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Complementary Therapies for JA: Try This, Not That

Not every complementary therapy is right for children with arthritis. Find out which ones to try and which ones to avoid.

By Mary Anne Dunkin

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Many families are turning to complementary therapies to help ease the pain of their children with arthritis. But not all complementary therapies are effective or even safe for kids. Here’s what you need to know about the different options.

Exercise. Research shows that regular exercise is both safe and beneficial for kids with arthritis. It can improve muscle strength, joint range of motion, cardiovascular health and pain levels. It can also build bone – and self-esteem. A 2013 Swedish study published in the online journal Pediatric Rheumatology found that exercising three times per week for 12 weeks, with free weights, core exercises and jumping rope can improve both physical and mental health in children with juvenile arthritis without increasing pain scores.

Of all the non-medication therapies, exercise is the one University of Alabama at Birmingham pediatric rheumatologist Timothy Beukelman, MD, recommends the most for young patients. “It is important to stay active and exercise is good for everyone,” he says.

Children with arthritis should avoid high-impact sports such as gymnastics or jumping on a trampoline, says Laura Schanberg , MD, co-chief of the Division of Pediatric Rheumatology at Duke University School of Medicine. “If you have arthritis, your joints are weaker and you are more likely to injure yourself,” she says. If your child is interested in participating in sports, first speak with his or her rheumatologist.

Mind-body therapies. Mind-body therapies, such as deep breathing, progressive muscle relaxation, guided imagery and self-hypnosis, have long been used by adults with arthritis to relax the body and distract the mind from pain. Two small studies by Northwestern University Medical School, Children’s Memorial Hospital Chicago  and Schneider’s Children’s Hospital of Long Island Jewish Medical Center), dating back to the early 1990s, show they may improve pain intensity in children with juvenile arthritis, and cause no negative side effects. A physical therapist, psychologist, social worker, or counselor can teach your child to perform relaxation exercises, says Dr. Schanberg.

Water therapy. For children with juvenile arthritis, soaking in a warm tub – with or without jets – is a good way to limber up stiff joints in the morning and relax tight, aching muscles at bedtime. If pain or stiffness makes it difficult for your child to exercise, a warm shower can relieve pain and stiffness to make gentle exercises easier.

Massage. One of the most-studied complementary therapies for children with arthritis, massage relaxes muscles, lessens pain and improves circulation. As far back as 1997, a study out of the University of Miami School of Medicine found that a daily 15-minute massage from a parent for 30 days decreased anxiety levels, blood levels of the stress hormone cortisol, pain and morning stiffness in children with JIA. If you are interested in learning massage, Dr. Schanberg recommends speaking with your child’s physical therapist or a massage therapist. Also, she advises against relying too heavily on massage for older children, because it requires the help of a parent, and older children can learn techniques they can perform on their own such as relaxation and guided imagery. “If child learns to manage pain on their own, that is an empowering thing,” she says.

Calcium and vitamin D supplements. Adequate calcium intake is crucial to bone growth in all children with JIA, but particularly for those using corticosteroids, which put them at risk of osteoporosis. The Recommended Dietary Allowances (RDAs) for calcium are 1,000 mg per day for 4- to 8-year-olds and 1,300 mg for 9-to-18-year-olds. If your child doesn’t get enough calcium through diet alone, speak to her doctor about a calcium supplement. In two studies out of Cincinnati Children's Hospital Medical Center, children who received calcium supplements experienced statistically significant increases in bone mineral density – and lower levels of markers showing bone loss – compared to children who received a placebo. Similarly children who are deficient in vitamin D, which is required by the body to use calcium properly to build strong bones, should receive a vitamin D supplement and have some exposure to sunlight, which enables the body to synthesize the vitamin. Your child’s doctor can run a test for vitamin D deficiency.

Acupuncture/Acupressure. A 2008 review of acupuncture in children from the National Center for Complementary Medicine, National Institutes of Health, found evidence that acupuncture is generally safe in children, but that trials of acupuncture for musculoskeletal pain in children have been inconclusive. Furthermore, acupuncture is more complicated in children than in adults due in large part to their fear of needles, says Karine Toupin April, PhD, a research scientist at the Children’s Hospital of Eastern Ontario in Canada, whose work has focused on the use of complementary and alternative therapies in pediatrics.

Acupressure, an alternative, which involves applying pressure, instead of needles, at acupuncture locations, seems to be well accepted by younger children, she says. 

