Ask the Expert: Dr. Emma MacDermott, Pediatric Rheumatologist, Answers Your Questions on Juvenile Arthritis
Q1. Are there different types of juvenile arthritis?
In children, just as in adults, there are many kinds of arthritis. Broadly, we divide arthritis into the kind that affects a few joints (pauciarticular disease), affecting many joints (polyarticular) and the kind that can affect not only joints but also cause fever and rash, which is known as systemic disease. In addition, there is a large family of spondyloarthropathies. This group accounts for many of our patients and includes the arthritis associated with psoriasis, thyroid disease, inflammatory bowel disease and others. It is important to remember that very few children have true ‘rheumatoid’ arthritis, a type of arthritis seen more commonly in adults.
Q2. I’m a mom and curious what signs and symptoms to look out for? My child is complaining of joint pain in her legs. What is the difference between growing pains and juvenile arthritis?
Growing pains occur mainly at bedtime, or wake the child from sleep. Children usually complain of pain in the lower legs, which can be helped by massage, warm bath or over-the-counter-medication. They wake up with no joint pain. Arthritis should be considered in children who are complaining of joint pains during the day, who have frequent complaints after activity, who wake with joint stiffness or are stiff when they sit for a long period of time. Any child with a swollen red or hot joint, or who is limping should be assessed as an emergency.
Q3. Can children grow out of arthritis or is it a lifelong condition?
For many children, arthritis can be a lifelong condition. However, the great majority of these children lead normal, active lives thanks to the wealth of medication and therapy options available today. Some forms of arthritis, particularly the kind that develops in association with infection, and in some cases pauci- or few joint arthritis can resolve completely.
Q4. Can injuries or other conditions cause arthritis in children?
Arthritis following injury or overuse is more commonly seen in adults. In children, we often see arthritis occurring following an infection. Some common childhood infections that can result in arthritis include strep throat, infectious mononucleosis and parvovirus (which causes fifth disease). Arthritis can also occur in the setting of celiac disease, inflammatory bowel disease or psoriasis. Indeed, it is sometimes the presenting symptom of these illnesses.
Q5. My child has juvenile rheumatoid arthritis and it has affected her growth. Right now she is using a shoe lift but as a nine year old, she still has plenty of time to grow. If the difference between legs does not change – when is it time to consider surgery or limb lengthening?
We work closely with the pediatric orthopedic surgeons and they advise of the need and timing of surgery. We treat our patients early and aggressively to minimize the joint inflammation that can cause leg length discrepancy. Nowadays, few patients need any surgical intervention for the complications associated with juvenile arthritis.