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Juvenile Rheumatoid Arthritis

Juvenile Rheumatoid Arthritis

Juvenile Rheumatoid Arthritis_FBsize

Definition

Juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis, is a disease of the joints in children. It can affect a child over a long period of time. JRA often starts before the child is 16 years old.

In Juvenile rheumatoid arthritis, the joint becomes swollen. It will make the joint painful and difficult to move. JRA can also lead to long term damage to the joint. For some, JRA can interfere with the child’s growth and development.

There are 5 major types of juvenile rheumatoid arthritis:
• Pauciarticular JRA—4 or less joints are affected in the first 6 months of illness
• Polyarticular JRA—5 or more joints are affected in the first 6 months of illness
• Enthesitis associated arthritis—swelling of the tendon at the bone
• Psoriatic arthritis—associated with a skin disease called psoriasis
• Systemic onset JRA (also called Stills disease)—affects the entire body, least common type of JRA

Causes

Juvenile rheumatoid arthritis is caused by a problem of the immune system. The normal job of the immune system is to find and destroy items that should not be in the body, like viruses. With JRA, the immune system attacks the healthy tissue in the joint. It is not clear why this happens. The immune system problems may be caused by genetics and/or factors in the environment.

People of Hispanic American, Asian American, Pacific Islander, Native American, or African American descent are at higher risk.
Having prediabetes means that you are at high risk for developing diabetes and may already be experiencing adverse effects of elevated blood sugar levels.

Risk Factors

Girls are more likely to get JRA than boys.

There are no clear risk factors for JRA. Factors that may be associated with some types of JRA include:
• Family history of:
• Anterior uveitis with eye pain
• Inflammatory back arthritis (ankylosing spondylitis)
Inflammatory bowel disease

kids toes

Symptoms

• Symptoms may include:
• Joint stiffness, especially in the morning or after periods of rest
• Pain, swelling, tenderness, or weakness in the joints
• Fever
• Weight loss
• Fatigue or irritability
• Swelling in the eye—especially associated with eye pain, redness, or sensitivity to light
• Swollen lymph nodes
• Growth problems, such as:
• Growth that is too fast or too slow in one joint (may cause one leg or arm to be longer than the other)
• Joints grow unevenly, off to one side
• Overall growth may be slowed

Some symptoms are specific to each type of juvenile rheumatoid arthritis . For example:
• Symptoms common with pauciarticular JRA include:
• Problems most often found in large joints. These joints include knees, ankles, wrists, and elbows.
• If the left-side joint is affected, then the right-side similar joint will not be affected. For example, if the right knee is affected, then the left knee will be healthy.
• May also have swelling and pain at on the tendons and ligaments attached to the bone

• Symptoms common with polyarticular JRA include:
• Problems found most often in small joints of the fingers and hands. May also affect weight-bearing joints like the knees, hips, ankles, and feet.
• Joints on both sides of the body are affected. For example, if the left hand is affected, then the right hand will also be affected.
• May also have a blood disorder called anemia. This is an abnormally low number of red blood cells.
• One type of polyarticular JRA may occur with:
• A low-grade fever
• Nodules—bumps on parts of body that receive a lot of pressure such as elbows

• Symptoms common with systemic onset JRA include:
• Some of the first signs may be a high fever, chills, and a rash on the thighs and chest. May appear on and off for weeks or months
• May have swelling in the heart, lungs, and surrounding tissues
• The lymph nodes, liver and/or spleen may become enlarged
• Children with enthesitis arthritis often have tenderness over the joint where the pelvis and spine meet.
• Children with psoriatic arthritis often have finger or toe swelling. There may also be damage on fingernails.

Often, there are remissions and flare-ups. Remission is a time when the symptoms improve or disappear. Flare-ups are times when symptoms become worse.

Diagnosis

You will be asked about your child’s symptoms. You will also be asked about your family medical history. A physical exam will be done. An eye examination may also be done to check for swelling in the eye. Your child may be referred to a specialist if JRA is suspected. The specialist is a doctor that focuses on diseases of the joints.