Elimination diets. While people often associate different foods with worsening of their arthritis symptoms, research has failed to show the benefits of eliminating certain foods from the diet. For that reason, most pediatric rheumatologists, including Drs. Schanberg and Beukelman, advise against them. Furthermore, for children, elimination diets can be particularly difficult, especially if their favorite foods are suspected to worsen their arthritis, says Toupin April.  If you would like to try an elimination diet, she recommends doing so only after trying other options, including massage, exercise and even acupressure.  Because good nutrition is particularly important for children with chronic diseases, work with your child’s doctor ensure the elimination diet does not eliminate nutrients your child needs.

Herbal products. Just because a product is natural doesn’t necessarily mean it’s safe. “Herbal products are made in factories just like pharmaceutical products, but unlike pharmaceuticals they are not tested or regulated by the Food and Drug Administration,” says Dr. Schanberg.

Furthermore, some herbal products can be harmful, particularly if combined with certain medications, says Toupin April. Research shows that echinacea, for example, can make methotrexate and corticosteroids less effective. Other herbs, including St. John’s Wort, garlic and Ginko biloba, may cause excessive bleeding or interact with anesthesia in children undergoing surgery, she says.

Before beginning any herbal therapy, it is important to speak with your child’s doctor to make sure there is no conflict with the medications your child is taking.

Bee venom. Although there is some evidence that venom from bee stings – or bee venom given through acupuncture – reduces inflammation in rheumatoid arthritis in adults, the practice is controversial – even for adults. Few doctors would recommend bee stings for children. They are difficult, painful and put your child at risk of a potentially fatal allergic reaction. In short, they should be avoided, says Dr. Schanberg.

Glucosamine and chondroitin. These popular supplements that are used by some adults for osteoarthritis have not been tested for children with JIA, “I don't think there is sufficient evidence to warrant the use of glucosamine or chondroitin,” says Toupin April.

Dr. Schanberg sometimes recommends these supplements for children with longstanding JIA that has caused secondary degenerative arthritis.

But for children with active JIA, the best advice, of course, is to take the prescribed medications to prevent destructive arthritis in the first place, says Dr. Beukelman.

 

 

 

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Complementary Therapies for JA: Try This, Not That

Not every complementary therapy is right for children with arthritis. Find out which ones to try and which ones to avoid.

By Mary Anne Dunkin


Many families are turning to complementary therapies to help ease the pain of their children with arthritis. But not all complementary therapies are effective or even safe for kids. Here’s what you need to know about the different options.

Exercise. Research shows that regular exercise is both safe and beneficial for kids with arthritis. It can improve muscle strength, joint range of motion, cardiovascular health and pain levels. It can also build bone – and self-esteem. A 2013 Swedish study published in the online journal Pediatric Rheumatology found that exercising three times per week for 12 weeks, with free weights, core exercises and jumping rope can improve both physical and mental health in children with juvenile arthritis without increasing pain scores.

Of all the non-medication therapies, exercise is the one University of Alabama at Birmingham pediatric rheumatologist Timothy Beukelman, MD, recommends the most for young patients. “It is important to stay active and exercise is good for everyone,” he says.

Children with arthritis should avoid high-impact sports such as gymnastics or jumping on a trampoline, says Laura Schanberg , MD, co-chief of the Division of Pediatric Rheumatology at Duke University School of Medicine. “If you have arthritis, your joints are weaker and you are more likely to injure yourself,” she says. If your child is interested in participating in sports, first speak with his or her rheumatologist.

Mind-body therapies. Mind-body therapies, such as deep breathing, progressive muscle relaxation, guided imagery and self-hypnosis, have long been used by adults with arthritis to relax the body and distract the mind from pain. Two small studies by Northwestern University Medical School, Children’s Memorial Hospital Chicago  and Schneider’s Children’s Hospital of Long Island Jewish Medical Center), dating back to the early 1990s, show they may improve pain intensity in children with juvenile arthritis, and cause no negative side effects. A physical therapist, psychologist, social worker, or counselor can teach your child to perform relaxation exercises, says Dr. Schanberg.

Water therapy. For children with juvenile arthritis, soaking in a warm tub – with or without jets – is a good way to limber up stiff joints in the morning and relax tight, aching muscles at bedtime. If pain or stiffness makes it difficult for your child to exercise, a warm shower can relieve pain and stiffness to make gentle exercises easier.

