Dr.ª Joana Almeida Santos

Pediatric arthritis and other rheumatic diseases because infantile rheumatism also exists!

HPA Magazine 6

Most people think that rheumatic diseases are exclusive to adults. But the truth is that there are quite a number of rheumatisms that can affect children, and they manifest themselves in the same way as they do for adults: pain, swelling and stiffness in the joints, with injuries or limitations that can permanently compromise their future. Despite the therapeutic approach being identical to that for adults, infantile and juvenile rheumatism diseases require treatments and follow-ups of even greater intensity. Dr. Joana Almeida Santos, Paediatrician specialising in Infantile Rheumatism, clears up some questions.

WHAT ARE PAEDIATRIC ARTHRITIS AND OTHER RHEUMATIC DISEASES?
Paediatric arthritis is only one type/category of rheumatic disease. Arthritis affects joints, muscles, tendons, ligaments, and bones. Rheumatic diseases in general can also affect other areas of the body, including organs such as the skin, the heart or the eyes.
Some rheumatic diseases affect connective tissues (muscles, tendons, and ligaments) and are therefore known as connective tissue diseases. Other types of diseases are caused by the body's immune system attacking its own healthy cells and tissues and are known as autoimmune disorders.

HOW COMMON ARE THESE CHILDHOOD DISEASES?
About 1 in 1,000 children have juvenile arthritis. This includes not only children with juvenile idiopathic arthritis but also those with other rheumatic or connective tissue diseases.

WHAT CAUSES THESE CONDITIONS?
The exact cause of most types of rheumatic diseases is not yet known.  In many cases, the cause may vary depending on the disease type. Researchers think that certain factors may play a part: the immune system, genes and family history, injury, infection, metabolic and nervous system problems, excessive wear and tear and stress on the body, environmental triggers and the effect of some hormones.

WHAT TYPES OF RHEUMATIC DISEASES CAN CHILDREN GET?
Children can get chronic arthritis – called juvenile idiopathic arthritis (JIA), previously known as juvenile rheumatoid arthritis, as well as other rheumatic di-
seases such as systemic lupus erythematosus (known as lupus or SLE), juvenile dermatomyositis, vasculitis, among others.

WHO IS AT RISK OF DEVELOPING THESE DISEASES?
Arthritis and rheumatic diseases can affect any child. They can occur at any age in any race, but some are more common in certain children, such as: juvenile idiopathic arthritis – more often affects children under the age of 15; systemic lupus erythematosus –  occurs more often in girls; ankylosing spondylitis – more common in boys.

WHAT ARE THE SYMPTOMS?
Each type of rheumatic disease has its own set of symptoms, and symptoms can occur a bit differently in each child, but the most common symptoms in all the diseases include: joint pain/chronic pain or tenderness in the joint(s), swelling in one or more joints, warmth and redness in the joint area, joint stiffness that lasts for at least one hour in the early morning/limited movement in the affected joint(s), fatigue, fever that doesn't go away, or that comes back. However, these symptoms can mimic other health conditions that should be considered for various other diagnoses.

HOW ARE THEY DIAGNOSED?
The process starts with a medical history and a physical exam by a doctor who has specialized training (or experience) in childhood rheumatic diseases. Preliminary evaluation should be by the family doctor or paediatrician, but a paediatric rheumatologist ideally makes the final diagnosis. There are no blood or urine tests, x-rays or other imaging tests specific for the diagnosis, but these tests may be useful to determine the type of disorder, to assess the severity, or to identify complications. Other tests may also be done, such as: joint aspiration (arthrocentesis), genetic testing, skin and muscle biopsy. 

HOW ARE THEY TREATED?
Treatment will depend on the child's symptoms, age, and general health. It will also depend on the type of disease and its severity. A treatment plan is often drawn up with a health care team. This team includes the child's primary health care provider, a rheumatologist, orthopaedist, physical therapist, and other health care providers. There is no cure for most paediatric rheumatic diseases. The goal of treatment is often to limit pain and inflammation, and help ensure joint function. Certain organs, such as the eyes and heart, are also often checked for problems. 
Treatment plans often use both short-term and long-term methods and include medicines, heat and cold, massage, exercise, physical therapy, and surgery.

IS CHILDHOOD ARTHRITIS TREATED IN THE SAME WAY AS ADULT-TYPE ARTHRITIS?
Children with arthritis are not just kids with an adult disease. Although the drugs and therapies used to treat children are similar, the intensity of treatment and the frequency of follow-ups need to be much greater.

WHAT ARE THE COMPLICATIONS OF PAEDIATRIC ARTHRITIS AND OTHER RHEUMATIC DISEASES?
If only a few joints are affected, arthritis may cause little or no joint damage. Some children may have chronic pain and disability. Other complications include slowed growth, anaemia, and problems with the eyes or heart. While there is no cure for juvenile arthritis, current available therapy often prevents the long-term damage and disability that may be left by arthritis even after it has been resolved.

HOW TO HELP YOUR CHILD TO LIVE WITH THESE CONDITIONS?
Help your child manage the symptoms by sticking to the treatment plan. Encourage exercise and physical therapy. Find ways to make it fun. Work with your child’s school to make sure the child has help as needed. Work with other caregivers to help the child take part as much as possible in school, social and physical activities. You can also help by finding a support group to be around other children with similar health conditions.