Images may be taken of your child’s bodily structures. This can be done with x-rays.

Your child’s bodily fluids may be tested. This can be done with:
• Blood tests
• Urine tests
• Tests of joint fluid

Treatment

Talk with your doctor about the best plan for your child. The plan will work to control swelling, relieve pain, and control joint damage. The goal is to keep a high level of physical and social function. This will help keep a good quality of life. Treatment options include the following:

Medication

There are several types of medication that may be used:

• Nonsteroidal anti-inflammatory drugs (NSAIDs)—to help swelling and pain
• Disease-modifying antirheumatic drugs (DMARDs)—to slow the progression of the disease
• Tumor necrosis factor (TNF) blockers—to decrease swelling, pain, and joint stiffness
• Interleukin inhibitors—to reduces disease activity
• Corticosteroids through IV or by mouth—for swelling
• Steroid injections into the joint—may help relieve swelling and pain in some children

Polyarticular JRA may become inactive in children who begin medications within 2 years of onset.

Physical Therapy

Exercise is done to strengthen muscles and to help manage pain. Strong nearby muscles will support the joint. It also helps to recover the range of motion of the joints. Normal daily activities are encouraged. Non-contact sports and recreational activities may be good options. Physical activities can also help boost a child’s confidence in their physical abilities.

Physical therapy may be needed. This will help to make the muscles strong and keep the joints moving well.

Maintenance Devices

Splints and other devices may be recommended. They may be worn to keep bone and joint growth normal. Some joints may get stuck in a bent position. These devices can help prevent this.

Prevention

There is no known way to prevent JRA.

by Jacquelyn Rudis

RESOURCES:
American College of Rheumatology
http://www.rheumatology.org

Arthritis Foundation
http://www.arthritis.org

CANADIAN RESOURCES:
The Arthritis Society
http://www.arthritis.ca

Health Canada
http://www.hc-sc.gc.ca

REFERENCES:

Hofer MF, Mouy R, et al. Juvenile idiopathic arthritides evaluated prospectively in a single center according to the Durban criteria. J Rheumatol. 2001. 28:1083.

Juvenile idiopathic arthritis (JIA) enthesitis related. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

Juvenile idiopathic arthritis (JIA) oligoarticular. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

Juvenile idiopathic arthritis (JIA) polyarticular. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

Juvenile idiopathic arthritis (JIA) systemic-onset. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 16, 2015. Accessed December 21, 2015.

JAMA Patient Page. Juvenile idiopathic arthritis. JAMA. 2005;294:1722.

Petty RE, Southwood TR, et al. Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol.1998; 25:1991.

2/5/2013 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: De Benedetti F, Brunner HI, Ruperto N, et al. Randomized trial of tocilizumab in systemic juvenile idiopathic arthritis. N Eng J Med. 2012;367(25):2385-95.

2/24/2014 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Limenis E, Grosbein HA, et al. The relationship between physical activity levels and pain in children with juvenile idiopathic arthritis. J Rheumatol. 2014 Feb;41(2):345-351.

9/2/2014 DynaMed’s Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Guzman J, Oen K, et al. The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-Out cohort. Ann Rheum Dis. 2014 May 19.

Last reviewed December 2015 by Kari Kassir, MD Last Updated: 12/20/2014

EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.

aquatic therapy

Is Aquatic Therapy For You?

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Aquatic therapy offers an alternative environment for therapeutic exercise. If you have tried traditional physical therapy, or have restrictions on your physical therapy program, aquatic Therapy may be the perfect solution for your physical therapy needs.

Why Aquatic Therapy is Beneficial

Less pressure: The buoyancy of the water decreases the amount of pressure, or compressive forces, on your joints and spine. When you’re immersed in water up to your neck, the weight pressing down on your body is reduced by 90%. When the water is up to your waist, the pressure is reduced by 50%.

Reduced swelling: The pressure of the water helps to move fluid from the injured area back into the body. Decreased swelling is essential for regaining the strength and motion needed for recovery.

