Kids Get Arthritis Too!

Arthritis Care for Kids (from DukeHealth.org)

Children’s Pain Often Goes Undertreated:
Many people think of arthritis as a disease of aging, but it's surprisingly common in children as well. The most common form, Juvenile Rheumatoid Arthritis (JRA), affects an estimated 150,000 children in the United States, causing pain, stiffness, swelling, and even growth disorders.

Children with arthritis tend to complain less than adults about their symptoms, however--and that can lead to subpar treatment, says Laura Schanberg, MD, co-chief of Duke's division of pediatric rheumatology.

In a recent Duke study, children with JRA kept diaries reporting their daily levels of pain, activity, and stress. "One thing that became clear is that children with arthritis, even when treated, have more pain than we realize," says Schanberg. "In clinic children typically report low levels of pain. In their diaries the children said they experienced pain on more than 70 percent of the days, and 31 percent said their pain was severe."

The study also found that even low levels of pain (2 or 3 on a scale of 10) caused children to cut back on social activities. "Adults tell physicians about their symptoms and complaints," Schanberg says. "Children just stop doing things that hurt. And because they say they're fine they often go undertreated."

New Medications Offer Relief:
As three of the four pediatric rheumatologists in the Carolinas, Schanberg and her colleagues Deborah Kredich, MD, and Egla Rabinovich, MD, are devoted to making sure children with arthritis receive the tailored treatment they need. One of their first priorities is to bring the child's pain and other symptoms under control--and new medications are making that much easier, says Schanberg.

In addition to NSAIDS such as ibuprofen and disease-modifying anti-inflammatory drugs such as methotrexate, the team now uses newer biologic agents, in particular tumor necrosis factor-blockers such as etanercept, infliximab, and adalimumab. Duke has used infliximab to treat JRA based on the drug's effectiveness in adults, and found it particularly successful in treating inflammatory eye disease, a common condition in children with arthritis.

Trials of other promising biologic agents for systemic-onset JRA--a highly inflammatory form that often causes rash and fevers--will begin in the next few years, Schanberg says.

Reducing Stress Is Critical:
Since their research has shown that JRA flare-ups may frequently be mood- and stress-related, treatment combining medication and stress reduction may be most effective in managing the condition.

"We recommend counseling, pain-coping skills training, and relaxation techniques to help children deal with 'daily-hassle' things that come up," says Schanberg. "We also pay attention to the child's school and family situation, calling the schools when needed and helping parents adjust to their child's illness. As a specialized arthritis center for children, we can really walk with a child every step of the way."