Find out more about diagnosing and treating Juvenile Idiopathic Arthritis.
WORDS NURULHUDA SUHAIMI
A child is diagnosed with Juvenile Idiopathic Arthritis (JIA) through two methods: the child’s medical history and a physical examination. Analysing the medical history will help to rule out other possible causes of the symptoms, while a physical examination involves the doctor checking the child’s joints for inflammation or swelling.
In addition to these two methods, other tests may be conducted to help in the confirmation of the diagnosis. “X-rays may indicate the severity of the disease. An ultrasound or magnetic resonance imaging may help to confirm the diagnosis,” explains Dr Elizabeth Ang, paediatric consultant in the Division of Allergy, Immunology and Rheumatology, Paediatrics at National University Hospital and assistant professor in the Department of Paediatrics at National University of Singapore.
Blood tests may also be done, but only when the child has been diagnosed with JIA, according to Dr Ang. “Blood tests are not useful for diagnosing arthritis and the result may only be abnormal if there is widespread joint involvement. They are done only when a child is diagnosed with arthritis to get clues to the prognosis,” she says.
There is no way to cure JIA yet, but there are medications available to help relieve symptoms as well as “prevent joint destruction and maintain joint function and mobility”, says Dr Chew Li-Ching of the Department of Rheumatology & Immunology at Singapore General Hospital.
She further elaborates on these medications, “NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen, naproxen or diclofenac, are prescribed to reduce pain and stiffness, and therefore helpful in helping the child feel more comfortable.” The downside is these drugs are not beneficial in preventing JIA from progressing in the long-term.
Dr Chew adds, “Depending on the severity and progression of the disease, DMARDs (disease-modifying antirheumatic drugs) are often necessary and are added as a second-line treatment. These include methotrexate and sulfasalazine. Such drugs can slow the progression of the disease and prevent arthritis flares, but they do take several weeks to reach their full effect.”
During these few weeks of waiting for the DMARDs to
take effect, oral steroids (e.g. prednisolone) may also be used in
low doses, says Dr Chew. However, she warns against their l
ong-term use because of their side effects.
In addition to these medications, there have been new drugs developed in the last 15 years, called biologics, which are given as injections or infusions, explains Dr Ang. “New biologics have been approved in the last five to 10 years, including a class of medicines that can be given orally. Some of the newer biologics are given less frequently, which means fewer injections for the children,” she adds.
With JIA, there will be periods of time when the symptoms go away (remission) or worsen (flares), but there are ways to manage the condition, one of which is through exercise. “Exercise helps to build muscle strength and endurance which is needed for joint stability and recovery of range of motion. Splints and other devices are sometimes useful to prevent joint contractures and deformities,” says Dr Chew.
During remission, encourage your child to engage in
physical activities, such as swimming.
“Swimming is particularly useful because it uses many joints and muscles without putting weight on the joints,” explains Dr Chew. When your child is going through a flare, reduce the frequency of these activities so your child can rest.
Dr Chew emphasises the role of physiotherapists and occupational therapists in the management of JIA, so do seek help from these experts, who will be able to guide you on ways you can best care for your child.