| When a smaller number of joints are affected (the | | | | cartilage with areas of cartilage erosion and in some |
| oligoarticular type) there are four or fewer joints | | | | cases a fusion across the joint, with thickening of the |
| exhibiting arthritic symptoms with the larger joints | | | | synovial membranes and effusions within the joints. |
| being preferentially affected. Such children do not | | | | Long term changes in a joint which is arthritic can |
| present as unwell although they may limp when | | | | include partial dislocation, joint stiffness and |
| asked to walk. Arthritis may be confined to one hip | | | | contractures, bony enlargement and deformities, |
| but if the symptoms are limited to this joint then an | | | | especially of the fingers. Other findings can be loss of |
| alternative diagnosis should be sought as this is much | | | | bone stock around the joints and narrowing of the |
| more common, with Perthes disease a typical | | | | joint spaces due to cartilage loss. |
| outcome. Arthritis over some time develops | | | | A reduction of extension in the neck may not |
| weakness and loss of bulk in the main knee muscles | | | | produce any symptoms but it is important to identify |
| and a knee bend contracture partly due to tightening | | | | this as it can indicate arthritic changes in the cervical |
| of the hamstrings. A discrepancy in length of legs can | | | | spine which can lead to partial dislocation (subluxation) |
| develop if arthritis affects only one leg. | | | | of the upper neck bones, a potentially dangerous |
| The polyarticular type of juvenile arthritis, which has | | | | situation. The neck bones can also fuse together |
| a larger number of joints affected, is indicated by | | | | along the posterior structures. The jaw joints, the |
| five or more joints becoming inflamed in a | | | | tempero-mandibular joints, may also be affected and |
| symmetrical manner, the same joints being inflamed | | | | lead to reduced amount of growth in the lower jaw |
| on both sides. A low level fever may be present and | | | | with inability to open the mouth as wide as normal. |
| if the joints are badly limited in terms of range of | | | | There may also be involvement of the eyes in the |
| motion there is likely to be weakness of the | | | | inflammatory process. |
| associated muscles and a limitation in function. | | | | The management of children with juvenile arthritis |
| Examining the patient thoroughly is crucial to | | | | works best as a team process as many aspects |
| determine if they do have the diagnosis of juvenile | | | | need to be considered such as medication, |
| arthritis, where they have particular difficulties and | | | | physiotherapy, occupational therapy, family education |
| which form of arthritis they possess. | | | | and school function. Individual treatments on their |
| Settling on the diagnosis of juvenile arthritis depends | | | | own will not be successful. Seeing the patient for |
| on a joint showing an effusion which is the presence | | | | regular examinations allows the medication to be |
| of inflammatory fluid within the joint, along with other | | | | regularly reviewed and changed, aiming at a reduction |
| symptoms and signs such as warmth, redness, limited | | | | in morning stiffness and the number of joints |
| range of motion and pain. Some joints may have an | | | | involved until the number of affected joints drops to |
| effusion which is not apparent such as the hip, but | | | | zero. The team will likely consist of a paediatric |
| they can still show limited movement of the joint and | | | | rheumatologist, a nurse, a physiotherapist and |
| pain. It may not be possible to establish the diagnosis | | | | occupational therapist and social workers to help with |
| of juvenile arthritis as the fever and rashes may | | | | family and school issues. |
| come on initially without the arthritis at the time, with | | | | Surgical care is not typically engaged although joint |
| the arthritis appearing later by several months. | | | | injections of steroids may be useful in some cases. |
| Enlargement of lymph nodes and the liver and | | | | Joint replacement can be used for hip or knee |
| tenderness of muscles may be evident. | | | | arthritis in patients with polyarticular arthritis but is |
| In the many jointed polyarticular form of juvenile | | | | usually delayed until skeletal maturity means bone |
| arthritis the weight bearing joints are typically | | | | growth has stopped. Activity is usually encouraged as |
| affected in a symmetrical pattern, as are the small | | | | long term rest is unhelpful and increased activity |
| joints of the hand. There may be loss of the articular | | | | indicates a better outcome. |