Juvenile Arthritis (cont.)
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
What are some other forms of arthritis which can affect children?
There are several other forms of arthritis that can affect children and adolescents that can be considered separately from juvenile rheumatoid arthritis. Interestingly, these most often affect older children (greater than 8 years of age) and teenagers, while typical juvenile rheumatoid arthritis most often affects young children. One of these is the teenager who has rheumatoid factor-positive arthritis with involvement of the small joints in the hands and feet. Rheumatoid factor is a blood-test finding which is present in most adults with rheumatoid arthritis but is absent in most children with JRA. It is present in this group because they usually are teenagers who have adult-type rheumatoid arthritis starting early. Because it is starting early, this is a very worrisome group, and these children need to be treated aggressively. Often they will have lifelong arthritis.
Another form of arthritis that is common in this "older" group is spondyloarthropathy. This is a family of diseases in which the arthritis is the same, but the associated problems are very different. The typical findings of a spondyloarthropathy are early involvement of the hips and other large joints. In addition, these forms of arthritis tend to be asymmetric (one side of the body is more severely affected than the other). The key finding is that these children not only have inflamed joints, but they also have inflammation at the points where tissues attach to bone, such as tendons and ligaments. Often they have ankle or heel pain due to inflammation of the tendons inserting in the foot. In some mild cases, the tendon inflammation occurs without obvious swollen joints.
It is important to recognize the spondyloarthropathies as different from juvenile rheumatoid arthritis because the optimal treatment, monitoring, and outcome is likely to be different. In addition, one must look carefully for evidence of the other diseases that can be associated with spondyloarthropathies. These include inflammatory bowel disease, psoriasis, reactive arthritis, and Behcet's syndrome. The most worrisome children with spondyloarthropathies are the HLA B27-positive boys. They are at risk for developing ankylosing spondylitis. However, most children with spondyloarthropathies seem to do reasonably well. In general, for children who are HLA B27 negative and do not have an associated condition, the arthritis is more likely than JRA to come and go repeatedly over a period of years but is less likely to be very severe or destructive. Unfortunately, we have only recognized children with spondyloarthropathies as being "different" since the middle 1970s, so no good long-term follow-up data is available yet.
Sometimes, children with a form of chronic skin inflammation, called psoriasis, can develop arthritis. This form of arthritis is referred to as psoriatic arthritis. Occasionally, there is a family history of psoriasis that can help to clue the doctor into this diagnosis.
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Juvenile Arthritis - Symptoms Question: What were the symptoms associated with juvenile arthritis in you or your child?
Juvenile Arthritis - Pauciarticular Juvenile Rheumatoid Arthritis Question: What type of rheumatoid arthritis does your child have? Please share your experience.
Juvenile Arthritis - Treatments Question: What was the treatment for your juvenile arthritis?
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