How do children develop arthritis?

We don't know. We don't know why people get long-term or chronic arthritis. For some reason, the immune system goes into overdrive and starts to attack body tissues. In rheumatoid arthritis, the tissue that is attacked is joint tissue.

Is arthritis the same in children as it is in adults or does it take on a different set of problems, symptoms, etc.?

There are different types of arthritis that occur in children that are distinct from adult types. General points about children with arthritis are that they have a better chance of outgrowing arthritis, have a much lower chance of disability, and many types of arthritis will show up in one or two joints only. There is overlap in the types. Some children can get a form identical to adult rheumatoid arthritis. Most cases of arthritis occur in girls/women, and we don't understand why that tendency occurs. In childhood arthritis, the most typical kind is called JRA - juvenile rheumatoid arthritis. It will occur around age four to five.

What are the symptoms for which a parent should watch? Are there any hard & fast rules in this area?

Worrisome symptoms to watch for would be persistent symptoms, symptoms that last for several weeks. Those symptoms would include stiffness in the morning that is prolonged. Other symptoms would be persistent swelling of joints or persistent aching in joints. One hard and fast rule is unusual symptoms and persistent symptoms. Other symptoms would be fatigue, weight loss, fevers.

Does the arthritis in a child continue into adulthood?

In most cases it can, or will, remit. Most cases are very treatable. About one in 1000 children will get JRA. Children can also develop a temporary or transient arthritis after a viral illness. This is not a serious problem and will last only a week or two.

In your previous response, you said that the immune system attacks body tissue--such as with rheumatoid arthritis. What are the mechanics of it & how does it affect children?

In terms of the immune system, that is a very complicated question. The best place would be to go to a reference book. The mechanics of the immune system are very complicated and is better found in a reference book. The Arthritis Foundation has very good references. It is very, very complicated, to say it briefly.

What is the treatment for childhood arthritis, and how can it be put in remittance? Can adult arthritis be put into remittance?

The important thing to remember with childhood and adult rheumatoid arthritis is that we cannot cure this. They are very treatable. The person with arthritis should be evaluated and treated by someone with experience. The choice of treatments and medications has to be developed on an individual basis and a plan worked out with the patient and after a lot of discussion. Treatments would include control of pain and preservation of the joint function. The choice of medications will depend on how severe the arthritis is and the person's general health or other health problems. The medications are the same. Many are approved to work in children as well. The dose for the children would be based on their weight.

Are the same medications used in children as in adults?

The medications are the same. Many are approved to work in children as well. The dose for the children would be based on their weight.

Have any "triggers" other than viruses been identified for arthritis--or is that pretty much the cause?

We don't know the cause of chronic arthritis. We don't know why it is more common in females. We don't know what in a person's life triggers this process. My guess is that we will find many triggers and particularly for the childhood forms, there will be many causes. Until we know causes, we will not have cures I think.

Are there preventative measures one can take?

We don't know. I recommend people just do things that are common sense, take good care of themselves, eat healthy, and exercise. We can prevent old age arthritis in terms of staying fit and trim, and keeping our weight normal. However, rheumatoid arthritis involves inflammation and we don't know how to prevent the inflammation from starting.

How can it be treated when causes aren't known? Seems difficult.

We don't know causes of many diseases including diabetes, and I could list another 100 diseases. However, we can treat many, many diseases very well. We know the immune system is involved. We have good medications to control the immune system. Again, the medications would depend on how severe the arthritis is. Another important point is that not all medications work for everyone; there are no perfect medications.

Is rheumatoid more serious than other types of arthritis?

The short answer is yes. This is a type of arthritis that occurs in very young people. Untreated, the adult form can result in half of patients having disability to the point they can no longer work. Rheumatoid arthritis is second only to back pain as a cause of disability. It should be taken seriously and should be seriously managed. It is a very treatable condition. Someone with a lot of experience who knows the medications and knows the individual should handle the person. With treatment, we can prevent disability. A general comment is that this decade, we have had major advances in understanding the immune system and major advances in developing medication. I am very optimistic about management of rheumatoid arthritis.

Is there treatment for JA that is not medicinal?

Yes there are treatments that are not medicinal including physical therapy, exercise, appropriate nutrition, and stress reduction. Not every child necessarily will need medicine. It is important to get accurate information and not be afraid of the medications. Also, participate carefully in a decision about which medicines are needed. Children are very healthy and do very well with medicines. I would not hesitate to treat a 2 year old with strong medications if that child needed those medications for arthritis.

Can Lyme Disease cause JA?

No. If the person has Lyme disease, then the treatment would focus on antibiotics. The two diseases can look very similar. Lyme disease can cause joint symptoms.

What is JA?

JA refers to arthritis occurring in juveniles, that is children under 16. In the US, we call it JRA or juvenile rheumatoid arthritis. This refers to persistent arthritis lasting many weeks to months. JA refers to arthritis where we have not found other causes such as Lyme. JRA has three distinct types. Each distinct type has a very characteristic outcome. Further information can be obtained from reference sources.

Can it be helped by moving to warmer climates, as some older arthritis patients do?

Patients feel better in comfortable environments. However, there are three pediatric rheumatologists in Hawaii. This disorder occurs worldwide. A change in climate will not cure the arthritis. This is a common question, and I tell parents to do what is best for the family. An important point when a child gets arthritis is also to not let the arthritis run the family. The child needs to do all the normal things children do. The child needs to go to school and needs the normal development of all children. These are healthy children and should be treated as healthy children and encouraged to do sports and encouraged to plan a future that is appropriate.

Can you tell us about the three distinct types of JA?

The most common type which occurs in half of children is pauciarticular. This refers to arthritis in four or fewer joints. It has the best outcome. 80 to 90 percent of children will outgrow the arthritis and have no disability. There is a chance the pauciarticular type can get inflammation in the eye. Reference books could tell you more about that. The next most common type is polyarticular. This refers to arthritis in many joints. Some of these children look very similar to adult rheumatoid arthritis. These children do well but some can go on to permanent joint damage. The third type which is one in 10 JRA patients is called systemic. These children have a very dramatic onset with very high fever and rashes and it might be months before they develop arthritis. Usually they develop arthritis in many joints. The systemic type would be the one most likely to require the child to be in the hospital, especially when the condition first starts.

I have also heard about Ankylosing Spondylitis. Can you explain this one too?

Ankylosing spondylitis (AS) is a type of arthritis that occurs in the spine. In contrast to rheumatoid arthritis, AS is more common in men. It can show up in children and look like pauciarticular JRA. There are groups of arthritis that are seen in spondylitis and the group name is spondyloarthropathy. The Arthritis Foundation has a good references or a standard medical textbook can go through some of the finer points of the spondyloarthropathy conditions. Treatments are similar. Again, it would be decided on an individual basis.

Another point to remember is to not give up. If one treatment does not work, make a plan and try another treatment. Be persistent with the person taking care of your arthritis and agree on whether or not the treatments are working or whether or not they are right for you. I am a big believer in people participating very actively in their treatment. They should be with someone they feel comfortable with who will answer their questions and respect their choices. My personal opinion on the natural remedies is that they are not strong enough. Most of them are safe, but do your own thinking and research and ask lots of questions before trying one of them. I don't prescribe natural remedies because I don't think they are strong enough but am very willing to work with patients who want to try them. Another point is don't hesitate to get a second opinion if your arthritis is not doing well. Sometimes a second point of view can be very useful.