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`You Are Here: Home > Health_Info > Juv_Arthritis > Questions And Answers About Juvenile Arthritis
`
`Juvenile Arthritis
`
`August 2013
`
`Questions and Answers about Juvenile Arthritis
`
`This publication contains general information about juvenile arthritis (JA). It describes what juvenile arthritis
`is and how it may develop. It also explains how juvenile arthritis is diagnosed and treated. At the end is a list
`of key words to help you understand the terms used in this publication. If you have further questions after
`reading this publication, you may wish to discuss them with your doctor.
`
`What Is Juvenile Arthritis?
`
`“Arthritis” means joint inflammation. This term refers to a group of diseases that cause pain, swelling,
`stiffness, and loss of motion in the joints. Arthritis is also used more generally to describe the more than 100
`rheumatic diseases that may affect the joints but can also cause pain, swelling, and stiffness in other
`supporting structures of the body such as muscles, tendons, ligaments, and bones. Some rheumatic
`diseases can affect other parts of the body, including various internal organs. Juvenile arthritis (JA) is a
`term often used to describe arthritis in children. Children can develop almost all types of arthritis that affect
`adults, but the most common type that affects children is juvenile idiopathic arthritis.
`
`What Is Juvenile Idiopathic Arthritis?
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`Questions and Answers About Juvenile Arthritis
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`What Causes Juvenile Arthritis?
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`What Are Its Symptoms and Signs?
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`How Is It Diagnosed?
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`Who Treats It?
`
`How Is It Treated?
`
`How Can the Family Help a Child Live Well With Juvenile Arthritis?
`
`Do These Children Have to Limit Activities?
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`What Research Is Being Conducted on Juvenile Arthritis?
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`Where Can People Find More Information About Juvenile Arthritis?
`
`Key Words
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`Both juvenile idiopathic arthritis (JIA) and juvenile rheumatoid arthritis (JRA) are classification systems
`for chronic arthritis in children. The juvenile rheumatoid arthritis classification system was developed about
`30 years ago and had three different subtypes: polyarticular, pauciarticular, and systemic-onset. This
`classification system is rarely used today. More recently, pediatric rheumatologists throughout the world
`developed the juvenile idiopathic arthritis classification system, which includes more types of chronic arthritis
`that affect children. This classification system also provides a more accurate separation of the three juvenile
`rheumatoid arthritis subtypes.
`
`Prevalence statistics for juvenile arthritis vary, but according to a 2008 report from the National Arthritis Data
`Workgroup, about 294,000 children age 0 to 17 are affected with arthritis or other rheumatic conditions.1
`
`1According to the National Arthritis Data Workgroup, the actual number of new cases of JA is higher than
`previously reported because the statistic includes conditions not previously captured, as cited in Helmick
`CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, et al.; National Arthritis Data Workgroup.
`Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis
`Rheum. 2008 Jan;58(1):15-25.
`
`What Is Juvenile Idiopathic Arthritis?
`
`Juvenile idiopathic arthritis is currently the most widely accepted term to describe various types of chronic
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`Questions and Answers About Juvenile Arthritis
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`arthritis in children.
`
`In general, the symptoms of juvenile idiopathic arthritis include joint pain, swelling, tenderness, warmth, and
`stiffness that last for more than 6 continuous weeks. It is divided into seven separate subtypes, each with
`characteristic symptoms:
`
`1. Systemic arthritis (formerly known as systemic juvenile rheumatoid arthritis). A patient has
`arthritis with, or that was preceded by, a fever that has lasted for at least 2 weeks. It must be
`documented as an intermittent fever, spiking for at least 3 days, and it must be accompanied by at
`least one or more of the following:
`Generalized enlargement of the lymph nodes.
`
`Enlargement of the liver or spleen.
`
`Inflammation of the lining of the heart or the lungs (pericarditis or pleuritis).
