Child Care

…is a grow­ing health con­cern. Don’t be fooled to think arthri­tis only hap­pens to adults.

Health & Nutrition - - CONTENTS - Dr PrADeeP MAhAJAn Re­gen­er­a­tive Medicine Re­searcher, StemRx Bio­science So­lu­tions Pvt Ltd, Mum­bai

Don’t think arthri­tis only hap­pens to adults

Arthri­tis as we know it, is knee or joint pain that com­monly oc­curs in old age. How­ever, most of us are un­aware that the con­di­tion may also af­fect young in­di­vid­u­als, some­times as young as one -three years of age. Here, we present the ba­sics of JA (Ju­ve­nile Arthri­tis) and the re­cent treat­ment modal­i­ties to help our chil­dren walk tall!

Un­der­stand­ing JA

JA is a chronic in­flam­ma­tory con­di­tion which may in­volve one or many joints. The dif­fer­ent forms of JA are: Ju­ve­nile Rheuma­toid Arthri­tis, Ju­ve­nile Idio­pathic Arthri­tis, Ju­ve­nile Der­mato­myosi­tis, Ju­ve­nile Lu­pus, Ju­ve­nile Sclero­derma, Kawasaki Dis­ease, Mixed Con­nec­tive Tis­sue Dis­ease and Fi­bromyal­gia. Ju­ve­nile Idio­pathic Arthri­tis is con­sid­ered the most com­mon type of JA and has fur­ther sub­types such as O li go arthri­tis, Po ly arthri­tis, Sys­temic, En­the­si­tis­re­lated, Ju­ve­nilePs or ia tic Arthri­tis etc.

Di­ag­no­sis

Di­ag­nos­ing JA is chal­leng­ing as one would not ex­pect the con­di­tion to oc­cur in young age. More­over, the symp­toms may not clas­si­cally

Arthri­tis, apart from be­ing an au­toim­mune con­di­tion, is also as­so­ci­ated with our way of life. Seden­tary lifestyle habits and im­proper di­etary prac­tices cause the con­di­tion a to progress at more rapid and se­vere rate.

re­flect that of arthri­tis as ob­served in older in­di­vid­u­als. Ad­di­tion­ally, no di­ag­nos­tic test is avail­able presently too. Low red blood cell and el­e­vated white blood cell counts in hema­to­log­i­cal in­ves­ti­ga­tions may be seen, but these find­ings are not char­ac­ter­is­tic of JA. In­ves­ti­ga­tions to iden­tify pres­ence of an­ti­nu­clear an­ti­bod­ies, anti-cyclic cit­rul­li­nated pep­tide etc may be done. The fact of the sit­u­a­tion is that JA is of­ten di­ag­nosed only when joint in­flam­ma­tion be­comes vis­i­ble, which usu­ally hap­pens at ad­vanced stages. JA may be di­ag­nosed based on the fol­low­ing cri­te­ria: On­set of arthri­tis be­fore the age of 16, per­sis­tent, ob­jec­tive arthri­tis in 1 or more joints for at least 6 weeks, and ex­clu­sion of other po­ten­tial causes of child­hood arthri­tis. Fe­males are more com­monly af­fected than males.

Clin­i­cal Pre­sen­ta­tion

Re­cur­rent fever and in­ter­mit­tent rashes may be ob­served in pa­tients with JA. Apart from these, typ­i­cally an in­di­vid­ual may com­plain of stiff­ness in joints es­pe­cially on wak­ing in the morn­ing and dif­fi­culty per­form­ing fine mo­tor ac­tiv­i­ties. Joint swelling, how­ever, may not be apparent un­til months/ years of on­set of the symp­toms and sys­temic in­flam­ma­tion. Over­time, dis­abil­ity may en­sue which af­fects the move­ment of the af­fected in­di­vid­ual. In se­vere con­di­tions, the pa­tient may be bedrid­den due to ex­treme re­stric­tion of move­ments. JA may also af­fect the af­fected child psy­cho­log­i­cally. In mild cases, how­ever, symp­toms may not progress into adult­hood and the qual­ity of life may re­main un­af­fected.

