• Haemoglobin: shows whether or not the child is anaemic.
• Platelets: can increase with inflammation
Erythrocyte sedimentation rate (ESR)
• Reflects the amount of inflammation in the bloodstream.
• The higher it is, the more inflammation there is in the body.
C-reactive protein (CRP)
• A different measure of inflammation. It is not available in all hospitals and it does not always correspond to ESR.
Urea and electrolytes (U&E)
• A measure of kidney function.
Liver function tests (LFT)
• A measure of liver function.
Antibodies are produced by the body to fight infection. The body can produce antibodies against itself: autoantibodies. Some autoantibodies are associated with JIA: rheumatoid factor (RF) and antinuclear antibody (ANA). RF is associated with arthritis in children which can be similar to adult rheumatoid arthritis. ANA is associated with inflammation affecting the eye called uveitis.
Treatment of JIA can take many forms – but first your child will need to undergo tests.
Juvenile idiopathic arthritis (JIA) is a disease that is extremely variable in its severity and its course. It can affect joints (a single joint or numerous joints), muscles and tendons or it can affect the general health of the child (high temperatures, rashes, poor appetite, weight loss) making the child ‘systemically’ unwell, JIA is a disease that waxes and wanes: children will have periods of active disease followed by periods when the disease is less active or even appears to have gone away. Therefore treatment, patient care and even monitoring will vary from child to child.
Treatment of children with JIA involves medication, physiotherapy, occupational therapy, podiatry and psychological support. The aims of treatment are to reduce pain and disease activity, to maintain the range of movement of the joints, to promote muscle strength to stabilise affected joints, and if disability occurs, to maintain optimal function of individual joints and to maintain the independence of the child. The monitoring of a child with JIA, whether as an in-patient on the ward or as an out-patient in the clinic, tries to take into account all these aspects of treatment.
A typical clinic visit would start with the child being measured (height and weight). These give an overall assessment of the child’s well-being. An assessment of how the child has been since the last clinic visit is taken. This can include such questions as how much pain has the child had? How many joints are affected? Are the joints swollen? Are they stiff in the mornings, and how long does it last? Is the function of an affected joint impaired? How is that affecting the child’s life i.e. schoolwork or leisure activities? Questions about general health may also be asked: how is the child’s appetite and energy levels? How much school is being missed because of ill-health?
After the questions have been asked, the child may need to be examined. This may include a general examination, and then an examination of all the bodies joint, looking for signs of inflammation (swelling, redness, heat) and its effect on the way the joint moves. This would be compared to what was found at the previous visit.
The questions and physical examination may lead the doctor to want investigations to help monitor the disease. These may include ultrasound, X-rays, MRI and blood tests. Ultrasound and MRI’s shows inflammation in joints, X-rays show bone and so help in determining whether there has been any damage to the bone. They can also show inflammation of the tissues surrounding the joint. There are numerous blood tests, the commonest are shown below. They help in monitoring disease activity and the effects of drug treatment.
Dr. Nathan Hasson, Consultant Paediatrician and Paediatric Rheumatologist, The Portland, Hospital London