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There are three main types of juvenile arthritis: pauci-articular, poly-articular and systemic.
- Pauci-artricular juvenile arthritis usually starts very slowly, at age two or three, and symptoms are limited to four or fewer joints (usually the large joints such as knees, ankles or elbows) which become inflamed and painful. The child’s eyes can also be affected by a condition known as iridocyclitis, which is inflammation in the front of the eye.
- Poly-articular juvenile arthritis affects five or more joints (often in the hands or feet) and can start at any age. It usually spreads from one joint to another quite quickly. Children with this type of arthritis may often feel unwell and suffer from a fever or a rash.
- Systemic juvenile arthritis affects the whole body and causes fevers and rashes as well as swollen joints. It can also affect the internal organs. Systemic disease usually starts in pre-school children and is also known as Stills disease.
Arthritis in children is usually referred to as juvenile idiopathic arthritis, although it used to be known as juvenile chronic arthritis. About one in a thousand children has arthritis. Some will be more severely affected than others and most will have periods of remission, when symptoms will be mild, interspersed with more acute periods. In some children, it can change from day to day. Periods when the arthritis is particularly active are called flares.
Juvenile arthritis is not contagious and is thought to be an auto-immune disease. Falls and sudden changes in temperature can aggravate the condition and, in some cases, it is important to try to avoid contact with some childhood illnesses, especially chickenpox.
During a flare, the child will probably be reluctant to use the joints, limping or showing reluctance to walk for example, or to use both hands for a task. Stiffness is also a feature. When a joint is inflamed, the child will probably be most comfortable if the joint is rested in a bent position, but it will need to be straightened from time to time to prevent damage. Some children will eventually outgrow their arthritis, but others will develop joint damage and can have difficulties, often getting worse, into adult life.
Children with juvenile arthritis may:
- suffer from stiff and often painful joints, which inhibit their movements
- suffer from infections in their eyes
- have difficulties in concentrating and lack energy due to their medication, which has to be stronger during flares
- feel frustration, when in remission, at not being allowed to jump and climb when they want to in order to protect their vulnerable joints
- require daily physiotherapy, often more than once a day.
It will be important to follow medical advice and to work closely with the physiotherapist and the child’s parents. Strategies at school may include
- exercises to flex and strengthen joints
- adapting PE sessions for the child so as to avoid movements which will aggravate the arthritis or put too much pressure on affected joints
- helping the child with any problematic activities, such as using scissors
- protecting the child at playtimes from others bumping into them or from falls
- ensuring that the child’s parents are always notified if any classmates are suspected of having chickenpox or other illness that should be avoided.
Children’s Chronic Arthritis Association (CCAA)
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