`
`The characteristic rheumatoid rash, which is flat, pale, pink, and generally
`not itchy. The individual spots of the rash are usually the size of a quarter or
`smaller. They are present for a few minutes to a few hours, and then
`disappear without any changes in the skin. The rash may move from one
`part of the body to another.
`
`2. Oligoarthritis (formerly known as pauciarticular juvenile rheumatoid arthritis). A patient has
`arthritis affecting one to four joints during the first 6 months of disease. Two subcategories are
`recognized:
`Persistent oligoarthritis, which means the child never has more than four
`joints involved throughout the disease course.
`
`Extended oligoarthritis, which means that more than four joints are involved
`after the first 6 months of the disease.
`
`3. Polyarthritis—rheumatoid factor negative (formerly known as polyarticular juvenile rheumatoid
`arthritis—rheumatoid factor negative). A patient has arthritis in five or more joints during the first 6
`months of disease, and all tests for rheumatoid factor (proteins produced by the immune system that
`can attack healthy tissue, which are commonly found in rheumatoid arthritis and juvenile arthritis) are
`negative.
`4. Polyarthritis—rheumatoid factor positive (formerly known as polyarticular rheumatoid arthritis
`—rheumatoid factor positive). A patient has arthritis in five or more joints during the first 6 months of
`the disease. Also, at least two tests for rheumatoid factor, at least 3 months apart, are positive.
`5. Psoriatic arthritis. Patients have both arthritis and psoriasis (a skin disease), or they have arthritis
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`Questions and Answers About Juvenile Arthritis
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`and at least two of the following:
`inflammation and swelling of an entire finger or toe (this is called dactylitis)
`
`nail pitting or splitting
`
`a first-degree relative with psoriasis.
`
`6. Enthesitis-related arthritis. The enthesis is the point at which a ligament, tendon, or joint capsule
`attaches to the bone. If this point becomes inflamed, it can be tender, swollen, and painful with use.
`The most common locations are around the knee and at the Achilles tendon on the back of the ankle.
`Patients are diagnosed with this juvenile idiopathic arthritis subtype if they have both arthritis and
`inflammation of an enthesitis site, or if they have either arthritis or enthesitis with at least two of the
`following:
`inflammation of the sacroiliac joints (at the bottom of the back) or pain and
`stiffness in the lumbosacral area (in the lower back)
`
`a positive blood test for the human leukocyte antigen (HLA) B27 gene
`
`onset of arthritis in males after age 6 years
`
`a first-degree relative diagnosed with ankylosing spondylitis, enthesitis-
`related arthritis, or inflammation of the sacroiliac joint in association with
`inflammatory bowel disease or acute inflammation of the eye.
`
`7. Undifferentiated arthritis. A child is said to have this subtype of juvenile idiopathic arthritis if the
`arthritis manifestations do not fulfill the criteria for one of the other six categories or if they fulfill the
`criteria for more than one category.
`What Causes Juvenile Arthritis?
`
`Most forms of juvenile arthritis are autoimmune disorders, which means that the body’s immune system—
`which normally helps to fight off bacteria or viruses—mistakenly attacks some of its own healthy cells and
`tissues. The result is inflammation, marked by redness, heat, pain, and swelling. Inflammation can cause
`joint damage. Doctors do not know why the immune system attacks healthy tissues in children who develop
`juvenile arthritis. Scientists suspect that it is a two-step process. First, something in a child’s genetic makeup
`gives him or her a tendency to develop juvenile arthritis; then an environmental factor, such as a virus,
`triggers the development of the disease.
`
`Not all cases of juvenile arthritis are autoimmune, however. Recent research has demonstrated that some
`people, such as many with systemic arthritis, have what is more accurately called an autoinflammatory
`condition. Although the two terms sound somewhat similar, the disease processes behind autoimmune and
`autoinflammatory disorders are different.
