The Impact of JA on Your Child’s Body
How does juvenile arthritis affect different parts of your child’s body?
By Mary Anne Dunkin
Height: Children with JIA may experience a reduction in growth rate due to inflammation from the disease and the use of corticosteroid medications to treat it. It is important to keep regular checkups with your child’s pediatrician to make sure she is growing as she should.
Eyes: Eye inflammation (uveitis) may occur without warning in children with JIA. Speak with your child’s doctor about the need for regular eye exams.
Mouth/jaw: More than half of children with JIA experience involvement of the temporomandibular joint (TMJ), or jaw joint, often without symptoms.
To minimize the potential for future chewing difficulties or facial deformities ask your child’s doctor about screening for jaw involvement. If jaw problems make brushing and flossing difficult, alert your child’s dentist and inquire about devices or techniques for making dental care easier.
Neck: Arthritis that affects the cervical spine can cause neck pain and stiffness. Swollen lands in the neck could be a sign of systemic JIA, or they could signal an infection or other problem. If your child is taking a medication that suppresses the immune system and experiences swollen glands or other signs of infection, let her doctor know right away.
Ankles/feet: The small joints of the feet are most likely to be affected by polyarticular arthritis. Enthesis-related arthritis often affects the heel. If your child has foot pain and difficulty walking, custom-made foot orthotics may help reduce pain and improve function.
Knees: The knees are commonly affected by oligoarticular arthritis and enthesis-related arthritis. If a knee is the only joint affected, doctors may give a corticosteroid injection to relieve inflammation without the side effects of oral anti-inflammatories.
Hands/wrists: The small joints of the hands, wrists and fingers are most likely to be affected in polyarticular arthritis. Sausage-like swelling of the fingers occurs with psoriatic arthritis. If hand involvement makes it difficult for your child to perform daily tasks, a physical or occupational therapist can recommend ways or devices to make these tasks easier. A therapist can also design splints to protect the joint and prevent contractures.
Hips: Hip involvement is associated with oligoarticular arthritis and juvenile spondyloarthopathy. When hips are involved, proper medical treatment as well as exercise and/or physical therapy are important for keeping your child active.
Shoulders and elbows: The shoulders and elbows are among the joints most commonly affected by oligoarticular JIA. Controlling the disease with medications can minimize damage to these joints. If involvement of these joints interferes with daily activity, ask for a referral to a physical or occupational therapist.
Back/spine: Back pain could be a symptom of enthesis-related arthritis, including juvenile ankylosing spondylitis, which may result in erosion of the sacroiliac joint (where the spine joins the hip bone) and overgrowth of bone in the spine that leads to fusing and stiffening. Proper medical treatment, as well as exercise, is important to help keep the spine mobile.
Major Organs Affected by JA
Skin: Many forms of juvenile arthritis can have skin effects, ranging from the faint salmon-colored skin rash characteristic of systemic JIA to the scaly rash of psoriatic arthritis. Letting your child’s doctor know about any skin symptoms can be helpful for both diagnosis and treatment.
Lungs: Systemic JIA can affect the lungs and other internal organs. Carefully following your child’s treatment plan will minimize the risk of any long-term damage to the lungs or other organs.
Heart: The heart, like the lungs, can be affected in systemic JIA. Your child’s doctor will tell you if an echocardiogram is needed. If the disease is well treated it should not cause any lasting damage to the heart.
Stomach: The medications your child takes for JIA may cause nausea and other stomach problems. Ask her doctor about ways to minimize stomach upset, such as taking with food or at a certain time of day.
Liver: One of the most commonly used drugs for JIA, methotrexate has the potential to cause liver damage. Careful monitoring is important to catch problems early so the dosage can be adjusted if necessary.
Intestines: Children with arthritis of the spine may also develop inflammation of the small intestine or colon. If your child has spinal involvement (spondyloarthropathy), let your doctor know if he experiences symptoms such as abdominal pain and diarrhea. Prompt treatment can minimize the risk to the intestines.
Reproductive organs: Juvenile arthritis can affect sexual development so that your child may go through puberty later than his peers. Immunosuppressive medications, such as cyclophosphamide (Cytoxan), which may be used in the treatment of lupus and other autoimmune diseases, can lead to problems with fertility later.