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Most parents when told that their child has arthritis find it hard to believe it, as arthritis is regarded an adult’s disease. This however is not true. Arthritis can affect children as well. Children with arthritis often find it difficult to cope up with the disease and treatment therefore has to be aimed at restoring the functional activity of the child such as going to school, getting educated, holding jobs, raising families and so on. It is also vital to ensure that joint and bone function, vision are preserved to the maximum possible extent.


Arthritis is a collective term that represents more than 100 different conditions that share certain common features such as pain, inflammation (swelling), stiffness and loss of function of joints. About 1 in every 1000 children develop arthritis. This form of arthritis that occurs in children is called juvenile arthritis. The age of diagnosis ranges from time of birth to 16 years of age.

The definite cause of arthritis is unknown and it has not been possible to pinpoint any lifestyle activities or microorganism for the disease. The inheritance of specific genes is believed to increase the risk of arthritis in children. More research is clearly indicated to identify the cause for arthritis in children. Previously, all children with the diagnosis of arthritis were classified into one single class called juvenile idiopathic (due to unidentified cause) arthritis. This categorization is no longer valid as there are different forms of arthritis in children. Eight different subtypes of arthritis exist.


Medically, seven different types of juvenile arthritis include:
Oligoarthritis, pauciarticular and monoarticular arthritis

-> Extended oligoarthritis

-> Systemic onset arthritis

-> Polyarticular arthritis –
(where rheumatoid factor is negative)

-> Polyarticular arthritis –
(where rheumatoid factor is positive )

-> Enthesitis related arthritis

-> Psoriatic arthritis

These complicated sounding different types of arthritis help doctors to decide on the best line of treatment and long-term prognosis.


-> It is the most common and mild form of juvenile arthritis.

->It most commonly occurs between the age of 1 and 5 years.

-> It is more likely to occur in young girls rather than young boys.

-> Asymmetrical involvement of the joints is seen.

-> Children with Oligoarthritis are at an increased risk of developing inflammation of the inner eye (uveitis). Frequent, regular eye check up by an eye doctor is very vital to prevent permanent eye damage. Children who are tested positive for a blood antibody marker, called ‘anti-nuclear antibodies’ face an increased risk of developing uveitis and have to be monitored very closely.

-> Limping may be seen in young children due to different rate of growth of bones of the two lower limbs.

-> Anemia may be seen in some cases.

-> The presence of infection or rash associated with arthritis should raise suspicion of polyarthritis that requires more aggressive treatment. As the disease progresses, it can lead to either of the conditions.

-> Persistent Oligoarthritis:

If no additional joints are affected over a period of time, it is called as persistent Oligoarthritis. This condition is a milder version of the disease.

-> Extended Oligoarthritis:

If more than 4 joints are additionally affected over time, the disease is now called extended oligoarthritis. This type of arthritis is more likely to occur in young girls rather than boys. Similar joints are affected ( on both sides) and there is an increased risk of developing eye problems (uveitis). Compared to children with Oligoarthritis, these children are more prone to developing chronic arthritis and hence need a more aggressive treatment.


Diagnosis plays a very important role in the treatment as it can ensure the best possible outcome. Any child with symptoms of joint pain should be taken seriously and attended by a specialized physician (pediatric rheumatologist). Any delay in the diagnosis can result in irreversible damage to joints, eyes or other organs. It is very important to diagnose the type of arthritis the child is suffering from. If the problem is perceived to be mild, it may delay institution of proper available treatment. Diagnosis of a mild form as severe can lead to an overdose of drugs and result in side effects.

Several factors play a crucial role in the diagnosis. A few of the important aspects are given below.

-> Medical History.

-> Physical Examination

-> Blood tests

-> X-rays of the joints and limbs.

-> Eye examination for early detection of eye disease

-> Anti-Nuclear Antibody Test.


It is very important for parents to observe their child’s symptoms closely to avoid any complications. Infections and fever should raise concern and should be reported to the attending physician without any delay. Under some circumstances such as chicken pox, the usual arthritis medicines have to be stopped on a temporary basis until the condition improves.


In order to effectively treat arthritis in children, a team of medical professions comprising of physicians, nurses, paramedical staff (physiotherapists, occupational therapists, dieticians) pediatric rheumatologists work together. It is very essential for the parents to extend their cooperation to enjoy the benefit of the multi-faceted treatment.

Pain and inflammation relieving drugs are usually given. This class of medications is usually called non-steroidal anti-inflammatory drugs (NSAIDs).

Another class of drugs that need special mention in this regard is the use of disease modifying anti rheumatoid drugs (DMARDs). These drugs in addition to reducing the infection prevent further progress of the disease. Latest development in the drug treatment is the use of novel agents called ‘biologics’. Corticosteroid injections may be directly given into the affected joints. It can ensure prevention of uneven length of legs. This kind of treatment however may not suit every child. The steroids or immunosuppressive agents should not be used in this group of patients.

The physiotherapist can suggest some exercises to strengthen the muscles, maintain the flexibility of the joint. It may also be possible in some cases to achieve normal limb growth.

In addition to the above-mentioned treatments, regular eye check ups are vital to preserve and protect vision. If eye damage has already occurred, cortisone eye drops are given to treat the associated uveitis.



The known forms of diet supplements that claim to provide relief for arthritis can provide moderate relief only for adults suffering from osteoarthritis. This however is also associated with side effects. No observed clinical benefit has so far been documented in the treatment of childhood arthritis with any of the dietary supplements.


Fish oil contains a rich source of Omega-3 fatty acids and this substance can reduce inflammation. However, in order to observe real benefit, many capsules have to be consumed. It has now been found that this protective effect may only be temporary, not exceeding 6 months.


-> Glucosamine
-> Etoricoxib
-> Celecoxib
-> Mefenemic acid
-> Ibuprofen
-> Asprin
-> Glucosamine


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