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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 drugs, physiotherapy and occupational
therapy. 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 inpatient
on the ward or as an out-patient in the clinic, tries to take into account
all these aspects of treatment.
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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 red and 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?
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After
the questions have been asked, the child may need to be examined. This may
include a general examination, or an examination of the affected 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. |
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The
questions and physical examination may lead the doctor
to want investigations to help monitor the disease. These
may include X-rays and blood tests. 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. |
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Common
Blood Tests
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Full
Blood Count (FBC)
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.
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Urea
and electrolytes (U&E)
A
measure of kidney function.
Liver
function tests (LFT)
A
measure of liver function.
Autoantibodies
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.
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Written
by Dr C. Pickington, Senior Registrar, Great
Ormond Street Hospital, London
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