymphoma in children with JA treated with biologics. Vigilance is required.

Eye inflammation- iritis- occurs in about 30 per cent of children. It must be treated aggressively in order to prevent blindness.

Some children with JA have emotional or psychological problems.

The mortality (death) rate in children with JA is slightly higher than in healthy children. The highest death rate in children with JA occurs among patients with systemic JA.

Treatment for JA, like that for adult-type rheumatoid arthritis, has improved dramatically in the last 30 years, thanks mainly to the development of new medications.

These include the use of sulfasalazine, methotrexate, and more recently, the biologic medications.

For an excellent review of this problem, I recommend a book entitled, “It’s Not Just Growing Pains” by Dr. Thomas Lehman, the Chief of Pediatric Rheumatology at the Hospital for Special Surgery.

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