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`Questions and Answers About Juvenile Arthritis
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`When the immune system is working properly, foreign invaders such as bacteria and viruses provoke the
`body to produce proteins called antibodies. Antibodies attach to these invaders so that they can be
`recognized and destroyed. In an autoimmune reaction, the antibodies attach to the body’s own healthy
`tissues by mistake, signaling the body to attack them. Because they target the self, these proteins are called
`autoantibodies.
`
`Like autoimmune disorders, autoinflammatory conditions also cause inflammation. And like autoimmune
`disorders, they also involve an overactive immune system. However, autoinflammation is not caused by
`autoantibodies. Instead, autoinflammation involves a more primitive part of the immune system that in
`healthy people causes white blood cells to destroy harmful substances. When this system goes awry, it
`causes inflammation for unknown reasons. In addition to inflammation, autoinflammatory diseases often
`cause fever and rashes.
`
`What Are Its Symptoms and Signs?
`
`The most common symptom of all types of juvenile arthritis is persistent joint swelling, pain, and stiffness
`that is typically worse in the morning or after a nap. The pain may limit movement of the affected joint,
`although many children, especially younger ones, will not complain of pain. Juvenile arthritis commonly
`affects the knees and the joints in the hands and feet. One of the earliest signs of juvenile arthritis may be
`limping in the morning because of an affected knee. Besides joint symptoms, children with systemic juvenile
`arthritis have a high fever and a skin rash. The rash and fever may appear and disappear very quickly.
`Systemic arthritis also may cause the lymph nodes located in the neck and other parts of the body to swell.
`In some cases (fewer than half), internal organs including the heart and (very rarely) the lungs, may be
`involved.
`
`Eye inflammation is a potentially severe complication that commonly occurs in children with oligoarthritis but
`can also be seen in other types of juvenile arthritis. All children with juvenile arthritis need to have regular
`eye exams, including a special exam called a slit lamp exam. Eye diseases such as iritis or uveitis can be
`present at the beginning of arthritis but often develop some time after a child first develops juvenile arthritis.
`Very commonly, juvenile arthritis-associated eye inflammation does not cause any symptoms and is found
`only by performing eye exams.
`
`Typically, there are periods when the symptoms of juvenile arthritis are better or disappear (remissions) and
`times when symptoms “flare,” or get worse. Juvenile arthritis is different in each child; some may have just
`one or two flares and never have symptoms again, while others may experience many flares or even have
`symptoms that never go away.
`
`Some children with juvenile arthritis have growth problems. Depending on the severity of the disease and
`the joints involved, bone growth at the affected joints may be too fast or too slow, causing one leg or arm to
`be longer than the other, for example, or resulting in a small or misshapen chin. Overall growth also may be
`slowed. Doctors are exploring the use of growth hormone to treat this problem. Juvenile arthritis may also
`cause joints to grow unevenly.
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`Questions and Answers About Juvenile Arthritis
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`How Is It Diagnosed?
`
`To be classified as juvenile arthritis, symptoms must have started before age 16. Doctors usually suspect
`juvenile arthritis, along with several other possible conditions, when they see children with persistent joint
`pain or swelling, unexplained skin rashes, and fever associated with swelling of lymph nodes or
`inflammation of internal organs. A diagnosis of juvenile arthritis also is considered in children with an
`unexplained limp or excessive clumsiness.
`
`No single test can be used to diagnose juvenile arthritis. A doctor diagnoses juvenile arthritis by carefully
`examining the patient and considering his or her medical history and the results of tests that help confirm
`juvenile arthritis or rule out other conditions. Specific findings or problems that relate to the joints are the
`main factors that go into making a juvenile arthritis diagnosis.
`
`Symptoms
`
`When diagnosing juvenile arthritis, a doctor must consider not only the symptoms a child has but also the
`length of time these symptoms have been present. Joint swelling or other objective changes in the joint with
`arthritis must be present continuously for at least 6 weeks for the doctor to establish a diagnosis of juvenile
`arthritis. Because this factor is so important, it may be useful to keep a record of the symptoms and changes
`in the joints, noting when they first appeared and when they are worse or better.
