CPhT CONNECT™ Magazine - Jan/Feb 2021

Juvenile Arthritis Juvenile arthritis is also known as pediatric rheumatic disease. It is an autoimmune disease that causes a loss of function due to inflammation of the support structure in children and causes them to exhibit symptoms such as joint swelling, pain, and stiff- ness. Since this is an autoimmune disease, the immune system attacks some of the body’s own healthy cells and tissues. In some severe cases, it can attack the skin and other internal organs as well. Researchers believe that a certain gene may cause juvenile arthritis when activated by a virus, bacteria, or other external factors, but there the cause is not clearly defined. Although several types of juvenile arthritis exist, the most common is Juvenile Idiopathic Arthritis. Juvenile Idiopathic Arthritis is further broken down into six different types:

Rheumatoid Arthritis Rheumatoid arthritis is an autoimmune disease that causes chronic joint inflammation. It can affect many joints, including the hands and feet, causing painful swelling. This autoimmune disease causes the immune system to attack its own tissues, including the joints. In severe cases, it attacks internal organs and causes problems in the lungs, heart, and eyes. The signs and symptoms associated with rheumatoid arthritis are joint pain, stiffness, tenderness or swelling in joint areas, fever, fatigue, and weakness. When rheumatoid arthritis flares up, white blood cells inflame synovial tissues, causing them to thicken and swell. Over an extended period, the inflammation associated with rheumatoid arthritis can cause bone erosion and joint deformity. Some factors may put some individuals at an increased risk for developing rheumatoid arthritis, including a family history of rheumatoid arthritis, obesity, and smoking.

Additionally, women are two to three times more likely to be affected than men. While no cure exists, the main treatment goal is to slow down disease progression as it is with any other arthritic condition. The disease progresses along a dif - ferent timeline for each patient. The following examines the stages of rheumatoid arthritis and the possi- ble therapies and treatment options. Stage 1, Early Stage: During the early stages of rheumatoid arthri- tis, a patient may experience joint pain, swelling, and stiffness. While the bones are not damaged, the synovium is inflamed. The treatment option for early-stage rheumatoid arthritis is a low-dose steroid along with a low-dose disease-modifying ant rheumatic drug (DMARD) such as Methotrexate, which is commonly used as the first line of therapy. Stage 2, Moderate Stage: During the moderate stage, the synovium’s inflammation causes damage to joint cartilage leading to pain and loss of mobility, limiting range of motion. The treatment options during this

Oligo arthritis: This disease accounts for roughly two-thirds of all juvenile arthritis. It mainly affects young girls with an early onset between ages 2 to 4. Additionally, it affects four or fewer joints. Polyarthritis: Occurs when five or more joints are affected simultaneously. Systemic Juvenile Arthritis: Occurs when there is body-wide inflammation. Enthesitis Related: This inflammation of connective tissue occurs where ten- dons or ligaments attach to the bone. This condition can afflict joints in the spine, hips, knees, and ankles. Juvenile Psoriatic Arthritis: This con - dition causes chronic joint swelling and inflammation as well as asymptomatic eye inflammation. Undifferentiated: A disease state is labeled as undifferentiated when it does not fulfill any single category, or it may have criteria from more than one category.

stage are steroid injections, biologic DMARD such as Enbrel and Humira, and physical therapy to strengthen the muscles. Stage 3, Severe: During this stage, the damage extends beyond cartilage to the bones themselves. The bones rub together causing more pain and swelling. This may lead to muscle weak- ness; bone erosion and deformity may also occur. The treatment options at this point are based on a case-by-case scenario. The patient may be referred to an orthopedic surgeon to dis- cuss joint replacement, joint fusion, and tendon reconstruction. Stage 4, End Stage: During the end stages of rheuma- toid arthritis, the joints no longer work. The joints may be damaged, and the bones may fuse together. The treatment goal at this point is just to control the pain. A physician may prescribe pain modulators such as Gabapentin, muscle relaxers such as Cyclobenzaprine, and low dose antidepressants such as Amitriptyline.

The other forms of juvenile arthritis include juvenile lupus, which can affect the joints hearts, skin, and lungs. Vasculitis causes inflammation of the blood vessels leading to heart complications, the most common form being Kawasaki disease. Juvenile myo- sitis is an inflammatory disease that causes muscle weakness. However, juvenile scleroderma causes the skin to harden and tighten. And finally, fibromyalgia causes chronic pain syndrome, leading to widespread muscle pain and stiffness along with fatigue. Non-pharmacologic treatment for juvenile arthritis includes healthy eating habits, physical therapy, occu- pational therapy, and physical activities that strengthen muscles. Drug therapies include corticosteroids, DMARDs, and NSAIDs as well as treatment for depression if necessary. The prog- nosis for juvenile arthritis varies from child to child. In most cases, children who are affected go on to live normal lives.

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