Arthritis: One of nation’s leading causes of disability

About 300,000 children in the U.S. have juvenile arthritis. It can affect children as young as 2. About 6000 children in North Dakota and Minnesota are affected, according to the Arthritis Foundation.

Juvenile arthritis is marked by swelling and pain in the joints, said Dr. Eric Lunn, pediatrician and chief medical executive at Altru Health System in Grand Forks, as well as their growth and long-term function. It can lead to destruction of the joint. Some patients can develop inflammation in the eye which can result in blindness.

The medical community believes the cause of the juvenile arthritis is related to a particular genetic make-up or a person’s predisposition to the disease, he said.

This theory makes juvenile arthritis similar to other autoimmune diseases such as diabetes, thyroid and celiac disease, and multiple sclerosis, he said.

In autoimmune diseases, the body basically becomes confused and attacks itself.

“With juvenile arthritis, if one sibling has it, other siblings are likely to get it,” he said. Those who are predisposed to the disease may never actually acquire it if they avoid the particular environmental element that triggers it.

Seeking answers

Researchers, whose work is funded by the National Institutes of Health, the federal government’s primary health research enterprise, are trying to identify specific genes that may play a role in causing the disease.

Advances in medications, especially a class of drugs called “biologics,” in the past 10 years have given doctors another option besides steroids to treat patients.

“These drugs shut off the inflammation pathway and prevent the production of chemicals that cause inflammation (and therefore pain) before it even gets started,” Lunn said.

Steroids are “very good” in treating juvenile arthritis, he said, “but they have such bad side effects. They are not good to use long-term.” Steroids have been linked with cancer risk.

A multidisciplinary approach should be used in treating patients with juvenile arthritis, Lunn said. Health professionals — including family physicians or pediatricians, eye doctors, occupational and physical therapists, psychologists — should work together, and in tandem with the schools, for the good of their patients.

Psychologists can help kids who may have trouble, or become depressed, dealing with a disease that may prevent them from joining in activities with their peers.

Staying physically active

In his medical practice, Lunn has 10 patients with juvenile arthritis, he said. They range in age from 3 to 18.

He recommends not limiting patients’ physical activity.

“If there’s a big flare-up in the knee, for example, they may need to slow down,” said Lunn whose practice includes high school athletes in gymnastics, volleyball and other sports. “But we don’t want them to be playing video games.” Physical activity has been shown to be beneficial. “Swimming is an excellent sport for kids with juvenile arthritis,” he said. “It’s easier on the joints.”

When adolescent patients go through puberty, “a lot of them go into remission,” Lunn said. “It could be related to hormones or something else that we don’t know.”

Systemic juvenile arthritis, which Tori Byklum has, is one of three types of juvenile arthritis. It involves one or more joints and affects 10 to 20 percent of all patients with the disease. It’s characterized by a high spiking fever, a rash and pain.

Boys and girls are equally affected by systemic JA, and diagnosis is usually made between the ages of 5 and 10.

Pauciarticular JA, the most common and least severe type, affects fewer than four joints, usually knee, ankle, wrist or elbow. About 40 to 60 percent of JA patients have this type. Polyarticular JA affects about 40 percent of all JA cases and involves five or more joints simultaneously. More girls than boys are diagnosed with this form of JA, and it’s most common in children as old as 3 or after age 10.

Arthritis is one of the nation’s leading causes of disability.

Call Knudson at (701) 780-1107; (800) 477-6572, ext. 1107; or send e-mail to pknudson@gfherald.com.

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