Ask the Expert: Juvenile Arthritis

by Dr. Nancy Pan
Juv arthritis 610

Dr. Nancy Pan, Pediatric Rheumatologist at Hospital for Special Surgery, answers readers’ questions on juvenile arthritis.

Q1. Is juvenile arthritis genetic?
Juvenile arthritis is an autoimmune condition that can run in families. It is not a condition that is passed directly from a parent to a child, but there is an overall increased risk if any family member has juvenile arthritis.

Q2. What are the most common signs to look out for?
Arthritis is defined as inflammation in joints. Children with juvenile arthritis may have a variety of symptoms, including joint pain, stiffness or a limp. If there is arthritis of the hands, sometimes it may be difficult to hold a pen or open doors or faucets. Often, there is also swelling of the joints. There are many subtypes of juvenile arthritis, such as systemic-onset juvenile arthritis with symptoms such as unexplained fevers, rashes and joint pains.

Q3. How is juvenile arthritis diagnosed?
Juvenile arthritis is defined as persistent joint pain or swelling in a child under the age of 16 years with no known cause. There are many causes of joint pain and swelling, including infections or trauma. All of these common causes need to be checked for before juvenile arthritis can be diagnosed. If there is no other explanation for the joint pain and swelling, the diagnosis of juvenile arthritis may be considered and evaluation by a pediatric rheumatologist is recommended. There are various subtypes of juvenile arthritis, so a detailed clinical history, a thorough physical examination and some blood tests will help make the diagnosis. However, there is not one single blood test that will make the diagnosis.

Q4. How can family members help a child living with juvenile arthritis?
Family members can be supportive by coming to doctor’s visits and learning about how juvenile arthritis affects their child specifically as there is a wide range of manifestations of this condition. It is important to encourage the child to engage in physical activity as guided by their doctor. Children will require support in being compliant with medications that can have a dramatic effect on their joint pain and stiffness.

Q5. What does juvenile arthritis treatment entail?
The first line treatments are typically with non-steroidal anti-inflammatories in mild arthritis. Other treatments include methotrexate and anti-TNF agents, which help to control inflammation in the joints. Treatment plans are tailored to the individual patient and should be decided after discussion between the family, the patient and their pediatric rheumatologist.

Dr. Nancy Pan specializes in the care and treatment of children with rheumatic diseases including juvenile idiopathic arthritis, juvenile dermatomyositis, childhood systemic lupus and vasculitides of childhood. Dr. Pan then completed her fellowship in Pediatric Rheumatology at Hospital for Special Surgery. During her fellowship, Dr. Pan pursued clinical and translational research identifying biomarkers for flares in lupus as a part of the Mary Kirkland Center for Lupus Care.

Topics: Featured, Rheumatology
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The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.

Comments

Lanre Amao says:

Dear Dr, we are preparing for our first visit to a pediatrician (no Ped. Rheumatologist available in our area) after our 7 yr old son was diagnosed with Fleeting Arthritis. What should we expect? and what questions should we be asking. Blood test shows rheumatoid factor to be within normal levels. He experiences different joint pains daily.

HSS on the Move says:

Hi Lanre, thank you for your question. Dr. Nancy Pan, Pediatric Rheumatologist, says: “’Fleeting arthritis’ is an short-lived arthritis that can happen after an infection like the flu. Typically, the blood tests will be normal. In many types of childhood arthritis, the rheumatoid factor is negative. The doctor will likely take a detailed history to ask about symptoms such as rash and recent infections such as strep, and then do a complete physical examination to confirm the diagnosis. For fleeting arthritis, often a course of non-steroidal anti-inflammatories such as ibuprofen would help with the joint pain. If the pain persists or worsens or the joints remain swollen, seeing a pediatric rheumatologist may be helpful.” If you are interested in receiving care at HSS, please call our Physician Referral Service at 877-606-1555.

Aakash Shrivastav says:

My 5 year old son has juvenile dermatomyositis .. He is at present on Omnacortil 5mg ( tapered ) with supplements of iron and calcium .. He is on treatment since last 12 months . He is physically fit and his rashes on his eyes are gone. After his course of medicines will the disease relapse ? What precautions should we take ? Thanks and regards

HSS on the Move says:

Hi Aakash, thank you for reaching out. Dr. Nancy Pan, Pediatric Rheumatologist, says: “For many children, juvenile dermatomyositis has a relapsing and remitting course. This means that there are periods where the disease is well-controlled and the patient may not require much medication, but there may also be times where there will be a “flare” of the disease such as rash, muscle weakness, and fatigue. It is difficult to predict who will have a disease flare. There aren’t any specific ways to prevent disease flares. The most important thing is to follow closely with your child’s rheumatologist to monitor your child’s symptoms and adjust medications accordingly. They will be able to give you specific guidance on how to keep your child active and healthy.” It is always best to consult with your treating physician. If you are interested in care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

My son who is 24 years old suddenly developed joint pain mainly, feet,ankle and knee 1&1/2 years back. There were rashes on the toe area with balck veins visible. Doctors diagnosied it as Auto immune disease. After treatment he was ok for nearly 1 year.Now, it has relapsed though all tests were negative 6 months back. Is it curable permanently ? or the treatment need to continued. Doctors advised life long treatment. What precautions he needs to take and what kind of medicines and diet? Pl advise.

HSS on the Move says:

Hi Anjan, thank you for reaching out. For more information on autoimmune diseases, visit http://www.hss.edu/condition-list_autoimmune-diseases.asp. It is best for your son to consult with his treating physician to receive a better diagnosis. If your son wishes to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.

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