Juvenile Rheumatoid Arthritis Treatment in Delhi, India

Systemic Onset

It is the least common form of arthritis that involves one or more joints and is characterized by a high fever and a skin rash, inflammation of internal organs including the heart, liver, spleen, and lymph nodes. 

Oligoarticular

This type affects up to 4 joints in the initial six months of the onset of disease. If no further joints are affected after six months, it is termed persistent, whereas if more joints are involved after six months, it is termed extended.

Polyarticular

This type involves five or more joints in the initial six months of disease. Blood tests for rheumatoid factor (RF) will determine if this form is RF-positive or RF-negative.

Enthesitis-related

In this type, a child has a combination of arthritis as well as enthesitis. A child presents with swelling of the tissue. Commonly involved areas include the hips, knees, and feet.

Psoriatic arthritis

In this type, a child may have a combination of both arthritis and a red, scaly skin disease called psoriasis. In other cases, a child may have arthritis along with the following:

• Inflammation of a finger or toe
• Ridges in the fingernails
• Family member with psoriasis

Undifferentiated arthritis

This is arthritis that has the presence of symptoms of 2 or more JIA types mentioned above.

Symptoms may appear during episodes or flare-ups. Or they may be ongoing or chronic. Symptoms differ from one child to another. Symptoms consist of:

• Swollen, stiff, and painful joints in various areas of the body like knees, hands, feet, ankles, shoulders, or elbows often in the morning or after sleeping
• Inflammation around eyes
• Warmth and redness in a joint
• Less movement around one or more joints
• Fatigue
• Decreased appetite and poor weight gain
• High fever and rash (in systemic JIA)
• Swollen lymph nodes (in systemic JIA)

Juvenile idiopathic arthritis is generally difficult to diagnose because joint pain can be caused by various other issues. No single test can confirm the complete diagnosis, but the combination of tests can help to rule out certain other conditions that exhibit similar signs and symptoms.

Blood tests for Juvenile Rheumatoid Arthritis

Some of the most common blood tests performed for doubtful cases comprise of:

• Erythrocyte sedimentation rate (ESR). Elevated levels of ESR indicate inflammation. It is conducted to assess the extent of inflammation.
• C-reactive protein. This blood test also determines the level of inflammation in the body but on a different platform than ESR.
• Antinuclear antibody. These are proteins generated by the immune systems of people having certain autoimmune diseases, including arthritis. They act as a marker for an increased possibility of inflammation around the eye.
• Rheumatoid factor. This is rarely found in the blood of children having juvenile idiopathic arthritis and indicates an increased risk of damage resulting from arthritis.
• Cyclic citrullinated peptide (CCP). This is another antibody found in the blood of children with juvenile idiopathic arthritis and may indicate a higher risk of damage.

• Complete blood count (CBC). This test checks for low values of RBCs, WBC and platelets.
• Complement test. This is carried out to measure the level of complement. Lower levels of complement in the blood are linked to immune disorders.
• Hematocrit. This is carried out to measure the number of red blood cells in a blood sample. Low levels of red blood cells are common in people with inflammatory arthritis and rheumatic diseases.

Imaging scans for Juvenile Rheumatoid Arthritis

X-rays or MRIs may be done to exclude several other conditions, like fractures, tumours, infection, or other congenital defects.

Imaging may also be performed from time to time after the diagnosis to monitor bone development and to detect joint damage.

Bone scan. This makes use of a small amount of radiation to emphasize the bones in a scanner. Other tests consist of:

• Urine tests. These look for the presence of blood or protein in the urine, indicating that kidneys are not working properly.
• Joint aspiration (arthrocentesis). A small sample containing synovial fluid is collected from a joint to see if crystals, bacteria, or viruses are present.

The main aim of the treatment is to reduce pain and stiffness and help the child lead a normal lifestyle. Treatment depends on certain factors like the child's symptoms, age, overall health, and severity of the condition. Treatment may include medicines such as:

• Nonsteroidal anti-inflammatory medicines (NSAIDs), in order to decrease pain, tenderness, and inflammation
• Disease-modifying antirheumatic medicines (DMARDs), such as methotrexate. 
• Corticosteroid medicines to control inflammation and reduce severe symptoms
• Medicines called biologics that hamper the body's inflammatory response. They are recommended if no other mode of treatment is working.

Other treatments and lifestyle changes are as follows:

• Physical therapy, to improve overall range of motion and sustain muscle and joint function
• Occupational therapy, in order to improve the ability to perform activities of daily life
• Nutrition counseling
• Regular examination of eyes to look for any early eye changes resulting from inflammation.
• Regular exercise and weight control management 
• Proper rest

Various serious complications result from juvenile idiopathic arthritis. But timely intervention and seeking appropriate medical attention can vastly reduce the risk of these complications, which are as follows:

• Eye problems. Some forms of arthritis result in eye inflammation. If this condition is left as such and without treatment, it causes cataracts, glaucoma, and even blindness.
• Eye inflammation frequently takes place even without symptoms, so it's important for children to be assessed regularly and thoroughly by an ophthalmologist.
• Growth problems. Juvenile idiopathic arthritis can interfere with the growth of the child and bone development. Some medications used for treatment, mainly corticosteroids, can also contribute to growth inhibition.
• Permanent damage to joints
• Pericarditis or pleuritis 
• Chronic arthritis and disability (loss of function)

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