What is arthritis and what are its symptoms in children?
The term arthritis simply means inflammation (swelling, warmth, redness, pain at rest or motion of a joint). With the child’s age, the symptoms of arthritis vary. Since, a child learns to express and localise his pain only at the age of four, new-borns with arthritis (Yes, new-borns too!) may just manifest irritability and excessive crying. Infants may cry or wince when an affected limb is touched or stop moving that limb (pseudo paralysis pseudo = false). Toddlers may show preferential movement of one limb. For eg: When holding their hand out to wear a vest / tee shirt or may exhibit a limp. The school-goer localises the site and extent of the pain.
Is arthritis in children a single disease?
Arthritis can cause by a large number of diseases in children. The causes range from the most benign such as joint hypermobility to the most sinister such as leukaemia or blood cancer. Illustrative causes of arthritis include infections due to bacteria (septic arthritis or tuberculosis), viruses (dengue or chikungunya) or parasites (filarial) or post infectious causes such as rheumatic fever, transient arthritis of the hip, post dysenteric reactive arthritis. Blood disease such as hemophilia, sickle cell disease or leukemia, deficiency diseases such as Vitamin C or D deficiency, hereditary and genetic diseases, bone tumors, trauma may also present as arthritis.
A very large group of arthritis in children is caused by auto immune diseases such as lupus, Dermatomyositis, scleroderma etc and by diseases where the blood vessels of the body are inflamed eg: Kawasaki disease, Henoch Schonlein purpura and so on. Finally, there is a big group of children in whom the cause of arthritis remains unexplained and the disease goes on beyond 6 weeks. These children suffer from juvenile idiopathic arthritis formerly called juvenile rheumatoid arthritis.
How common is arthritis in children in India?
There are no official statistics available. But acute and sub-acute arthritis(less than 6 weeks of disease) are fairly common in a paediatricians clinic. The more long standing forms of arthritis are less common but yet using global prevalence estimates as done by an article in the Indian Journal of Pediatrics in 2008 and applied to population figures today would yield a figure of at least 4,00,000 ( yes! four lakh children) with chronic arthritis disorders.
Indeed, after the eradication of polio, arthritis disorders are now the commonest cause of acquired physical handicap in children. Many children are not being diagnosed or are diagnosed late being lost in the maze of wrong referrals.
How is the cause of arthritis in children diagnosed?
The family physician followed by the paediatrician is usually the first stop for an afflicted child. Cases needing a further work up should be referred to a rheumatologist (preferably a child rheumatologist).Orthopaedic surgeons (adult or child) deal with bones and deformities rather than with joints and this area does not come within their purview.
Fortunately, rheumatology is a very bedside oriented discipline, with most of the diagnosis being made by listening and looking carefully, by a rheumatologist Investigations, through blood and imaging to help to corroborate or rule out diagnosis.
What is the treatment of arthritis in children?
Luckily, this is a very gratifying branch of medicine with outcomes ranging from cure to complete control with excellent quality of life. The first principle consists of treating the identified cause as mentioned above.
For other more chronic diseases, drugs are available and the armamentarium in India just as in the West. Most of the drugs are at affordable rates though a few patients at the severe end of the range may need expensive therapy (but the costs of these are falling too). Non-steroidal anti- inflammatory drugs, steroids in various forms (oral, intraarticular intravenous) and a family of drugs called DMARDs and immunosuppressive are used. Many of these drugs need to be used with care and caution under skilled supervision.
Children with arthritis may also need multidisciplinary care with support from a physiotherapist or occupational therapist, ophthalmologist (there being a link between joints and eyes in some diseases) or an orthopaedic surgeon to correct deformities.
Alternative systems of medicine like homeopathy, ayurveda and so on have no scientifically proven role and may delay rational therapy.
Are any forms of arthritis in children preventable?
Unfortunately, there are no preventable strategies for arthritis disorders in children.
Any other issues the parents should keep in mind…
There is no link with diet, season, weather etc. Encourage a healthy mental outlook to chronic illness, drugs and doctor visits on time, maintain records, continue schooling and all activities and think positive.
The author is Director of Pediatrics and in-charge Ped Rheumatology Clinic, Jaslok Hospital and Research Center