Inflammatory Disease



Arthritis

In arthritis one or more joints become inflamed, resulting in local tenderness, swelling, redness, and pain with movement. Arthritis is much less common in children than in adults. Its occurrence is nearly always an acute condition and not the result of the long-term wear and tear that goes with aging.

Juvenile Rheumatoid Arthritis (JRA)

This is the most common cause of chronic arthritis in children, occurring generally between the ages of three and six or early in puberty. (It is uncommon before the age of one or after the age of sixteen.) In JRA, for reasons not clearly understood, the child’s own immune system begins to damage joints and in some cases other tissues as well. There are a number of different forms of JRA:



  • The polyarticular form involves multiple joints.
  • The pauciarticular form, which is more common, involves only one or two joints. It may be associated with inflammation of structures within the eye that can lead to glaucoma or cataracts.
  • The systemic form involves not only joints but also other tissues such as the lungs or heart or the fibrous linings that surround them.

A combination of persistent swelling and pain within one or more joints, often accompanied by fever, may lead a child’s physician to consider this diagnosis and order laboratory tests. If JRA is diagnosed, treatment will focus on containing the inflammation for prolonged periods of time. Because it is effective and inexpensive, aspirin is sometimes used on an ongoing basis – one of the few occasions when aspirin is specifically recommended in childhood, although it must be discontinued during any flulike illness or chicken pox because of its association with Reye’s syndrome. Other anti-inflammatory medications such as ibuprofen may be used as an alternative, and in severe cases more unusual drugs are given (often under the supervision of a rheumatologist).

Lyme Disease

This is the most common disease spread by tick bites. It is caused by bacteria carried by the pinhead-size deer tick. In untreated cases, arthritis may develop weeks or months after the initial infection. Symptoms primarily involve painful, swollen joints – especially of the knees – that become chronic in 10 percent of children.



Transient Synovitis

This inflammation occurs most commonly in the hip and much more frequently than septic arthritis. The child may have all the symptoms of septic arthritis – especially a limp or unwillingness to walk because of pain, and a slight fever – but she does not appear as ill as a child with septic arthritis. Medical evaluation will be necessary to make a diagnosis. If the physician is confident that the child does not have an infected joint, he or she may recommend rest, quiet activities, and ibuprofen