Although most people associate arthritis with aging, the fact is, one in 1,000 children is diagnosed with juvenile arthritis. Here, Pediatric Rheumatologist Dr. Julie Cherian addresses the most common questions from parents — and discusses what they can do if they suspect their child may have arthritis.
Is arthritis really that common in children?
Yes. That’s why awareness is so important. Collectively, the term referring to arthritis in children is Juvenile Idiopathic Arthritis (JIA). The most important thing about JIA is to diagnose and treat it early. Left unchecked, it can cause serious, irreversible side effects, including blindness, stunted growth and lifelong disabilities.
What are the signs and symptoms?
Unfortunately, many of the symptoms of JIA mimic those of other diseases, so a diagnosis of juvenile arthritis is one of exclusion. That is, we have to rule out other illnesses over time before we can definitely say a child has arthritis. If your child shows any of the following, we suggest talking with your primary care physician, pediatrician or a pediatric rheumatologist about investigating the possibility of juvenile arthritis further:
- Stiffness in the morning. This could mean impaired or slowed mobility after awakening. Smaller children who are already walking may crawl or want to be held when they first get up.
- Warm, swollen or tender joints. Knees and ankles are most common sites, but symptoms could appear in other joints as well.
- Fatigue, weight loss, lack of appetite, slowed activity level.
- “Growing pains.” Sometimes parents think that when a child complains of joint or leg pain, it is just “growing pains.” This is a common misconception. Growing pains affect the whole leg, and the pain is diffuse, especially at night. If a child is stiff, especially in the morning, investigate further.
How is it diagnosed?
There is no specific laboratory test to diagnose JIA. The diagnosis is made through a careful physical examination, a thorough medical history and by ruling out other diagnoses. We look at how long the symptoms have been noticeable, examine the joints and measure leg length, because if there is arthritis in one knee, the leg may grow at a different rate than the other. If we suspect JIA, we’ll follow the patient for about six weeks to confirm. We may run tests and perform labwork to ensure the symptoms are not caused by another disease. Once confirmed, we start treatment immediately.
What is the best treatment?
At Stony Brook Children’s, we believe that aggressive treatment as early as possible offers the best possible outcome.
Depending on the severity, we can prescribe from a wide range of medications. This includes common anti-inflammatories and pain relievers, DMARDs (disease modifying drugs, for example, methotrexate), and a new class of drugs known Julie Cherian, MD Pediatric Rheumatologist, Division Chief, Pediatric Rheumatology, Stony Brook Children’s Hospital as biologics or anti-TNFs (tumor necrosis factor). These latter medications have had amazing success. Children who once would have needed a wheelchair are now living a “normal” life — walking, running and participating in all the same activities as their peers.
We also take a multidisciplinary team approach, so we include physical therapists, pediatric ophthalmologists, pediatric orthopedic specialists and other children’s medicine experts on the team as needed.
Can a child outgrow JIA?
Some forms of JIA can be outgrown with the right treatment, and others can not. However, children have the best outcome if treated early. A timely correct diagnosis and an aggressive multidisciplinary approach to care is very important.
THE STONY BROOK CHILDREN’S DIFFERENCE
Stony Brook Children’s is the only hospital in Suffolk County and just one of two on Long Island to have a specialist in pediatric rheumatology (actually we have two!) on staff. In fact, there are only approximately 300 pediatric rheumatologists practicing in the country, so we are pleased to be able to offer this high level care close to home.
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