`
`Family History
`
`It is very rare for more than one member of a family to have juvenile arthritis. But children with a family
`member who has juvenile arthritis are at a slightly increased risk of developing it. Research shows that
`juvenile arthritis is also more likely in families with a history of any autoimmune disease. One study showed
`that families of children with juvenile arthritis are more likely to have a member with an autoimmune disease
`such as rheumatoid arthritis, multiple sclerosis, or thyroid inflammation (Hashimoto’s thyroiditis) than are
`families of children without juvenile arthritis. For that reason, having an autoimmune disease in the family
`may raise the doctor’s suspicions that a child’s joint symptoms are caused by juvenile arthritis or some other
`autoimmune disease.
`
`Laboratory Tests
`
`Laboratory tests, usually blood tests, cannot alone provide the doctor with a clear diagnosis. But these tests
`can be used to help rule out other conditions and classify the type of juvenile arthritis that a patient has.
`Blood samples may be taken to test for anti-CCP antibodies, rheumatoid factor, and antinuclear antibodies,
`and to determine the erythrocyte sedimentation rate (ESR), described below.
`
`Anticyclic citrullinated peptide (anti-CCP) antibodies. Anti-CCP antibodies may be detected in
`healthy individuals years before onset of clinical rheumatoid arthritis. They may predict the eventual
`development of undifferentiated arthritis into rheumatoid arthritis.
`Rheumatoid factor (RF). Rheumatoid factor, an autoantibody that is produced in large amounts in
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`Questions and Answers About Juvenile Arthritis
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`adults with rheumatoid arthritis, also may be detected in children with juvenile arthritis, although it is
`rare. The RF test helps the doctor differentiate among the different types of juvenile arthritis.
`Antinuclear antibody (ANA). An autoantibody directed against substances in the cells’ nuclei, ANA is
`found in some juvenile arthritis patients. However, the presence of ANA in children generally points to
`some type of connective tissue disease, helping the doctor to narrow down the diagnosis. A positive
`test in a child with oligoarthritis markedly increases his or her risk of developing eye disease.
`Erythrocyte sedimentation rate (ESR or sed rate). This blood test, which measures how fast red
`blood cells fall to the bottom of a test tube, can tell the doctor if inflammation is present. Inflammation is
`a hallmark of juvenile arthritis and a number of other conditions.
`
`X Rays
`
`X rays are needed if the doctor suspects injury to the bone or unusual bone development. Early in the
`disease, some x rays can show changes in soft tissue. In general, x rays are more useful later in the
`disease, when bones may be affected.
`
`Other Tests
`
`Because there are many causes of joint pain and swelling, the doctor must rule out other conditions before
`diagnosing juvenile arthritis. These include physical injury, bacterial or viral infection, Lyme disease,
`inflammatory bowel disease, lupus, dermatomyositis, and some forms of cancer. The doctor may use
`additional laboratory tests to help rule out these and other possible conditions.
`
`Who Treats It?
`
`Treating juvenile arthritis often requires a team approach, encompassing the child and his or her family and
`a number of different health professionals. Ideally, the child’s care should be managed by a pediatric
`rheumatologist, who is a doctor who has been specially trained to treat the rheumatic diseases in children.
`However, many pediatricians and “adult” rheumatologists also treat children with juvenile arthritis. Because
`there are relatively few pediatric rheumatologists and they are mainly concentrated at major medical centers
`in metropolitan areas, children who live in smaller towns and rural areas may benefit from having a doctor in
`their town coordinate care through a pediatric rheumatologist. Many large centers now conduct outreach
`clinics, in which doctors and a supporting team travel from large cities to smaller towns for 1 or 2 days to
`treat local patients.
