Trauma

• brain disturbances

• metabolic disturbances

• excessive wear and tear and stress on a joint(s)

• environmental triggers

Treatment

Exercise Getting plenty of exercise is a very important part of treatment for juvenile arthritis. For children with arthritis, exercise helps to keep joints mobile, keep muscles strong, regain lost motion or strength in a joint or muscle, make everyday activities like walking or dressing easier, and improve general fitness and endurance. While medications reduce pain and inflammation, only therapeutic exercise can restore lost motion in a joint. These exercises can make it easier for children to walk and perform other activities of daily living such as walking, eating, and writing. Range-of-motion exercises keep joints flexible and are especially important for children who have lost motion in a joint, or whose joints have become fixed in a bent position. Strengthening exercises build muscles.

Strong muscles and joint protection are the keys to participating in sports. Although contact sports are never recommended, even aggressive sports such as soccer and basketball may not be off limits. Special exercises and protective equipment can further reduce the risk of injury and help children with arthritis play sports.

Splints Splints can help keep joints in the correct position and relieve pain. If a joint is becoming deformed, a splint may help stretch that joint gradually back to its normal position. Commonly used splints include knee extension splints, wrist extension splints, and ring splints for the fingers. An occupational or physical therapist usually makes the splint, which can be adjusted as the child grows. Arm and hand splints are made from plastic; leg splints are sometimes made of cast material.

Medication Prescribing and administering medication for children with arthritis can be completely different from prescribing medication to adults with arthritis. Children will most likely require different dosages of medication, and they may have different or additional side effects to the same drug.

Surgery An operation is rarely used to treat juvenile arthritis in the early course of the disease, but it can be used to ease pain, release joint malformation, or replace a damaged joint. The latter procedure is used primarily with older children who have stopped growing and whose joints have been badly damaged by arthritis. This operation, which is usually used to replace the hip, knee, or jaw joints, can reduce pain and improve function.

Instead of replacement, soft tissue release may sometimes help to improve the position of a joint. In this operation, the surgeon cuts and repairs the tight tissues that caused the initial contracture, allowing the joint to return to a normal position. (See also arthritis, juvenile psoriatic; arthritis, juvenile rheumatoid.)

Arthritis Foundation The only national nonprofit organization that supports the more than 100 types of arthritis and related conditions with advocacy, programs, services, and research. The foundation also supports a special council devoted to juvenile arthritis, called the american juvenile arthritis organization.

Since 1948 the foundation has spent more than $244 million to support some 2,000 scientists and physicians in arthritis research. Organized as the Arthritis and Rheumatism Foundation, the organization's name was changed in 1964 to the Arthritis Foundation.

Arthritis Foundation efforts center on the threefold mission of the organization: research, prevention, and quality of life. The Arthritis Foundation currently provides nearly $20 million in grants to nearly 300 researchers to help find a cure, prevention, or better treatment for arthritis. The Arthritis Foundation's sponsorship of research for more than 50 years has resulted in major treatment advances for most arthritis diseases.

The foundation offers videotapes, brochures, and booklets about arthritis and publishes a national, bimonthly consumer magazine, Arthritis Today. In addition, the Arthritis Foundation provides community-based services nationwide, including self-help courses, water- and land-based exercise classes, support and home study groups, and continuing education courses and publications for health professionals. (See also arthritis, juvenile psoriatic; arthritis, juvenile rheumatoid; Appendix I.)

arthritis, juvenile psoriatic A type of arthritis linked to psoriasis. While the chronic rash of psoriasis is a common skin condition, only about 12 to 14 percent of people with psoriasis will develop related arthritis.

Causes

Genetic and environmental factors play a strong role in the development of psoriatic arthritis. A family history of psoriasis is linked to many children with juvenile psoriatic arthritis, as well as a family history of other forms of spondyloarthropa-thy, but there is little relationship between the severity of a rash and the risk of getting juvenile psoriatic arthritis.

Symptoms

Symptoms include pitting or thickening and yellowing of the fingernails and toenails, a small round scaly patch on the scalp, belly button, or buttocks; joint problems in large joints such as the hip, either on just one side or in the same joints on both sides of the body; swelling of fingers or toes.

Because eye inflammation occurs in between 10 and 20 percent of cases, children with juvenile pso-riatic arthritis should be examined by an ophthalmologist annually to check for eye problems.

Diagnosis juvenile psoriatic arthritis can be tricky to diagnose. In some children with the condition, symptoms of arthritis appear before the rash. In these cases, diagnosis can be so difficult that it may take up to 10 years to be certain of a definite diagnosis.

Complications

While many children have no long-term consequences of juvenile psoriatic arthritis, there are a number of possible complications, including eye problems; decreased range of joint motion; shortening or lengthening of a limb, finger, or toe; damaged cartilage; or enlargement of a joint. (See also arthritis, juvenile rheumatoid; arthritis foundation.)

arthritis, juvenile rheumatoid The most common type of juvenile arthritis, which is an inflammation of the joints characterized by swelling, heat, and pain. Arthritis can be short-term or chronic, and in rare cases it can last a lifetime. juvenile arthritis is the term used for all the types of arthritis that affect more than 285,000 children in the United States. juvenile rheumatoid arthritis (JRA) affects about 75,000 American children.

Cause

Doctors do not know what causes rheumatoid arthritis (also called idiopathic arthritis) in children, but research suggests that it is an autoimmune disease. In autoimmune diseases, white blood cells lose the ability to tell the difference between the body's own healthy cells and tissues and harmful bacteria and viruses. The immune system, which is supposed to protect the body from invasion, instead releases chemicals that can damage healthy tissues and cause inflammation and pain.

Symptoms

JRA usually appears between the ages of six months and 16 years. The first signs are often joint pain or swelling and reddened or warm joints. Rashes may suddenly appear and disappear, developing in one area and then another. High fevers that tend to spike in the evenings and suddenly disappear are characteristic of systemic JRA.

There are several types of JRA; which type a child has is determined by the pattern of symptoms that occurs within the first six months. About half the time children eventually outgrow the disease, but it is hard to predict who will continue to suffer with symptoms. Often the more joints that are affected, the more severe the disease and the less likely that the symptoms will eventually go away.

The three major types of JRA are polyarticular arthritis, pauciarticular JRA, and systemic JRA.

polyarticular arthritis primarily affects girls, causing swelling or pain in five or more joints. The small joints of the hands are affected as well as the weight-bearing joints such as the knees, hips, ankles, feet, and neck. There may be a low-grade fever as well as bumps on the body in areas subjected to pressure from sitting or leaning.

pauciarticular JRA affects fewer than four joints; the knee and wrist joints are most often involved. Symptoms include pain, stiffness, or swelling of affected joints. In this subtype of JRA, an inflammation of the iris of the eye may occur with or without active symptoms. This eye inflammation, called iridocyclitis or iritis or uveitis, can be detected by an ophthalmologist. systemic JRA affects the entire body, with high fevers that rise at night and then suddenly drop to normal. During the onset of fever, the child may feel very ill, appear pale, or develop an intermittent rash. The spleen and lymph nodes may become enlarged. Eventually many of the body's joints are affected by swelling, pain, and stiffness.

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