Massage. One of the most-studied complementary therapies for children with arthritis, massage relaxes muscles, lessens pain and improves circulation. As far back as 1997, a study out of the University of Miami School of Medicine found that a daily 15-minute massage from a parent for 30 days decreased anxiety levels, blood levels of the stress hormone cortisol, pain and morning stiffness in children with JIA. If you are interested in learning massage, Dr. Schanberg recommends speaking with your child’s physical therapist or a massage therapist. Also, she advises against relying too heavily on massage for older children, because it requires the help of a parent, and older children can learn techniques they can perform on their own such as relaxation and guided imagery. “If child learns to manage pain on their own, that is an empowering thing,” she says.

Calcium and vitamin D supplements. Adequate calcium intake is crucial to bone growth in all children with JIA, but particularly for those using corticosteroids, which put them at risk of osteoporosis. The Recommended Dietary Allowances (RDAs) for calcium are 1,000 mg per day for 4- to 8-year-olds and 1,300 mg for 9-to-18-year-olds. If your child doesn’t get enough calcium through diet alone, speak to her doctor about a calcium supplement. In two studies out of Cincinnati Children's Hospital Medical Center, children who received calcium supplements experienced statistically significant increases in bone mineral density – and lower levels of markers showing bone loss – compared to children who received a placebo. Similarly children who are deficient in vitamin D, which is required by the body to use calcium properly to build strong bones, should receive a vitamin D supplement and have some exposure to sunlight, which enables the body to synthesize the vitamin. Your child’s doctor can run a test for vitamin D deficiency.

Acupuncture/Acupressure. A 2008 review of acupuncture in children from the National Center for Complementary Medicine, National Institutes of Health, found evidence that acupuncture is generally safe in children, but that trials of acupuncture for musculoskeletal pain in children have been inconclusive. Furthermore, acupuncture is more complicated in children than in adults due in large part to their fear of needles, says Karine Toupin April, PhD, a research scientist at the Children’s Hospital of Eastern Ontario in Canada, whose work has focused on the use of complementary and alternative therapies in pediatrics.

Acupressure, an alternative, which involves applying pressure, instead of needles, at acupuncture locations, seems to be well accepted by younger children, she says. 

Elimination diets. While people often associate different foods with worsening of their arthritis symptoms, research has failed to show the benefits of eliminating certain foods from the diet. For that reason, most pediatric rheumatologists, including Drs. Schanberg and Beukelman, advise against them. Furthermore, for children, elimination diets can be particularly difficult, especially if their favorite foods are suspected to worsen their arthritis, says Toupin April.  If you would like to try an elimination diet, she recommends doing so only after trying other options, including massage, exercise and even acupressure.  Because good nutrition is particularly important for children with chronic diseases, work with your child’s doctor ensure the elimination diet does not eliminate nutrients your child needs.

Herbal products. Just because a product is natural doesn’t necessarily mean it’s safe. “Herbal products are made in factories just like pharmaceutical products, but unlike pharmaceuticals they are not tested or regulated by the Food and Drug Administration,” says Dr. Schanberg.

Furthermore, some herbal products can be harmful, particularly if combined with certain medications, says Toupin April. Research shows that echinacea, for example, can make methotrexate and corticosteroids less effective. Other herbs, including St. John’s Wort, garlic and Ginko biloba, may cause excessive bleeding or interact with anesthesia in children undergoing surgery, she says.

Before beginning any herbal therapy, it is important to speak with your child’s doctor to make sure there is no conflict with the medications your child is taking.

Bee venom. Although there is some evidence that venom from bee stings – or bee venom given through acupuncture – reduces inflammation in rheumatoid arthritis in adults, the practice is controversial – even for adults. Few doctors would recommend bee stings for children. They are difficult, painful and put your child at risk of a potentially fatal allergic reaction. In short, they should be avoided, says Dr. Schanberg.

Glucosamine and chondroitin. These popular supplements that are used by some adults for osteoarthritis have not been tested for children with JIA, “I don't think there is sufficient evidence to warrant the use of glucosamine or chondroitin,” says Toupin April.

Dr. Schanberg sometimes recommends these supplements for children with longstanding JIA that has caused secondary degenerative arthritis.

But for children with active JIA, the best advice, of course, is to take the prescribed medications to prevent destructive arthritis in the first place, says Dr. Beukelman.