Rheumatoid Arthritis In Children
Rheumatoid Arthritis In Children
Arthritis in children is different from the one of the largest, and is not simply the beginning of a child in adult rheumatoid arthritis. Childhood arthritis is a disease (or set of diseases) which we call juvenile chronic arthritis (or idiopathic, also commonly called juvenile rheumatoid arthritis juvenile chronic arthritis). The majority of children with juvenile arthritis has an excellent prognosis, and with proper treatment, 80% of them will grow without deformities and arthritis in adulthood.
A program of exercises, specially designed by the doctor and physical therapist, is one of the main components of the treatment. Although arthritis causes damage to articulate, bones and cartilage in growing children have amazing abilities to heal. Exercise prevents the loss of movement joints and makes the damaged members grow properly. The medication the doctor prescribed acts by reducing inflammation joint and allows the exercise program to be less painful and more effective. The type and power of this medication will depend on the severity and the type of arthritis that child has.
Arthritis
Arthritis means inflammation of the joints ( "itis" means inflammation).
The immune system of our body is a delicate mechanism of defenses. It responds to infection causing inflammation. Tonsillitis, for example, is caused by a bacterial infection. Red, swollen and painful tonsils indicate that the immune system of the body is acting properly to beat this infection. In juvenile chronic arthritis, there is inflammation joints, becoming rigid, hot, swollen and painful, but no infectious reason.
Space joint between two bones is surrounded by a capsule. The inner layer of this capsule is called synovial membrane, and it is that produces synovial fluid that lubricates the joint and nourishes it. The ends of bones are covered with cartilage, which is very smooth. The cartilage is designed to allow the ends of the bones to slide together smoothly. In arthritis, the synovium becomes thick and produces too much liquid. If the synovium becomes too thick, can damage the cartilage and bones. In children, unlike adults, cartilage and bone are still the ability to grow, allowing them to repair and heal damage to articulate in a large proportion of cases.
The Causes Of Rheumatoid Arthritis
The cause of arthritis is not known. What is known is that it is not hereditary, and that arthritis of a parent or grandparent has no relationship with arthritis in a child. Juvenile arthritis is not caused by any infection or illness which the father or the mother could have had before. It has no relationship with any circumstances of the pregnancy. It is not caused by any food, and doesn't heal or is improved by changing the diet. Some foods and vitamins for arthritis are useless for another thing to waste money. Copper bracelets or medicinal herbs heal arthritis. Juvenile arthritis is neither caused nor is cured with a change of climate, although it is true that the arthritic patients (children or adults) have more symptoms when there are sudden changes in atmospheric pressure.
Although some children with arthritis have fever and is spring, it is not an infectious disease, and thus it is not contagious. And although arthritis sometimes appears after a banal accident or infection, which are very common in children, these events do not cause arthritis. That is shown by not yet very well known causes, the immune system (defenses) of children with arthritis is malfunctioning. Children with this disease may have an immune system that may be working too well, or that it does not have good control, and triggers inflammation without having a Microbe. Many children with arthritis tend to improve with time and growth the immune system matures and he is corrected only. Unfortunately, this does not happen in all cases.
Diagnostics For Rheumatoid Arthritis
The boys do not always complain of pain. For this reason, it is sometimes difficult to say if a child joints are inflamed. The only clue may be some stiffness accompanied by transient morning "lameness" or strength overnight to use an arm or a leg. At times juvenile rheumatoid arthritis can be very difficult to diagnose, and can go unnoticed for a pediatrician.
Juvenile arthritis is an inflammation of one or more joints that lasts for six or more weeks, without a cause to justify it. Once you know that a child has inflammation of the joints, you should rule out other serious Mmore than rheumatoid arthritis, such as infections diseases. There is no analysis that only make the diagnosis of rheumatoid arthritis (even RF) or you discard other diseases. Therefore, that child will need x-rays, analysis of bleeding and urine, on occasions a study of synovial fluid (or joint), and of course, a visit to the specialist.
The question that exists in the first weeks after it was discovered the arthritis can be a difficult time. It is necessary to know that takes some time until the doctor is sure of the diagnosis of juvenile chronic arthritis, and that it will be some time before medicines and recommended exercises to make effect.
The Types Of Juvenile Chronic Arthritis
It is important to know what type of arthritis has a child, because it will depend on the type of complications that may have, the prognosis and the treatment that you will receive.
There are characteristics common to all forms of arthritis, such as morning stiffness in times of inflammation. But it is also important to know the variability that exists in the behavior of arthritis in different children who can share a same form of the disease. The arthritis of children sometimes lasts a few months or years, and sometimes disappears forever.
But most of the guys have an alternating course for several years. Exacerbations ("shoots" or "relapses") are the moments in which the disease is worse. Referrals are the moments when it seems that the arthritis is gone. Sometimes, a viral infection that is common (such as the flu or cold) can trigger a relapse. It can be frustrating for parents see that this happens, especially when it seemed that the disease had left or had improved much, but we should not lose hope. Fortunately, in the majority of the guys these exacerbations tend to be less severe and occur less frequently over time.
