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July is Juvenile Arthritis Awareness Month

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pain in the knee joints of the child. the boy's knees hurtEvery July is Juvenile Arthritis Awareness Month. This campaign is led by important organizations like the Arthritis Foundation and public health agencies specializing in chronic childhood and teenage illnesses. Their goal is to raise awareness about juvenile arthritis (JA) because children with JA often can’t advocate for themselves and get the help they need. Public knowledge about this painful and debilitating condition is skewed by the common perception that arthritis is a condition that comes as people age. Most of the information in the public space and social media talks about rheumatoid arthritis in terms that emphasize its effects on adults. As a result, it can be easily be overlooked. Many younger people are living with the same symptoms and may be facing a lifetime of ongoing, debilitating pain. We’re pleased to shed some light on this very important topic. 

Q1 – What are the characteristics of rheumatoid arthritis?

Rheumatoid arthritis is characterized by inflammation and pain in the joints. It occurs when the immune system malfunctions and targets the lining (synovium) of diarthrodial joints (where bones meet.) The synovium covers both the tendons that hold bones in position and the cartilage that acts as a shock absorber to reduce friction. It produces the lubrication (synovial fluid) that allows smooth movement when muscles tighten and relax.

In rheumatoid arthritis, the body misidentifies its own natural cartilage as a foreign substance that must be attacked. This causes an overproduction of synovial fluid, which causes joints to swell and the capsule to stretch, causing pain. The condition commonly affects areas like the hands, knees, or ankles, often impacting corresponding joints on both sides of the body, such as both hands or both knees. 

Additionally, rheumatoid arthritis can sometimes lead to complications in other body parts, such as the eyes (causing eye inflammation), heart, circulatory system, or lungs. Other symptoms may include swollen lymph nodes, high fever, fatigue, weight loss, and nodules beneath the skin near the inflamed joints.

Q2. How common is rheumatoid arthritis in children

Overall, it is quite rare, with an incidence of roughly 1 in 1000 children and teenagers. Still, that has created a pool of about 150,000 children who are living with active juvenile arthritis and many more who have transitioned into adulthood and are still deeply affected by this condition with no cure.

Juvenile Idiopathic Arthritis (JIA) is a form of arthritis found in children and comprises various subtypes (Idiopathic means the causes or triggers are unknown). The definition of the subtypes published by the American College of Rheumatology includes;

  • Systemic Juvenile Idiopathic Arthritis (SJIA). Symptoms include fevers, rash, internal organ inflammation, joint pain and swelling.
  • Oligoarticular JIA affects four or fewer joints, often affecting knees, ankles, and elbows.
  • Polyarticular JIA involves five or more joints, the ones affected are the same as for Oligoarticular JIA, plus joints in the hands and feet.
  • Juvenile Ankylosing Spondylitis (JAS) primarily causes inflammation in the spine and sacroiliac joints, leading to back pain and stiffness. It can also impact hips, shoulders, and other joints.
  • Juvenile Dermatomyositis (JDM) is characterized by symptoms like muscle weakness and a skin rash, typically seen around the eyes and knuckles. The immune system targets muscles and skin, and inflammation in blood vessels may also occur.
  • Juvenile Scleroderma can cause thickening and hardening of the skin and connective tissues. The condition can be localized (affecting the skin) or systemic (affecting organs). The immune system triggers collagen production, leading to skin tightening and organ damage.
  • Fibromyalgia presents with symptoms such as muscle pain, fatigue, tender points along with sleep disturbances, and cognitive issues. It is thought to be linked to pain processing in the nervous system.
  • Lupus (Systemic Lupus Erythematosus or SLE) affects organs, including joints, skin, kidneys, heart, lungs, and brain. Typical signs may involve discomfort in the joints, skin irritations, and fatigue. 

Q3. Are there any new drug-based treatments for juvenile arthritis.

There is no complete cure for any type of arthritis, including juvenile idiopathic arthritis. Still, progress has been made over the past few years in developing drugs that reduce the levels of disease activity and relieve some of the symptoms.  Early treatment as soon as the condition has been identified is the key to getting control before permanent damage is done to the joints.

Targeted medications for JIA have seen a revolution in treatments. Prior to this, the main focus was on reducing pain and discomfort with routine non-steroidal anti-inflammatory drugs (NSAIDs) and stepping up to high doses of corticosteroids if they didn’t relieve the symptoms sufficiently rapidly. The main benefit of these drugs was to reduce fever, joint pain, and swelling, which did help to improve the quality of life of children with JIA but offered no longer-term solution.

The newer agents for treating JIA can more substantially reduce both the level of discomfort and the risk of permanent damage in children with JIA, which can be caused by inadequate control of the inflammation. These new drugs include nonbiologic disease-modifying antirheumatic drugs (DMARDs) such as Methotrex. In cases where more aggressive treatment is needed, drugs referred to as biologic DMARDs (bDMARDs), including antitumor necrosis factor (TNF) alpha agents such as Remicade, are now being used.

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