Rheumatic diseases can present in a vague fashion with what might seem like subtle nonspecific symptoms. This often leads to children being referred to a rheumatologist without them or their families entirely understanding what rheumatologists do and what types of diseases that they treat. A common question first question we hear from new families: “What is rheumatology?” After explaining what rheumatology is and the range of diseases we treat, the follow-up question is often: “Wait, kids get arthritis?” We all respond, “Yes, kids get arthritis, too.”
Rheumatologists see a broad range of medical conditions, but autoimmune diseases represent the bulk of those we treat. Juvenile idiopathic arthritis (JIA, formerly called juvenile rheumatoid arthritis) is the most common autoimmune disease treated in pediatric rheumatology clinics. JIA is a chronic inflammatory arthritis which is estimated to affect 294 000 children in the United States as of 2008. Arthritis can manifest with swelling, warmth, limited range of joint motion, and pain. However, arthritis can actually be painless! Acute forms of arthritis last less than 6 weeks and are most commonly related directly or indirectly to infection, though many causes exist.
Children who have persistent arthritis for more than 6 weeks without another identifiable cause may be labeled as having JIA. JIA encompasses many different flavors and actually has 7 subtypes, each with different prognostic implications. In addition, children with JIA have an elevated risk of developing uveitis, inflammation in the eyes. This can be painless, so children undergo routine eye examinations for screening. While rheumatoid arthritis in adults is often a lifelong disease, active arthritis in children with JIA may not persist. The typical disease course is waxing and waning with medications being used to quash disease flares and, if frequent or affecting many joints, patients may be placed on maintenance medication. Since JIA is caused by the immune system targeting the joints, treatment revolves around suppressing the immune system, sometimes with chemotherapy, targeted immune therapy, or anti-inflammatory medications. Although the disease may “burn out,” we counsel most patients that it is likely they will have JIA for the rest of their life and don’t consider patients as ever being cured. Instead, we refer to prolonged periods of inactive disease as remission.
The outlook for most patients with JIA is positive. Children often lead a fairly normal life without limitations in physical activity, but they may need medications and ongoing rheumatology involvement to support an active lifestyle. The number of treatment options have significantly improved in the last 2 decades. As a result, happily, we rarely see children in wheelchairs, and most are pain-free without physical limitations. For more information, check out the American College of Rheumatology JIA site at http://bit.ly/JIAoverview.
So yes, kids get arthritis too!
References and Suggested Readings
Helmick CG, Felson DT, Lawrence RC, et al. Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part I. Arthritis Rheum. 2008;58(1):15-25.
Ma L, Cranney A, Holroyd-Leduc JM. Acute monoarthritis: what is the cause of my patient’s painful swollen joint? CMAJ. 2009;180(1):59-65.
Prabhu AS, Balan S. Approach to a child with monoarthritis. Indian J Pediatr. 2010;77(9):997-1004.