Diagnosing Juvenile Arthritis – Boys Town National Research Hospital

Diagnosing Juvenile Arthritis – Boys Town National Research Hospital


We really try to encourage families and primary
care doctors to watch for is morning stiffness, so stiffness in the morning after a child
lays in bed all night, that arthritis gets very stiff so they get up, they start to limp
and it takes a while to loosen up. So early morning stiffness, limping in the
morning, limping after naps, long car rides is very useful and then joint swelling. If the joint is swollen, that usually indicates
the chance that there’s an arthritis. One of the most challenging diagnoses are
the very young children because they can’t communicate so it really requires having the
parents see something that’s changed. Often we’ll see that it’s a child that
went from their toddler type gait or crawling to now wanting to be carried or going from
walking to back to crawling. So they stopped using the joints that they
used to use or they go from someone who is more of a right hand dominant to more of a
left hand so they start to favor using the other hand so they don’t want to use the
hand that’s a little bit stiff or sore and then I think the other part is just looking
for the symptoms that a child seems to get better as the day goes on. They get up. They start moving around they start crawling
and they seem to look a little bit better but then after their nap or after or in the
morning they just look kind of slow, hard to move, kind of more cranky and that’s
just a sign that it has that stiffness. When we approach a child with juvenile arthritis
our goal really is to try to achieve a clinical remission meaning inactive disease, and our
first goal would be to target the arthritis with whatever medications we can, to get it
in a remission on medications. Then over time if we maintain that remission
on those medications, then we slowly pull those medications back off to see if they
maintain that remission. The most common form of arthritis, the oligoarthritis
subset which is the one that only has a few joints, a large percentage of patients can
enter a lasting remission off meds. The other forms of arthritis, we still try
to get to that point where the remission is maintained off of meds, but a lot of patients
do need long term medication, however they can control their arthritis and not have active
arthritis which again is the goal. It just requires more duration of the medications.

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