Arthritis in Children

Hello everybody, I'm back. Yes, it's been awhile since I spoke to you all through cyberspace. But, I'm back now, so let's dive right back in.

Recently I had a conversation with a colleague about arthritis in children. I get lots of questions all the time, but this particular conversation coincided with questions from you, our viewers on FOX News and listeners on FOX News Radio. So I went back to that colleague, Dr. Yukiko Kimura, of Hackensack University Medical Center, and asked her to answer some of your questions.

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Dr. Manny: How common is chronic arthritis in children?

Dr. Yukiko Kimura: Arthritis in children is the third most common chronic diseases in childhood, affecting one to four children in every 1,000. More than 300,000 children in the U.S. have arthritis, making it more common than cystic fibrosis, sickle cell anemia, and muscular dystrophy combined. Arthritis can affect children as young as several months of age. In fact, one of the most common types of arthritis in children can start at about one to two years of age.

There are over 100 different causes of arthritis in children, and many types of juvenile rheumatoid arthritis (the most common name for chronic arthritis in children). Some forms cause arthritis in only a few joints, whereas others can cause arthritis in almost every joint in the body (and may seem similar to rheumatoid arthritis in adults). Still others can cause high fevers, rashes, and inflammation in parts of the body other than the joints.

Dr. Manny: What are the some of the symptoms?

Dr. Yukiko Kimura: The most common symptoms of arthritis in children include pain in a joint, sometimes accompanied by swelling and warmth of the joint. Limping and stiffness that feels worst first thing in the morning and gets better as the day goes on is highly suggestive of arthritis. However, since arthritis can affect very young children who can't verbalize what they are feeling, the symptoms could be just irritability and crankiness accompanied by refusal to walk first thing in the morning. "Clumsiness" and recurrent injuries, being more tired and fatiguing easily, as well as trouble running well may also be signs of arthritis in children. A surprising number of children do not complain of pain, perhaps because they are so used to living with the symptoms of arthritis.

Dr. Manny: Are sports injuries in children related to the early onset of juvenile rheumatoid arthritis?

Dr. Yukiko Kimura: Sports injuries, per se, do not cause juvenile rheumatoid arthritis, but sports injuries are often blamed for the symptoms of arthritis. Many children who actually have arthritis are erroneously referred to orthopedists and sports medicine physicians, and then the diagnosis is delayed. The problem is that many people, including physicians, are not aware that arthritis occurs relatively frequently in children. This is unfortunate, because early recognition and treatment is very important to preventing the damage that can occur with long-term arthritis.

Dr. Manny: Do changes in lifestyle, diet, exercise, or taking vitamin supplements, reverse the course of arthritis?

Dr. Yukiko Kimura: There are no special diets of supplements that are recommended to prevent or treat arthritis. However, living a healthy lifestyle is always a good thing. For example, if you already have arthritis, being overweight can worsen symptoms.

Exercise is good for arthritis, because it keeps joints limber and discourages stiffness. However, repetitive, high-impact exercise (like distance running) is not recommended if you already have arthritis in your knee or another leg joint. Swimming is one of the best activities if you have arthritis, because it strengthens muscles without the impact of gravity. If a child has arthritis in the spine or the neck, anything that involves tumbling (such as gymnastics or cheerleading) is also not recommended. That being said, we encourage children to participate in whatever sports activities they desire within reason.

The treatment goal at our pediatric rheumatology center is to allow every child with arthritis to have the most normal life possible. There are now many extremely effective new treatment options available for children with arthritis that make this a reality.

Dr. Manny: What is lupus?

Dr. Yukiko Kimura: Lupus is a common autoimmune disease that occurs in children and adolescents as well as in adults. The body's immune system exists to protect the body against foreign invaders such as viruses and bacteria, but with lupus, the body's immune system turns on itself and begins causing damage. For example, people with lupus suffer from rashes, arthritis, and inflammation in the kidneys and other important organs. It is much more common in adult females, but in children, lupus can occur almost as often in boys.

Dr. Manny: How do we make the diagnosis and what are the current treatment plans?

Dr. Yukiko Kimura: The diagnosis of lupus is based on a combination of symptoms and blood and urine test results. Unlike juvenile rheumatoid arthritis, in which blood tests are often not helpful in making the diagnosis, there are specific tests for lupus that are almost always positive. Treatments for lupus are much more effective and less toxic than in previous decades. Although 30 or 40 years ago it was not unusual to die from lupus, this is now fortunately very rare.

An important problem that has recently emerged about lupus is that the disease itself causes accelerated atherosclerosis, or "hardening of the arteries." This is something that is usually a problem in older age, but in people with lupus, this can become a problem much earlier in life. For example, women with lupus are at risk of having a heart attack as early as 20 or 30 years old. We are now participating in a national research study of lupus in children, which is looking at ways to slow down atherosclerosis.

Dr. Kimura is Section Chief of Pediatric Rheumatology at Joseph M. Sanzari Children's Hospital, in the Hackensack University Medical Center and also Associate Professor of Pediatrics at UMDNJ-New Jersey Medical School.

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Dr. Manny Alvarez serves as Fox News Channel's senior managing health editor. He also serves as chairman of the department of obstetrics/gynecology and reproductive science at Hackensack University Medical Center in New Jersey. For more information on Dr. Manny's work, visit