Cause

While there is no de­fin­i­tive cause for oc­cur­rence of the con­di­tion, dys­func­tion of the im­mune sys­tem has been im­pli­cated. Ge­netic pre­dis­po­si­tion has been sug­gested as a fac­tor, but the con­di­tion develops only after ex­po­sure to an in­fec­tion or other trig­gers. Synovial mem­brane,

Mod­er­ate in­ten­sity ex­er­cises, swim­ming etc can aid in main­tain­ing the strength of the mus­cle groups and pre­vent­ing the dis­abil­ity.

which is the lin­ing of the joints is tar­geted by the mal­func­tion­ing im­mune sys­tem. The end re­sult of the path­o­genic process is joint in­flam­ma­tion and de­struc­tion.

epi­demi­ol­ogy

The lack of stan­dard di­ag­nos­tic cri­te­ria ham­pers de­ter­min­ing the ex­act preva­lence of JA. JA af­fects ap­prox­i­mately 1 in 1,000 chil­dren in any given year, with about 1 in 10,000 hav­ing a more se­vere form. Arthri­tis, apart from be­ing an au­toim­mune con­di­tion, is also as­so­ci­ated with our way of life. Seden­tary lifestyle habits and im­proper di­etary prac­tices cause the con­di­tion to progress at a more rapid and se­vere rate. It is there­fore im­por­tant to fol­low a dis­ci­plined lifestyle along with reg­u­lar mon­i­tor­ing of health in or­der to iden­tify the con­di­tion at the ear­li­est and plan ap­pro­pri­ate in­ter­ven­tions.

Pre­ven­tion And Treat­ment

As no de­fin­i­tive cause of the con­di­tion is known, there is no spe­cific pre­ven­tive mea­sure or cure for the con­di­tion in con­ven­tional medicine. Early iden­ti­fi­ca­tion of symp­toms may aid in di­ag­nos­ing the con­di­tion and plan­ning ap­pro­pri­ate in­ter­ven­tions to limit dis­abil­ity. Lifestyle and di­etary mod­i­fi­ca­tions play an im­por­tant role in au­toim­mune con­di­tions as these are as­so­ci­ated with mod­u­lat­ing the core pathol­ogy of the dis­ease. Mod­er­ate in­ten­sity ex­er­cises, swim­ming etc can aid in main­tain­ing the strength of the mus­cle groups and pre­vent­ing the dis­abil­ity. Ad­di­tion­ally, ma­ter­nal/ pa­ter­nal screen­ing for pres­ence of au­toim­mune an­ti­bod­ies is im­per­a­tive in iden­ti­fy­ing pos­si­ble man­i­fes­ta­tion of the con­di­tion in chil­dren. Anti-in­flam­ma­tory med­i­ca­tions and phys­io­ther­apy re­ha­bil­i­ta­tion may be ad­vised, which tem­po­rar­ily al­le­vi­ate the symp­toms, but do not halt pro­gres­sion of the dis­ease. Dis­ease mod­i­fy­ing an­tirheuma­toid drugs/ agents, steroids may also be ad­vised, how­ever, they may be as­so­ci­ated with ad­verse ef­fects when used for long du­ra­tions. Ul­ti­mately, when the con­di­tion pro­gresses to ad­vanced stages, pros­thetic re­place­ment of the af­fected joints may be ad­vised. This is a se­ri­ous mat­ter to be con­sid­ered, as re­sults of pros­thetic joint re­place­ment are not per­ma­nent, there­fore the in­di­vid­ual may re­quire re­peated surg­eries dur­ing their life­time, ow­ing to early on­set of the con­di­tion. In re­cent years, re­gen­er­a­tive medicine and cell-based ther­apy has been show­ing prom­ise in the treat­ment of con­di­tions pre­vi­ously thought to be un­treat­able. This form of ther­apy aims to har­ness the power of the repar­a­tive mech­a­nisms of the hu­man body to treat var­i­ous con­di­tions. It is more ef­fec­tive in young in­di­vid­u­als ow­ing to bet­ter heal­ing abil­ity and gen­eral ab­sence of co-mor­bid health con­di­tions (as seen in older in­di­vid­u­als) that may af­fect the over­all out­come of the ther­apy.

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