`
`Other members of your child’s health care team may include:
`
`Physical therapist. This health professional can work with your child to develop a plan of exercises
`that will improve joint function and strengthen muscles without causing further harm to affected joints.
`Occupational therapist. This health professional can teach ways to protect joints, minimize pain,
`conserve energy, and exercise. Occupational therapists specialize in the upper extremities (hands,
`wrists, elbows, arms, shoulders, and neck).
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`Counselor or psychologist. Being a child or adolescent with a chronic disease isn’t easy, for the child
`or his or her family. Some children may benefit from sorting out their feelings with a psychologist or
`counselor trained to help children in this situation. Members of the child’s family may benefit from
`counseling as well.
`Ophthalmologist. If your child’s medications or form of arthritis can affect the eyes, catching problems
`early can help keep them from becoming serious. All children with juvenile arthritis need to have
`regular exams by an ophthalmologist (eye doctor) to detect eye inflammation.
`Dentist and orthodontist. Dental care can be difficult if a child’s hands are so affected by arthritis that
`thorough brushing and flossing of the teeth becomes difficult. In addition, children with involvement of
`the jaw may have difficulty opening the mouth for proper brushing. Therefore, regular dental exams are
`important. Because juvenile arthritis can affect the alignment of the jaw, it is important for children with
`this disease to be evaluated by an orthodontist.
`Orthopaedic surgeon. For some children, surgery is necessary to help minimize or repair the effects
`of their disease. Orthopaedic surgeons are doctors who perform surgery on the joints and bones.
`Dietitian. For children with chronic diseases, good nutrition is particularly important. A dietitian can
`help design a nutritious diet that will benefit the whole family.
`Pharmacist. A pharmacist is a good source of information about medications, including possible side
`effects and drugs that have the potential to interact with one another. If a child has trouble swallowing
`large pills or taking other medication, the pharmacist may have suggestions for different ways to take
`the medication or may be able to formulate or help you get kid-friendly versions of some medications.
`Social worker. A social worker can help a child and his or her family deal with life and lifestyle
`changes caused by arthritis. A social worker also can help you identify helpful resources for your child.
`Rheumatology nurse. A rheumatology nurse likely will be intimately involved in a child’s care, serving
`as the main point of contact with the doctor’s office concerning appointments, tests, medications, and
`instructions.
`School nurse. For a school-age child, the school nurse also may be considered a member of the
`treatment team, particularly if the child is required to take medications regularly during school hours.
`
`How Is It Treated?
`
`The main goals of treatment are to preserve a high level of physical and social functioning and maintain a
`good quality of life. To achieve these goals, doctors recommend treatments to reduce swelling, maintain full
`movement in the affected joints, relieve pain, and prevent, identify, and treat complications. Most children
`with juvenile arthritis need a combination of medication and nonmedication treatments to reach these goals.
`
`Following are some of the most commonly used treatments.
`
`Medication Treatments2
`
`Nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin, ibuprofen, naproxen, and naproxen
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`Questions and Answers About Juvenile Arthritis
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`sodium are examples of NSAIDs. They are often the first type of medication used. All NSAIDs work
`similarly by blocking substances called prostaglandins that contribute to inflammation and pain.
`However, each NSAID is a different chemical, and each has a slightly different effect on the body.
`
`2All medicines can have side effects. Some medicines and side effects are mentioned in this publication.
`Some side effects may be more severe than others. You should review the package insert that comes with
`your medicine and ask your health care provider or pharmacist if you have any questions about the possible
`side effects.
`
`Some NSAIDs are available over the counter, while several others, including a subclass called COX-2
`inhibitors, are available only with a prescription.
`
`All NSAIDs can have significant side effects, so consult a doctor before taking any of these
`medications. 3 For unknown reasons, some children seem to respond better to one NSAID than
`another. A doctor should monitor any child taking NSAIDs regularly to control juvenile arthritis
`symptoms as effectively as possible, at the optimal dose.
