Q. I am the mother of a 20-year-old son diagnosed with psoriatic arthritis and rheumatoid arthritis at age 15. What are your thoughts on alternative or natural treatment options. Previously he has taken methotrexate and Enbrel. At least 50-60percent of his body, head and face is involved with severe plaques.
A. Complementary medicines can be a helpful adjunct for the treatment of arthritis but none have been shown to change the natural course of the arthritis as the medications you mentioned can do. Most of the complementary medications have not been subjected to the rigorous study using a comparison of a group on the drug to a group taking nothing or another drug with careful outcome measures. I would look into the Alternative Treatments for Arthritis: An A-to-Z Guide published by the Arthritis Foundation and check with your physician if he/she has any suggestions as to what can be added to the well proven treatments you have mentioned.
Q. My seven year old daughter has had systemic juvenile rheumatoid arthritis since age three. We had been told that she had a severe case, with all of her large joints affected. She has remained stable for 2 1/2 years, with some abnormal lab results but no joint symptoms. She is on Humira and methotexate. Is it still possible that she may go into permanent drug-free remission, or does the severity and length of her disease indicate that she may have JRA for her lifetime?
A. The course of systemic juvenile rheumatoid arthritis is varied but most of those who will go into a permanent drug free remission tend to do so in the first year and then less than a quarter of those with continued active arthritis will do so later. The more severe the case and the more difficult it is to bring on a lessening of symptoms and normalizing of lab tests with medications means there is less of a chance for a drug-free remission. The key here is to do as you have done by treating her early with drugs that can alter the natural history of her arthritis, which will allow her to be like her friends without arthritis and have an active life.
Q. My daughter was diagnosed in 2004 with systemic JRA. She is flaring now and even the steriods are bringing little relief. She has her worst flares in the summers. How do we find out if she is really systemic JRA or possibly lupus?
A. Thank you for your question. Lupus and systemic juvenile rheumatoid arthritis can have some symptoms that are similar but many are different. For example, people with systemic juvenile arthritis do not have kidney involvement which is common in people with lupus. In addition most people with lupus have white blood counts that are low whereas a person with systemic juvenile arthritis usually has white blood counts that are elevated. People with lupus also have other laboratory tests such as a positive anti-DNA antibody and low C3 and C4 complement levels both of which are not seen in systemic juvenile arthritis. The diagnosis of lupus is a combination of taking a careful history, looking at the findings on physical exam and completing a series of specific laboratory tests. To learn more about lupus, order the Arthritis Foundation's Lupus brochure.
Q. I am 34 and was recently diagnosed with rheumatoid arthritis. Both my maternal grandparents had it. What are the chances my 9-year-old son may get it? What signs should I look for?
A. Genetics play a role in the cause of rheumatoid arthritis but research has not clarified exactly how much of a role it plays. When many family members have it, the stronger the genetic component. As there is no way to predict who in the family will get arthritis, paying close attention to the warning signs of arthritis is important so treatment can be started early. The arthritis warning signs for inflammatory arthritis are morning stiffness, joint swelling, tenderness and pain and limited motion of a joint. If these symptoms appear, have your son evaluated by a pediatric rheumatologist.
Q. My 13 year old daughter was recently diagnosed with juvenile spondyloarthropathy. Her blood work is essentially normal, although she is HLA-B27 positive. We do have a strong family history of ankylosiing spondylitis. She began physical therapy this week, and the therapist noted that her left sacroiliac joint was misaligned. He gently manipulated it back into place, and she had an immediate, although temporary, reduction in pain and improvement in walking. Could inflammation cause the sacroiliac to become misaligned? Is this typical in spondyloarthropathies? I know that chiropractic care is not advisable, but is this kind of joint manipulation OK? They will be working on exercises to strengthen this area.
A. Inflammation of the sacroiliac joint is common in spondaloarthropathies and mainly affects the lower third of the sacroiliac joint. Often with inflammation, the muscles, tendons and ligaments become tight and stiff and moving or manipulating the joint will stretch the surrounding muscle, tendons and ligaments resulting in some relief. As one can injure the surrounding tissues of the joint, it is important to check with your physician before moving a joint through any extreme motion. It is better for the tissues to be stretched and strengthened with gentle and graduated exercises.
