What is Juvenile Rheumatoid Arthritis?
Also known as juvenile idiopathic arthritis (JIA), juvenile rheumatoid arthritis (JRA) is the most common arthritic condition for children under 16 years of age. JRA causes joint swelling, pain and stiffness that can last anywhere from a few months to a lifetime, depending on the individual.
JRA is classified as an autoimmune disorder, a condition in which the body’s immune system attacks itself. When JRA appears in the spine, it can lead to a condition known as Juvenile Onset Ankylosing Spondylitis (AS).
What is Ankylosing Spondylitis?
Ankylosing spondylitis (AS) is an inflammatory disease of the spine that begins with painful swelling of the joints in the spine and pelvis that can eventually lead to fusion of the bones (vertebrae) in the spine. The vertebrae fuse when new bone forms in-between them and the spinal discs become hardened as the body attempts to heal itself. The fusion may result in a hunched-forward position and makes breathing difficult if the ribs become affected, as well.
Though the causes of this condition are unknown, it is believed that there may be a genetic predisposition. Many patients with AS have a blood test that is positive for a particular surface protein called HLA-B27. It has also been theorized that some cases of AS may be caused by a bacterial infection.
What Are the Symptoms of Ankylosing Spondylitis?
In the early stages, the most common symptoms are pain and stiffness in the lower back and hips, particularly after long periods of inactivity. Although AS primarily affects the spine, symptoms may not be limited solely to the joints since AS is a systemic disease. Symptoms may include:
- Eye inflammation
- Loss of appetite
- Lung and heart problems (in rare cases)
- Pain in the ligaments and tendons of the spine (this may also occur in the Achilles’ tendon located in the heel of the foot)
How Is Ankylosing Spondylitis Diagnosed?
After taking a medical history, the physician may perform a physical examination where patients may be asked to bend their back in certain directions to check flexibility. The physician may also measure their chest circumference (once when lungs are inflated, once when deflated) to assess chest compression. Patients might even be asked to stand upright and rest their head and heels against a wall to assess for abnormal curvature of the spine known as kyphosis; in patients with severe kyphosis this maneuver is not possible.
In addition, imaging tests, such as an X-ray or a magnetic resonance imaging (MRI) scan, may be used to aid in diagnosing the condition. There are also blood tests which can aid in diagnosis.
How Is Ankylosing Spondylitis Treated?
Though there is no known cure for AS, there are a variety of treatments available to manage the condition and keep it from causing permanent damage to the joints.
Medications – Non-steroidal, anti-inflammatory medications (both over-the-counter as well as prescription) are most commonly used to reduce the inflammation, pain and stiffness in the joints. Other medicines which have been used in the treatment of AS include TNF (tumor necrosis factor) blockers, Sulfasalazine and corticosteroids.
Physical Therapy – A physician may recommend physical and occupational therapy to help maintain function of the spine and minimize deformity based on individual needs. Activities, such as range-of-motion and stretching exercises can help maintain flexibility and proper posture, as well as manage pain and stiffness.
Surgery – Most patients living with AS do not require surgery for the condition. However, surgery may be recommended to those with severe and extensive joint damage and pain, especially in the hip. (Extreme damage in the hip may result in a hip replacement.)
Tips for Parents of Children With Ankylosing Spondylitis and Juvenile Rheumatoid Arthritis
Having a child with AS or JRA can present additional challenges for your child as well as your family. Below are some tips for managing life with a child affected by AS or JRA:
- Secure the best possible care. In addition to the care your child receives from the pediatrician, a pediatric rheumatologist should also see your child at least once or twice a year to ensure your child is receiving the best care for his/her condition.
- Educate yourself about how the disease affects your child specifically. There are a variety of treatment regimens available for managing AS. Talk to your physician if you see that your child isn’t improving with his/her current treatment plan and what alternative options may be available.
- Join a support group. Talking with other families that have children with AS will let you (and your child) know that you are not alone. You can also exchange tips on how to manage the condition.
- Encourage physical activity and therapy. Exercise is vital as it keeps the joints strong and flexible. During symptom-free periods, your physician may recommend that your child participate in a sport or physical therapy regimen.
At The Center for Musculoskeletal Disorders, our orthopedic spine specialists are vastly experienced in effectively treating those living with juvenile arthritis and ankylosing spondylitis. Our practice offers superior quality of care for patients living with these and other debilitating spinal conditions by utilizing innovative techniques and advanced technology.
For more information or to schedule an appointment with one of our orthopedic specialists, contact us today.