Beth Gottlieb MD Pediatric Rheumatology talks about Juvenile Rheumatoid Arthritis.
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Male Speaker: JRA, what is JRA? Beth Gottlieb: Juvenile rheumatoid arthritis is a form of chronic arthritis in children and it’s 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 its 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 pain and its 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. Beth Gottlieb: 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 a just couple of joints and generally big joints. The knees, the ankles, the wrists it could affect small joints also but fortunately that’s not for most children the case. Male Speaker: And your goals to keep the kid have the most motion and least amount of pain and least amount of complications with the drugs that are least toxic in this, is that correct? Beth Gottlieb: Absolutely, it’s extremely important that the arthritis is treated quickly because children are growing and we want their cartilage and their bones and all of their joint 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. Male Speaker: What’s the youngest child you have seen with JRA. Beth Gottlieb: Under a year. The peak age for JRA is 3 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 develop their arthritis. Male Speaker: Sometimes misunderstood as flu or fever. Beth Gottlieb: It can, that 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 time frame where you would think of an infection because infection should go away after you know 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 don’t notice it when the child doesn’t have the fever. The arthritis part can come months later, its fortunate if its 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 may help with the diagnosis but unfortunately there is no diagnostic task for child with arthritis of any kind. Male Speaker: So it’s basically the more information you get the more you get the more fact you should get more likely it is and obviously and the pediatric situations of developing story. Beth Gottlieb: Exactly, its very important that we ruled 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 either we see the rash with the arthritis together and that makes the diagnosis or we just continue to fol