`
`3Warning: NSAIDs can cause stomach irritation or, less often, they can affect kidney function. The longer a
`person uses NSAIDs, the more likely he or she is to have side effects, ranging from mild to serious. Many
`other drugs cannot be taken when a patient is being treated with NSAIDs because NSAIDs alter the way the
`body uses or eliminates these other drugs. Check with your health care provider or pharmacist before you
`take NSAIDs. Also, NSAIDs sometimes are associated with serious gastrointestinal problems, including
`ulcers, bleeding, and perforation of the stomach or intestine. People age 65 and older, as well as those with
`any history of ulcers or gastrointestinal bleeding, should use NSAIDs with caution.
`
`Disease-modifying antirheumatic drugs (DMARDs). If NSAIDs do not relieve symptoms of juvenile
`arthritis, the doctor may prescribe this type of medication. DMARDs slow the progression of juvenile
`arthritis, but because they may take weeks or months to relieve symptoms, they often are taken with
`an NSAID. Although many different types of DMARDs are available, doctors are most likely to use one
`particular DMARD, methotrexate, for children with juvenile arthritis.
`
`Researchers have learned that methotrexate is safe and effective for some children with juvenile
`arthritis whose symptoms are not relieved by other medications. Because only small doses of
`methotrexate are needed to relieve arthritis symptoms, potentially dangerous side effects rarely occur.
`The most serious complication is liver damage, but it can be avoided with regular blood screening tests
`and doctor followup. Careful monitoring for side effects is important for people taking methotrexate.
`When side effects are noticed early, the doctor can reduce the dose and eliminate the side effects.
`
`Corticosteroids. In children with very severe juvenile arthritis, stronger medicines may be needed to
`stop serious symptoms such as inflammation of the sac around the heart (pericarditis). Corticosteroids
`such as prednisone may be added to the treatment plan to control severe symptoms. This medication
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`can be given either intravenously (directly into the vein) or by mouth. Corticosteroids can interfere with
`a child’s normal growth and can cause other side effects, such as a round face, weakened bones, and
`increased susceptibility to infections. Once the medication controls severe symptoms, the doctor will
`reduce the dose gradually and eventually stop it completely. Because it can be dangerous to stop
`taking corticosteroids suddenly, it is important to carefully follow the doctor’s instructions about how to
`take or reduce the dose. For inflammation in one or just a few joints, injecting a corticosteroid
`compound into the affected joint or joints can often bring quick relief without the systemic side effects
`of oral or intravenous medication.
`
`Biologic agents. Children with juvenile arthritis who have received little relief from other drugs may be
`given one of a newer class of drug treatments called biologic response modifiers, or biologic agents.
`Tumor necrosis factor (TNF) inhibitors work by blocking the actions of TNF, a naturally occurring
`protein in the body that helps cause inflammation. Other biologic agents block other inflammatory
`proteins such as interleukin-1 or immune cells called T cells. Different biologics tend to work better for
`different subtypes of the disease.
`
`Treatments Without Medication
`
`Physical therapy. A regular, general exercise program is an important part of a child’s treatment plan.
`It can help to maintain muscle tone and preserve and recover the range of motion of the joints. A
`physiatrist (rehabilitation specialist) or a physical therapist can design an appropriate exercise program
`for a person with juvenile arthritis. The specialist also may recommend using splints and other devices
`to help maintain normal bone and joint growth.
`Complementary and alternative therapies. Many adults seek alternative ways of treating arthritis,
`such as special diets, supplements, acupuncture, massage, or even magnetic jewelry or mattress
`pads. Research shows that increasing numbers of children are using alternative and complementary
`therapies as well.
`
`Although there is little research to support many alternative treatments, some people seem to benefit
`from them. If a child’s doctor feels the approach has value and is not harmful, it can be incorporated
`into the treatment plan. However, it is important not to neglect regular health care or treatment of
`serious symptoms.
