Outlook Improving for Kids with Juvenile Arthritis

Duke University Medical Center
Thursday, 8 July 2004

Many people aren't aware that arthritis is a big problem for children. However, Juvenile Rheumatoid Arthritis (JRA) is the third most common chronic childhood illness, affecting almost 300,000 children in the United States.

Symptoms of JRA typically include pain, stiffness and swelling, and severe cases can cause growth disorders. Laura Schanberg, M.D., co-chief of the division of pediatric rheumatology at Duke University Medical Center, says the illness is not the same as the more common form of rheumatoid arthritis in adults.

"Children with arthritis are only about 10 percent positive for the rheumatoid factor, the test that diagnoses this condition in adults," she says. "Also, about 50 percent of juvenile arthritis goes away over time, which doesn't happen in adults. Kids can suffer a great deal of disability or joint damage before it goes away, however. So we need to be as aggressive as we can in treating it, not just sit around and wait for it to go away. We use all the medications at our disposal to try and prevent any long-term disability."

Schanberg says medications commonly used today include non-steroidal anti-inflammatories, such as ibuprofen, as well disease-modifying anti-inflammatory drugs such as methotrexate. She also mentions ongoing studies of newer biologic agents, in particular anti-tumor necrosis factor medications such as etanercept and infliximab.

"There are a lot of new drugs that are now available and still more that are coming down the pike," says Schanberg. "We're really able now, as opposed to 20 years ago, to significantly improve the life and outcome of children with arthritis."

Since JRA flare-ups are frequently mood- and stress-related, Schanberg says a treatment combining medication and stress reduction often proves effective in managing the condition.

"Our research has shown that we can best treat children using these exciting new medications that are available, but also paying attention to their daily complaints, with a combination of medications and other kinds of therapies, including counseling, pain-coping skills training, relaxation techniques and other ways of helping children deal with 'daily-hassle' things that come up.

"It's a very exciting time to be a pediatric rheumatologist," adds Schanberg. "While it's true that there is currently no cure for juvenile arthritis, we certainly are at a spot where our expectation is that we use medications to put children into remission, and we're looking for long-lasting remissions. There are many, many medications to treat juvenile arthritis today, and most children do very well."

For more information, or to contact Duke University Medical Center, see their website at: www.mc.duke.edu

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