Doc Talk! Expert Answers to Juvenile Arthritis Questionsby Megan McMorris Health Writer
Arthritis was probably the last thing on your mind when you decided to have a kid. So when you hear your doctor say the A-word, it can feel overwhelming. The good news is that new treatments have come a long way. “The treatment for juvenile idiopathic arthritis (JIA) from the 1930s to the early ’80s was to hospitalize children for a month,” says Daniel J. Wallace, M.D., associate director of the rheumatology fellowship program at Cedars-Sinai Medical Center in Los Angeles. Hospitalize??? So, you know, progress. Still it’s natural to be worried. We asked our experts to answer common JIA questions to help put your mind at ease.
What Are the Main Symptoms of JIA?
Juvenile arthritis is not always easy to detect. Symptoms can be subtle or vary from one child to the next. “The most common presentation is a chronically swollen single large joint such as a knee,” says Amir Orandi, M.D., a pediatric rheumatologist at the Mayo Clinic in Rochester, MN. Your child may be happy and playful, but if you notice a limp or if they consistently avoid putting full weight on one leg, keep an eye on it. See your pediatrician for a diagnosis for any swollen joint that lingers.
What Are the Treatment Options for JIA?
In milder cases, your doctor may suggest topical treatments applied directly to affected joints or anti-inflammatory meds like ibuprofen. In more severe instances, they might prescribe disease-modifying anti-rheumatic drugs. “DMARDs are effective for half to two-thirds of people,” says Dr. Wallace. “You try it for 12 weeks to see if it works.” Another option: Biologic drugs, given as injections every week or two weeks. “Before biologics came out, 30% to 40% of children with arthritis would have severe deformities,” says Dr. Wallace. “Now it’s down to 10% to 20%.”
Are There Treatments Beyond Medication?
You bet! Your doctor will typically recommend physical or occupational therapy, which can help with strengthening, range of motion, and navigating everyday tasks. And remember, emotional support is a big part of treatment as well—for your child and the whole family. “Counseling is important to educate and support the family,” says Dr. Orandi. “There are a lot of resources that are written for both parents and children, online and in-person seminars and talks, and even camps where children can meet others like them.”
Can My Child Outgrow JIA?
Arthritis is a chronic autoimmune disease, so there’s not a “cure” per se—but remission (when symptoms disappear) can sometimes last for years. “It’s hard to put a number on it, but there’s definitely a subset of patients who will be in clinical remission and can actually be withdrawn from treatment altogether as adults,” says Dr. Orandi. “In the case of a younger child, some studies suggest that 30% of kids can achieve remission after therapy for 6 to 12 months.”
Are There Risks with Medication?
It’s natural to be cautious about giving medication of any sort to your child. But the pros far outweigh the cons, says Dr. Orandi. “These medications are very effective,” he says. “And the therapies are safe if administered appropriately and used judicially.” Don’t shy away from an Rx just because your child isn’t exhibiting major symptoms, either. “We used to use medication only in cases of deformity or severe mobility issues, but now we’re finding them so useful that we’re prescribing them in cases of prevention, too,” he says.
Will My Child Be Able to Play Sports?
We’ve come a long way since JIA treatment involved 30 days of bedrest, says Dr. Wallace. Now, doctors recommend the opposite approach: moving more. The Arthritis Foundation suggests activities like swimming, yoga, tai chi, cycling, and walking to help build muscles and increase joint range of motion. Depending on the severity of your child’s JIA, your doctor may also recommend physical therapy to help with mastering everyday activities like getting in and out of a bathtub, says Dr. Wallace.
Is There a Special Diet for JIA?
There’s no specific diet for juvenile arthritis, but certain anti-inflammatory foods like whole grains, berries, and fatty fish may soothe symptoms. In general, though, “the best diet is a balanced one for a growing child,” says Dr. Wallace. Herbs and spices, such as ginger, turmeric, and cinnamon may also be beneficial for pain or inflammation, but don’t fall for misleading claims that these ingredients can cure arthritis—they can’t. If you’re unsure whether a food will exacerbate symptoms, check with your child’s rheumatologist.
Where Do I Find a Juvenile Rheumatologist?
JIA is relatively rare—affecting approximately one in 1,000 kids, according to the National Institutes of Health—so finding a specialist can be tough. “There are about 7,000 board-certified rheumatologists in the U.S. and only 300 are pediatric rheumatologists,” says Dr. Wallace. “The main thing is to find a pediatrician who has access to a rheumatologist to guide them on treatment.” That’s where support groups can help a parent out: Try the Arthritis Foundation’s resources, where you can connect and compare notes with other families in your area.
Are There New Treatments Coming?
In a word: Yes! “We’re in a great new era of therapeutics for juvenile arthritis,” says Dr. Orandi. “Treatments are very dynamic, where we’re figuring out how they work in conjunction with each other.” Five years from now, that landscape may look quite different, he says, because of how quickly the science is evolving. “It’s an exciting time, because we’re able to treat the disease aggressively if we need to,” he explains. “These days, a child rarely reaches the point of serious disability.”