Juvenile Rheumatoid Arthritis

How is it Treated?

Eye Care

Several forms of eye inflammation are associated with various forms of juvenile arthritis. However, frequent eye exams can identify inflammatory problems early and reduce the potential for serious eye complications.

Chronic iridocyclitis occurs most commonly in young girls with pauciarticular JRA whose blood contains an antibody protein called the ANA. This inflammation of the eyes may occur without obvious signs or symptoms. Therefore, it is important for all children with JRA to have their eyes checked by an ophthalmologist as soon as the diagnosis is suspected. This allows the doctor to detect any eye problems early and to begin proper treatment to avoid serious problems. Children diagnosed before 7 years old with pauciarticular JRA and a positive ANA are at the greatest risk of developing chronic uveitis. Their eyes should be checked every 3 months for several years. Acute or sudden onset of eye inflammation is called iritis. This may occur particularly in the spondyloarthropathies.

The ophthalmologist will give your child a complete medical eye evaluation, including a slit lamp test. This simple and painless procedure can spot problems before symptoms are present. Children should continue to get periodic eye exams, since eye inflammation may occur when the joint disease is inactive. The frequency of eye exams will depend on your child's risk for developing eye problems.

Dental Care

Children with arthritis may have limited jaw movement, which can make brushing and flossing their teeth difficult. Your child's dentist may suggest various toothbrush handles, electric toothbrushes, floss holders, toothpicks and rinses that will help your child maintain healthy teeth and gums.

Medications may also affect your child's oral health and development. Always inform your dentist about the status of your child's disease and the medications she is taking. The dentist will consider these when planning any treatment, general anesthesia, sedation or oral surgery. Older children who have had joint replacements may require an antibiotic before dental treatment.

The joint in front of the ears, where the lower jaw connects to the base of the skull, is called the temporomandibular joint (TMJ). Arthritis may affect this joint in the same way it does others, by causing pain, stiffness and altered growth. Jaw exercises and therapy may be recommended for the pain and stiffness. If the lower jaw does not develop properly, it may create an overbite. Your child's dentist may recommend an early consultation with an orthodontist if this occurs. Surgery is also sometimes necessary for this condition.

A child with active arthritis may not always have the stamina for even routine dental work. If possible, schedule appointments when your child has the most stamina, or schedule shorter appointments.

Diet

Children with arthritis sometimes have poor appetites, leading to weight loss and poor growth; medication side effects may cause excessive weight gain.

Chronic disease places increased demands on a child's body and creates a need for additional calorie intake. Children may have little appetite when they feel ill, or may have a difficult time eating when they have painful joints or limited mobility. Some children with arthritis might feel too sick or too tired to eat. Encourage him/her to eat a well-balanced diet at regular meal times and include planned snacks even when he/she may not feel like eating. Try to reduce the amount of food he/she needs to eat by increasing the nutrient content of each bite of food or drink. For example, add melted cheese, gravies, margarine and dips to foods, and offer whole milk. This can help prevent weight loss and poor growth.

At the opposite end of the spectrum, children with arthritis may gain too much weight due to medication side effects or limited activity. Excess weight puts more stress on joints such as knees, hips and ankles. Appropriate exercise combined with eating a well-balanced diet based on the basic four food groups can help your child keep a normal body weight. A registered dietitian can teach you ways to improve your child's diet.

Many children with arthritis need additional calcium and vitamin D to help strengthen their bones. Giving your child a multivitamin with breakfast is usually worth the effort.

Medications | Exercise | Splints/Surgery | Eye & Dental Care/Diet