Arthritis is a condition characterized by pain and inflammation in the joints, which are the points where bones meet. While often linked with older age, arthritis can affect individuals across all age groups, including infants, children, and adolescents.
Forms of Arthritis Affecting Young People
The most prevalent form of arthritis in young individuals is Juvenile Idiopathic Arthritis (JIA), a term encompassing several distinct conditions that cause persistent joint inflammation. JIA is an autoimmune disease where the body’s immune system mistakenly attacks its own joint tissues, leading to swelling, pain, and stiffness. This condition affects approximately 1 in 1,000 children in the United States and is defined by arthritis occurring before 16 years of age and lasting at least six weeks.
One common subtype is oligoarticular JIA, which typically affects four or fewer joints, often larger ones like the knee, ankle, or elbow. This form is frequently seen in young girls, and about half of all children with JIA have this type. Polyarticular JIA, in contrast, involves five or more joints, often affecting the same joints on both sides of the body, including smaller joints in the hands and feet, as well as the neck and jaw. This subtype accounts for about 20% of JIA cases and can present with mild systemic features such as low-grade fever or reduced appetite.
Other forms of JIA include:
Systemic JIA, a less common but widespread form, affects the entire body with symptoms like high fevers, a distinctive rash, and enlarged lymph nodes, liver, or spleen.
Psoriatic JIA, diagnosed when a child has both arthritis and psoriasis (a skin condition), or related features like swollen fingers or nail changes.
Enthesitis-related arthritis, common in older children and teenagers, causes inflammation where tendons or ligaments attach to bones (e.g., heels, hips, knees), and can be associated with eye inflammation.
Undifferentiated JIA, for cases that do not fit neatly into a single subtype or meet criteria for multiple types.
Recognizing Symptoms in Children and Adolescents
Identifying arthritis in young people can be challenging because symptoms may be subtle or mimic other common childhood illnesses. Persistent joint pain is a primary indicator, although very young children might not express it verbally, instead showing reluctance to use a limb or limping. Swelling in one or more joints is a common visible sign, often noticed in larger joints like the knee.
Stiffness, particularly in the morning or after periods of inactivity, is another frequent symptom, making movement difficult upon waking. Children might appear clumsier or have a reduced range of motion.
Beyond joint-specific signs, systemic symptoms can include unexplained fever, a rash, or fatigue. Some forms of arthritis can also lead to eye inflammation (uveitis), which may not cause noticeable symptoms but can be detected through specialized eye exams. Symptoms can fluctuate, with periods of worsening known as “flare-ups.” If these signs persist for more than a week, seeking medical evaluation is advisable.
Diagnosis and Treatment Approaches for Youth
Diagnosing arthritis in young patients involves a comprehensive approach to differentiate it from other conditions. A physical examination is important, where a healthcare provider assesses affected joints for swelling, warmth, tenderness, and range of motion. This is often followed by blood tests to check for markers of inflammation, such as erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), and specific autoantibodies like antinuclear antibodies (ANA) or rheumatoid factor (RF), though their presence alone does not confirm diagnosis.
Imaging studies like X-rays, MRI, or ultrasound are utilized to assess joint damage, inflammation, or to rule out other potential causes of joint pain, such as fractures or infections. In some instances, a sample of synovial fluid from the affected joint may be taken for analysis. The diagnostic process often requires ruling out other conditions that can cause similar symptoms, and a pediatric rheumatologist, a specialist in childhood arthritis, is often involved.
Treatment for childhood arthritis aims to manage pain, reduce inflammation, preserve joint function, prevent long-term damage, and support the child’s normal growth and development. Medications are a primary component of treatment, beginning with nonsteroidal anti-inflammatory drugs (NSAIDs) to alleviate pain and inflammation. If NSAIDs are insufficient, disease-modifying antirheumatic drugs (DMARDs) may be prescribed to suppress the immune system and slow disease progression. Biologic agents, a newer class of DMARDs, specifically target parts of the immune system involved in inflammation and are used for more severe cases. Corticosteroids may be used for short periods to rapidly reduce inflammation, sometimes injected directly into affected joints.
Beyond medication, physical therapy is important to maintain joint mobility, strengthen muscles, and prevent stiffness. Occupational therapy helps children adapt to daily activities and learn strategies to protect their joints. Lifestyle adjustments, including regular exercise like swimming, proper nutrition, and balancing rest with activity, also contribute to overall well-being. Care is often managed by a multidisciplinary team, including rheumatologists, physical therapists, occupational therapists, and ophthalmologists, to address all aspects of the condition.