`
`How Can the Family Help a Child Live Well With Juvenile Arthritis?
`
`Juvenile arthritis affects the entire family, all of whom must cope with the special challenges of this disease.
`Juvenile arthritis can strain a child’s participation in social and after-school activities and make schoolwork
`more difficult. Family members can do several things to help the child physically and emotionally.
`
`Get the best care possible. Ensure that the child receives appropriate medical care and follows the
`doctor’s instructions. If possible, have a pediatric rheumatologist manage your child’s care. If such a
`specialist is not close by, consider having your child see one yearly or twice a year. A pediatric
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`rheumatologist can devise a treatment plan and consult with your child’s doctor, who will help you carry
`it out and monitor your child’s progress.
`Learn as much as you can about your child’s disease and its treatment. (The resources listed at
`the end of this publication can help.) Many treatment options are available, and because juvenile
`arthritis is different in each child, what works for one may not work for another. If the medications that
`the doctor prescribes do not relieve symptoms or if they cause unpleasant side effects, you and your
`child should discuss other choices with the doctor. A person with juvenile arthritis can be more active
`when symptoms are controlled.
`Consider joining a support group. Try to find other parents and kids who face similar experiences. It
`can help you—and your child—to know you’re not alone. Some organizations have support groups for
`people with juvenile arthritis and their families.
`Treat the child as normally as possible. Try not to cut your child too much slack just because he or
`she has arthritis. Too much coddling can keep your child from being responsible and independent and
`can cause resentment in siblings.
`Encourage exercise and physical therapy for the child. For many young people, exercise and
`physical therapy play important roles in managing juvenile arthritis. Parents can arrange for children to
`participate in activities that the doctor recommends. During symptom-free periods, many doctors
`suggest playing team sports or doing other activities. The goal is to help keep the joints strong and
`flexible, to provide play time with other children, and to encourage appropriate social development.
`Work closely with your child’s school. Help your child’s school to develop a suitable lesson plan,
`and educate your child’s teacher and classmates about juvenile arthritis. Some children with juvenile
`arthritis may be absent from school for prolonged periods and need to have the teacher send
`assignments home. Some minor changes—such as having an extra set of books or leaving class a few
`minutes early to get to the next class on time—can be a great help. With proper attention, most
`children progress normally through school.
`Talk with your child. Explain that getting juvenile arthritis is nobody’s fault. Some children believe that
`juvenile arthritis is a punishment for something they did. Let your child know you are always available
`to listen, and help him or her in any way you can.
`Work with therapists or social workers. They can help you and your child adapt more easily to the
`lifestyle changes juvenile arthritis may bring.
`
`Do These Children Have to Limit Activities?
`
`Although pain sometimes limits physical activity, exercise is important for reducing the symptoms of juvenile
`arthritis and maintaining function and range of motion of the joints. Most children with juvenile arthritis can
`take part fully in physical activities and selected sports when their symptoms are under control. During a
`disease flare, however, the doctor may advise limiting certain activities, depending on the joints involved.
`Once the flare is over, the child can start regular activities again.
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`Swimming is particularly useful because it uses many joints and muscles without putting weight on the joints.
`A doctor or physical therapist can recommend exercises and activities.
`
`What Research Is Being Conducted on Juvenile Arthritis?
`
`Researchers keep trying to improve existing treatments for children and find new medicines that will work
`better with fewer side effects. That effort received a major boost with the passage of the Pediatric Research
`Equity Act of 2003, which requires drugs that might be used in children to be tested in children. As a result
`of the act, increasing numbers of medications are being tested for safety and effectiveness in children.
`Consequently, doctors will have more information on appropriate medications and doses to prescribe for
`their pediatric patients.
`
`Scientists supported by the National Institutes of Health (NIH) are investigating the possible causes of
`juvenile arthritis. Researchers suspect that both genetic and environmen