Ease of movement:
Water is an element that supports and assists movement. It offers a safe setting for regaining strength and joint range of motion.

Faster progress: Aerobic conditioning can often be performed in the water, even when it may be too soon or too difficult to do in the clinic. Staying stable in the water, challenges your core and balance. Plus, sports specific activity can begin earlier than on land.

old man swimming

Who Can Benefit From Aquatic Therapy

• Chronic pain patients requiring a more gentle form of therapy
• Patients at risk of falls due to balance and gait disorders
• Patients with severe arthritis or other weight-bearing restrictions
• Prenatal and postnatal patients
• Patients with general deconditioning
• Sports medicine and orthopedic patients requiring an accelerated component to their rehab protocol

This information was written by Life Fitness Physical Therapy, a privately-owned, outpatient physical therapy practice operating 14 clinics in the metro and surrounding Baltimore, Maryland area. Life Fitness Physical Therapy was founded in 2000 based on the core values of providing the highest level of customer service and clinical excellence in outpatient physical therapy. For more information click here.

TMJ

There is Hope for TMJ Pain

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TMJ is where the lower jaw meets the skull.

The temporomandibular joint or TMJ, is a complex joint located in front of each ear. It is responsible for allowing mouth opening and closing. When the TMJ is not working correctly, you may experience jaw pain, clicking, popping, or locking of the joint. You may also experience headaches, neck pain, sinus pain, dizziness, and ear ringing or pain. TMJ pain or Temporomandibular Dysfunction (TMD) is not strictly limited to the jaw, it can also be influenced by the alignment of the head and neck.

The goal of Physical Therapy treatment for Temporomandibular Dysfunction (TMD) is to provide pain relief using a variety of techniques to improve your range of motion through exercise and manual therapy and to improve posture and muscle imbalance. There may be modifications to your activities or work station that would be helpful as well.

man with ear pain

SYMPTOMS
• Face or Jaw Pain
• Ear Pain
• Tinnitis (ringing in the ears)
• Dizziness
• Headache
• Jaw Clicking and/or Popping
• Neck Pain
• Limited Jaw Opening

TREATMENT
Your Physical Therapist will work closely with your Dentist or Physician to establish an individualized treatment plan based on results from a comprehensive evaluation. The most current treatment options will be utilized to ensure the best outcome for decreased pain and improved function.

TREATMENT WILL INCLUDE, BUT IS NOT LIMITED TO:
• Comprehensive evaluation of head, neck, and jaw
• Education regarding the diagnosis and related head, neck and jaw dysfunction. This includes addressing any of your questions or concerns.
• Individualized program specific to your needs including modalities, joint mobilization, soft tissue mobilization, postural education, neuromuscular re-education and TMJ management techniques.
• Collaboration between referring physician or dentist to ensure comprehensive and integrated care.

Shoulder Impingement Syndrome

ThinkstockPhotos-478265881
 
Article written by: Chris Wolfe, PT, Certified MDT, OCS
Director of Green Hills STAR Physical Therapy
www.StarPT.com

 
Shoulder disorders are some of the most common joint complaints, and shoulder impingement syndrome and rotator cuff tendonitis are considered to be the most frequent cause of shoulder pain and disability. The shoulder complex is unique in the body due to its structure and function. It is considered a ball and socket joint involving the large rounded end of the upper arm bone called the humerus and the small shallow socket of the shoulder blade. This disproportional shape allows for a wide range of directions that the arm can be moved; however, it does not provide much stability to hold it in place. The stability of the shoulder relies heavily on numerous ligaments, tendons and muscles; and the most common group is called the rotator cuff. The rotator cuff attaches to and surrounds the rounded end of the humerus and is bordered superiorly by a bony roof called the acromion. There is a small space between this bony roof and the rotator cuff. With reaching overhead, the space around the rotator cuff decreases, sandwiching and pinching the tendons between the two bones. This can lead to the disorder of shoulder impingement where the tendons become compressed and then inflamed.
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