Chronic Arthritis of Childhood

Juvenile Rheumatoid Arthritis is the commonest rheumatological disease which occurs in children and one of the commonest child chronic diseases. It covers a number of individual disorders which all have chronic joint inflammation in common. The causes of these conditions are not apparent and the underlying genetic reasons are complicated in that different types of arthritis cannot easily be distinguished. Juvenile idiopathic arthritis is gradually becoming more widely used, indicating the unknown reasons for this condition.

Three main divisions of juvenile rheumatoid arthritis can be described, that affecting many joints which is called polyarticular, that involving few joints and termed pauciarticular and a more body wide disease onset known as systemic arthritis. The arthritis is a chronic disease which flares up at times and then goes into remissions, with targeting of the medical treatment towards the induction and maintenance of a remission. Recent advances in the development of drugs have produced the biological agents which are much more effective for arthritic diseases.

How and why juvenile rheumatoid arthritis develops is not well understood, with an autoimmune attack against the tissues of the joints perhaps precipitated by infection or trauma. The lining of the joint, the synovial membranes, becomes larger and becomes chronically inflamed, with this occurring in individuals with some susceptibility of genetic origin. How the disease presents in the person and how it comes on is under the control of a number of genes. The incidence of these arthritic conditions is variable due to variations in influences from the environment, differences in the populations involved and in how susceptible individuals are.

The oligoarticular type of juvenile chronic arthritis, in which a small number of joints are inflamed, is the commonest disease type, consisting of about half of all patients. Thirty percent have a large number of joint affected, the polyarticular type, and the rest have the systemic form. Sufferers from chronic juvenile arthritis may at some type suffer also from another autoimmune disorders. The severe pain and disability due to the arthritis causes significant psychological distress, behavioural problems, anxiety and depression. The polyarticular and oligoarticular forms occur more often in girls than boys with a frequency of three to four and a half to one. The systemic form occurs equally.

The polyarticular or many affected joint form of arthritis has two peaks of incidence, one covering one to four years of age and another covering six to twelve years. The fewer joint type, the oligoarticular form, tends to occur in children who are two to four years old. The systemic type has no particular age of incidence. The disease pattern over the first six months determines which pattern the individual patient fits into. If four or fewer joints are affected during this period then the diagnosis is the oligoarticular or fewer joint group. More than five joints are symptomatic during the first six months this indicates the polyarticular or many joint diagnosis. Arthritis, rashes and a fever are the typical onset symptoms of the systemic form.

An arthritis must occur for six weeks in a joint to be able to make the diagnosis of juvenile arthritis of the various types. Morning stiffness is a common phenomenon and relates to the fact that the joints stiffen and become more painful after being still for any length of time. The onset of the disease can be slow and gradual or very sudden, with stiffness after resting, joint pain during the day, absences from school and a limp in walking. Inflammatory bowel disease may be associated with these conditions in some cases. Children may not complain particularly about joint pain but rather they may allow a joint to become unused or limp, leading to disuse of the joint or joint contractures.

The onset of juvenile arthritis which comes on systemically is indicated by the child spiking a fever either once or twice daily with the temperature going back to normal each time. This pattern allows some diagnostic usefulness as if does not occur in the event of infections. A short lasting skin rash may also be present over the limbs and the trunk, the child may seem unwell and have joint pains in the larger body joints.

Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for Physiotherapist London visit his website.