Understanding and treating juvenile arthritis

Approximately 300,000 children across the U.S. suffer from juvenile arthritis (JA), an autoimmune disease that can lead to loss of joint motion and vision problems and has been known to diminish life expectancy by 10–15 years. While there is no cure for JA, Hancock Health physical therapist Dr. Kylie Cushman says that remission is possible with early intervention and that children with the disease can lead normal lives.

In general, arthritis is inflammation, or swelling, of a joint, which results in pain and stiffness. Both osteoarthritis and rheumatoid arthritis are single conditions that can affect people later in life, starting at middle age.

Osteoarthritis is a breakdown of cartilage and bone in a joint producing pain, whereas rheumatoid arthritis is an inflammatory autoimmune disease that can affect more than just joints. Osteoarthritis can often be “fixed” with a joint replacement—most commonly in the knee, hip, shoulder, or ankle. Rheumatoid arthritis is more closely related to JA than osteoarthritis. But unlike rheumatoid arthritis, from which patients suffer lifelong symptoms, JA can be outgrown.

The most common symptoms of JA include joint swelling, pain, loss of motion, and stiffness. Children can also experience fever, rash, fatigue, eye inflammation, loss of appetite, and difficulty with daily activities such as walking, dressing, or playing. The symptoms are usually worse in the morning and after naps. Some types of JA only affect the skin and internal organs, as opposed to joints. Juvenile idiopathic arthritis (JIA) is the most common form of juvenile arthritis, and it includes six different types.

Juvenile arthritis is diagnosed in children under the age of 16. In girls, it is normally diagnosed after puberty.

The cause of JA is not exactly known, but we do know it’s an autoimmune disease, which means the immune system attacks the body’s own tissues. The “idiopathic” in the most common form of JA means “unknown.” Experts believe it could be a combination of genetics and the environment. Scientists think a virus, bacteria, or another external factor activates certain genes to cause it. There is no evidence that food, toxins, allergies, or vitamin deficiency cause JA.

There is no cure for JA, but remission is possible with early intervention. Remission means the disease is no longer active. However, any physical damage that has happened to a joint will remain.

As with most diseases, getting early treatment makes a big difference with minimizing the disease and alleviating pain. Exercise is important to maintain range of motion and function. Physical therapy can assist with establishing a good exercise routine and activities for maintaining function.

Medications will likely be used as well and may include NSAIDs (non-steroidal anti-inflammatory drugs), SAARDs (slow-acting antirheumatic drugs), DMARDs (disease-modifying antirheumatic drugs), corticosteroids, and antimetabolites. Biologics—which target the disease on the molecular level—are the newest drug-based treatment available.

Rehabilitation services are among the many ways we’re making health possible for our community each day. We provide a wide range of both inpatient and outpatient physical therapy services, including home health services, aquatic therapy, and more. These services are available at multiple locations across Hancock County. To learn more about the care Dr. Cushman and her colleagues offer, call our physical therapy department at (317) 468-4472. We’re available and ready to serve you Monday–Friday, from 7 a.m.–7 p.m.