Beth Gottlieb MD Ped Rheumatology wwwDrMDK.com
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Interviewer: JRA, what is JRA? Interviewee: Juvenile rheumatoid arthritis is a form of chronic arthritis in children and it is very important that somebody sees a rheumatologist to make the diagnosis because joint pain in children is extremely common and most often, joint pain is not arthritis, so there is a distinction between what we call arthralgia which is pain and arthritis which is fluid in the joint from inflammation in the joint and if there really is inflammation, the next step is to determine how long it is there for because there are many, many types of arthritis in children that go away so sometimes due to an infection or a reaction to something, there can be temporary arthritis, but if there really is fluid in the joint and it is continuous for at least six weeks, then the diagnosis of juvenile rheumatoid or juvenile idiopathic arthritis would be made and that is a response of the body attacking the joint and causing inflammation. Interviewer: Are there any particular joints that are more commonly affected than other joints? Interviewee: The most common joint for children is the knee and this is very different from adult arthritis and again, this is why seeing a pediatric rheumatologist is very important. Most adults who get arthritis have small joints like their fingers affected and very wide spread. The vast majority of children who get arthritis have it in just a couple of joints and generally big joints; the knees, the ankles, the wrists, it could affect small joints also but fortunately that is not for most children the case. Interviewer: And you could also keep the kid have the most motion, least amount of pain, least amount of complications with the drugs that are least toxic initially; is that correct? Interviewee: Absolutely, it is extremely important that the arthritis is treated quickly because children are growing and we want their cartilage, and their bones, and all of their joints structure to be healthy. And we want kids to be able to do what children should be able to do; to run and play and do all their activities, so one of the most important things for us treating children who have arthritis is to make sure that the child is doing normal childhood activities and that they are able to do that, despite the arthritis. Interviewer: What is the youngest child you have start with JRA? Interviewee: Under a year, the peak age for JRA is three. And so that means that an awful lot of children are very young when they are first diagnosed. So we see children who are just a few months old who have developed arthritis. Interviewer: Can it sometimes present as just pure fever? Interviewee: It can, there is one form of juvenile arthritis called systemic onset that starts with fever. Really relentless high spiking fevers and it goes on and on and it passes the timeframe where you would think of an infection because infection should go away after days or weeks even; but this fever continues and continues and sometimes it comes with a very characteristic rash, and sometimes the rash is only there during the fever and then fades in between so that you do not notice it when the child does not have the fever. The arthritis part can come months later, it is fortunate if it is there in the beginning because it does make the diagnosis easier, but sometimes it can be months before a joint even becomes swollen. There are very typical lab abnormalities that we look for in the blood counts and inflammatory markers that are in the blood and they help with the diagnosis, but unfortunately, there is no diagnostic test for childhood arthritis of any kind. Interviewer: So it is basically, the more inflammation you get, the more fat you should get and the more likely it is obviously, in the pediatric situation to get all the whole story? Interviewee: Exactly, it is very important that we rule out other causes, things that we are able to test for. We test for very quickly to try to eliminate those possibilities and in the end, eit

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