Q. My 5-1/2-year-old daughter was diagnosed with juvenile rheumatoid arthritis (JRA) when she was 19 months old. My question is what are your thoughts on milk allergies related to JRA. The reason I ask is that I have a 2-1/2-year-old son who is highly allergic to milk, and I have stumbled across some articles on the Internet linking food allergies with JRA symptoms. My daughter’s primary drinks are milk and water; she is not a juice or soda drinker. I am considering testing my daughter for this allergy even though she does not manifest any of the symptoms related to this allergy.
A. You ask an interesting question. Allergies can cause many of the symptoms that appear similar to JRA but may not be the cause JRA. Most children with JRA do not have milk allergies. If you have withdrawn the milk products and your daughter’s symptoms continued, an allergy is unlikely. Before you have your daughter tested for a milk allergy, understand what positive and negative results would mean. Sometimes showing an allergy by a skin test may have nothing to do with her primary problem, arthritis. Also, milk is the major source of calcium which is an important building block for her bones and she will need to take calcium if she can not drink milk or eat dairy products.
Q. Question about macrophage activation syndrome. Our daughter is having a "flare-up," and we have received this diagnosis. I tried to find more information on this online, but the terminology is too technical. Could you give us a basic explanation?
A. Macrophage activation syndrome is an unusual complication of juvenile arthritis and comes when the inflammatory process becomes markedly increased resulting in the worsening of many symptoms such as fevers, low blood pressure, low white cell counts, liver function abnormalities, and abnormal blood clotting. Often the most difficult aspect of this is to differentiate it from juvenile arthritis, which luckily you doctor has already done. Prompt treatment is necessary.
Q. My 2 year old was diagnosed with JRA. I have a few questions. Does JRA ever just “go away”? Could she outgrow it? Is taking Naprosyn for two months straight risky? She had a butterfly rash, but doesn’t any longer. The rash lasted for two months. Our doctor said that she does not have lupus since her ESR was negative. Why would she have had the classic lupus “butterfly” rash then? If the ESR was negative can I positively rule out lupus?
A. Thank you for your excellent question. JRA can just “go away” but in many cases it remains active into adulthood. Over 50 percent of children with JRA still have arthritis in adulthood but the arthritis may wax and wane throughout childhood and some children spontaneously may have several months to years of remission as they grow up and then have the arthritis return when they are adults. Luckily the treatment for JRA is very successful and allows children with JRA to do most of what all children do as they go up.
A mainstay of treatment is naproxen (Naprosyn) and many children have taken this medication for years under the careful eye of your pediatric physician. Be sure to take the mediation with food, watch for stomach and skin side effects and have your daughter follow up closely with her physician to be monitored. You can get more information from the Drug Guide.
Lupus is a mutisystem disease for which there is no one blood test that makes the diagnosis. Tests that can assist in the diagnosis are antinuclear antibody tests, anti DNA antibody tests and complement C3 and C4 tests. Their presence heavily suggests lupus but their absence does not completely rule lupus out. Therefore looking at the whole picture with your physician is required as the diagnosis is made combining the findings on the history, the physical exam and lab tests. I recommend you order the free Arthritis Foundation brochure on lupus for further information.
Q. My daughter has been suffering with JRA since she was 12 years old. She is now 20 and is on Enbrel and Relafen. She still has fevers, severe joint pain and fatigue. At times she still gets the rash on her body. Her rheumatologist tried a lot of different medications. What other avenues can you suggest we do to help her get relief? Also, how can we find out about JRA support groups in Florida and New Jersey where she goes to college? Thank you for taking the time to assist us with this.
A. The Arthritis Foundation offers a self help course at many of the offices around the country that can assist the participant in managing their arthritis, particularly with the pain associated with arthritis. Your daughter might find this helpful. In addition, I recommend that she contact both the Arthritis Foundation offices in Florida and New Jersey to learn what activities are available.
Q. I am a 50-year-mother of three sons, ages 18, 22, and 25. I have had RA for over 15 years. I have two aunts and several cousins with RA and my mother, who has passed away, had psoriasis. Should my sons be tested for arthritis? They show no symptoms.
A. You ask an excellent question. Because rheumatoid arthritis is an autoimmune disease and genetics, as you point out, is a part of the disease, many family members can have positive blood tests but may never get the symptoms of arthritis. Thus until your sons develop the symptoms of inflammatory arthritis such as morning stiffness, joint swelling and pain, I would not recommend that they be tested for rheumatoid arthritis. Learn more about arthritis lab tests.
