Childhood Arthritis

Overview

Childhood arthritis, or juvenile arthritis, is an autoimmune disorder causing pain, inflammation, swelling, and stiffness of joints in children. It includes various types such as juvenile idiopathic arthritis (JIA), juvenile myositis, and juvenile lupus, affecting joints, muscles, and organs.
Symptoms range from joint inflammation to skin rashes and vision problems. Early diagnosis is essential to prevent complications and support the healthy growth of the child. Treatment includes medication, physical therapy, and exercise to manage pain and maintain mobility.

What is Childhood Arthritis?

Childhood arthritis, also known as juvenile arthritis, is an autoimmune disease that causes joint pain, swelling, and stiffness in children. It occurs when the immune system attacks healthy joints, leading to inflammation. This can make it hard for children to move or do daily activities such as walking, running or playing. Early diagnosis and treatment through medications can help manage symptoms and prevent long-term joint damage.

Types of Childhood Arthritis

Juvenile arthritis is categorised into the following types:

Juvenile Idiopathic Arthritis (JIA)

It is the most common type of childhood arthritis in kids and teens, which generally causes swelling, persistent pain, warmth and stiffness in the hands, wrists, elbows, ankles and knees. This autoimmune disease makes it challenging for the immune system to fight germs and viruses, resulting in self-attacks.

In this process, the body releases inflammatory chemicals that attack the tissue lining around a joint (synovium). The inflammation of synovium causes difficulty in moving, and joints feel tender or looking red and swollen.

Juvenile Myositis

This is a rare autoimmune disease that causes swelling and inflammation in muscles, blood vessels and skin of children. This disorder is characterised by skin rashes and muscle weakness, found more commonly in children under the age of 18.

The common symptoms of JM include general tenderness, stomach aches, trouble lifting the head, calcinosis, hoarse-sounding voice, trouble swallowing and irritability. Juvenile dermatomyositis (more common in children which occurs in the form of skin rash and muscle weakness) and juvenile polymyositis are the two types of this disease.

Vasculitis

Vasculitis is a disorder that causes inflammation of the blood vessels. The walls of the blood vessels tend to thicken, decreasing the width of the passage through the vessel. This occurrence further causes a restriction in blood flow, which can result in tissue and tissue damage. Symptoms may include weight loss, fever, pain, rash, tiredness and headache.

Juvenile Scleroderma

It is a condition in children that hardens and thickens their entire body’s skin. Juvenile Scleroderma is caused by the body’s immune system that attacks healthy cells, triggering the swelling and production of excessive collagen. The overproduction of collagen leads to scarring or fibrosis of the skin’s tissue.

Common symptoms of this autoimmune disease include calcium deposits under the skin (calcinosis); enlarged blood cells in the skin on the face, hands and nail beds (telangiectasias); reduced hand function; and loss of skin’s ability to stretch.

Fibromyalgia

Fibromyalgia is a chronic disorder that causes widespread musculoskeletal pain and tenderness across the body. The condition amplifies painful sensations by disrupting the process through which one’s brain and spinal cord perceive painful and non-painful signals.

This condition is often accompanied by mood swings, fatigue and sleep and memory issues. One may also experience muscle and joint stiffness, tingling in the legs and arms, and abdominal cramps.

Juvenile Lupus

This is a chronic autoimmune disorder, common in adolescents, and rare in younger children of 12 or under, which causes the body’s immune system to attack its healthy cells. It results in inflammation, eventually damaging multiple organs including the joints, skin, nervous system, lungs, heart and kidneys.

Juvenile idiopathic arthritis is the most common arthritis type, affecting children. Here are the common JIA subtypes, highlighted in a table format:

Subtypes	Impacts
Polyarthritis	5 or more joints in the neck, jaw, hands and feet
Enthesitis-Related Arthritis	Entheses, spine and hips
Oligoarthritis	Fewer than 5 joints in the elbow, knee and ankle; uveitis
Psoriatic Arthritis	Skin lesions or rashes with silvery dead cell build-up
Systemic Arthritis	The entire body, including the heart, spleen, liver and lymph nodes

Symptoms of Childhood Arthritis

The symptoms of juvenile arthritis that one may notice in joints include swelling, tenderness, redness or persistent pain, causing difficulty to move. It may also result in weakness in the muscles and other soft tissues around the joint, leading to a child’s inability to play or run.

One may also notice skin symptoms including light spotted pink rash (systemic), red scaly rash (psoriatic), thick and hardened skin patches (scleroderma), or a rash in the shape of a butterfly across the cheeks or bridge of the nose (lupus).

Signs noticed in the eyes may include uveitis, chronic eye inflammation, pain, redness, dryness, blurred vision, or sensitivity to light. Diarrhoea, shortness of breath, fatigue, heart problems, loss of appetite and fever are other symptoms of childhood arthritis.

Causes of Childhood Arthritis

The causes of juvenile arthritis are not known, however, factors involved may include infection, the surrounding environment affecting the immune system, and genetics.

Risk Factors of Childhood Arthritis

Risk factors include age, genetics, gender, family history of autoimmune diseases, and environmental factors (smoking, air pollution, stressful events).

Diagnosis of Childhood Arthritis

While diagnostic tests cannot confirm arthritis in children, they can help identify other conditions (cancer, bone disorder or infection) that cause the same symptoms. Blood tests can help to confirm the suspicious presence of antinuclear antibodies, rheumatoid factor, erythrocyte sedimentation rate (ESR), c-reactive protein and cyclic citrullinated peptide (CCP).

Other laboratory tests may include urine and joint fluid tests, that help determine the degree of inflammation. Imaging tests such as MRI and X-rays can also help to detect joint damage (resulting from infection, fractures or tumours) and monitor bone development.

Treatment for Childhood Arthritis

Treatment for arthritis in childhood includes exercise and medications. A healthcare professional may recommend medications such as corticosteroids (steroids), nonsteroidal anti-inflammatory drugs (NSAIDs), biological modifying agents, disease-modifying agents (infliximab, abatacept, etanercept, rilonacept and adalimumab) and antirheumatic drugs (DMARDs). Physical and occupational therapy may also be included in a child's treatment plan to help reduce, maintain and improve muscle tone and mobility. It also helps prevent disabilities.

Prevention of Childhood Arthritis

While there is no proven method to prevent the development of juvenile arthritis, stretching and exercising can help maintain mobility and manage the symptoms. Other measures such as consuming a healthy balanced diet, keeping your child away from areas of stress and smoking, and taking them regularly for a medical screening can help control the complications of arthritis.

Myths and Facts Related to Childhood Arthritis

The myths and facts related to childhood arthritis are outlined through the following points:

Myth 1: Children with juvenile arthritis will outgrow the condition
Fact: While medications can help to manage the symptoms of the condition, affected children can live with the condition and require ongoing management.

Myth 2: Childhood arthritis only causes inflammation and pain in the joints
Fact: The autoimmune disease can also affect other parts of the body including the eyes, heart, skin and liver, causing different symptoms.

Myth 3: Physical activity can worsen arthritis in children
Fact: Controlled physical activity including stretching, exercising or swimming can help maintain joint mobility and reduce stiffness in children with juvenile arthritis.