Pauciarticular Form
This is the way more common and milder disease. Four or fewer joints are affected in half of the cases only one joint is swollen. There is very little or no alteration of the general condition or growth. You can have an evolution with outbreaks and referrals, but in general there is no definitive damage in the joints. This form tends to be short-lived, and almost half of children go into permanent remission in three to five years.
One of the main problems of the children with this form of arthritis is the onset of contractures in the joint or joints affected, and the lower limbs length discrepancy when the arthritis is asymmetric. Fortunately, these complications are treatable. There is a high risk of inflammation of the eyes (uveal) in children with this type of arthritis. These guys should have an eye exam every three months slit lamp, because this is the only way to detect early uveitis. There is a laboratory analysis called FAN or ANA (anti-nuclear antibody or Factor) that occasionally is positive in children with ocular inflammation. For this reason, the FAN helps us to detect those children at greater risk of developing ocular inflammation, and therefore requiring visits to the most frequent ophthalmologist.
Although it is very rare to happen, some guys with this form may develop inflammation of more than five joints with age, resembling the shape of polyarticular.
Polyarticular Form
In this way, five or more joints are affected. Usually, arthritis begins in several joints at the same time. Sometimes you can start one or two joints and then affect others. If you are taking other joints, this usually happens in the first 6 to 12 months of the disease. The duration of this type of arthritis is variable, but usually it's several years. Usually there are exacerbations and remissions. The tota of children who have this diagnosis, more than half will have no more symptoms of disease in 8 to 10 years. Although it is rare, you can some involvement of internal organs have, can appear subcutaneous nodules, or swollen blood vessels. This is a type of arthritis that can affect the growth of the child.
A small percentage of these children have a marker in the blood called Rheumatoid Factor. They are usually Biggie girls older than 9 years, and have a type of arthritis similar to the adults, with remarkable commitment and damage in several joints.
The use of drugs such as methotrexate is very useful in these patients. A SYSTEMIC (or disease STILL)
This is the way more rare but more severe arthritis. It is characterized by an outbreak of spots on the skin and fever peak daily. It was described originally by Dr G. Still at the end of the 19th century. The guys are very affected and sick during the evening rush, but feel better the next morning, when the temperature drops. They often have the swollen nodes. Your insides, such as liver, heart, or lungs, also may ignite, but do not suffer permanent damage.
When this type of arthritis lasts for several weeks, the child will be weak, lose weight and will be pale by anemia. Growth can also affect, but this recovers when the disease goes into remission. In the early stages of this form of arthritis, may be that there is no sign of inflammation of the joints, or that there is very few. It makes that sometimes a disease very difficult to diagnose, because there are many other diseases that can cause fever and spots on the skin. This is the cause why should perform several analyses and studies to be sure that it is not another entity. Arthritis usually appears in the first 6 months from the onset of fever and hives. Usually it agrees many joints, but can be mild or severe. Up to severe forms go into remission in some months or years. If it doesn't go into remission, the disease will have a course of outbreaks and partial remissions which is different for each child. In the majority of cases, these outbreaks are milder as time passes. There is a group of children with this form in which arthritis remains in permanent activity, with greater or lesser intensity.
Juvenile Ankylosing Spondylitis
This type of arthritis usually affects men who have more than 8 or 10 years. In general it is quite benign, although it can evolve to a more severe disease over time. It usually engages one or two joints in the limbs, such as the hips, knees or ankles. These children need a very intensive programme of special exercises. These forms of arthritis can evolve to a form of rheumatism that affects the spine and causing pain of waist and rigidity (ankylosing spondylitis).
When this happens, it must be special back exercises that prevent spine deformities. This is one of the few types of arthritis that can have a hereditary component. 90% of children with this disease have a gene called HLA-B27. That is why it is very useful to perform an analysis to detect it and guide the diagnosis.
Psoriatic Arthritis
Psoriasis is a skin disease characterized by whitish skin plates, as "dry", that is flaking on the elbows, knees and other areas. Six percent of people with psoriasis also have arthritis. This type of arthritis can begin in young children, even before they arise the Cutaneous manifestations of the disease. It is usually mild to moderate.
Often affects a single or few joints, but it can compromise your hips or spine. It is important to know if there is any history of psoriasis in some Member of the family of a child with arthritis, because it can help establish the diagnosis.
Treatments For Rheumatoid Arthritis
The treatment of a child with arthritis is particular and "tailor-made" for each patient. The bases of management consist of the constancy and the will of the child and their family to cope with the disease, taking medications indicated perform appropriate exercises and obtain the best benefit of the therapy.
At this time there are many anti-inflammatory drugs and immunomodulatory allowing to control successfully (if not at all, in the majority of cases) swelling and pain. New therapeutic compounds that emerged in recent years allow to be optimistic about future medications and their impact on the well-being of the rheumatic child.
Anyway, still not knowing is the cure for this disease, the treatment goals remain: the child relates with other children normally, you can continue attending class, which its physical and intellectual growth is normal, your joints to retain or regain normal function.
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