What if your child has joint pain?

If you believe arthritis is a condition that affects only old grannies you should come to grips with juvenile arthritis (JA).

Although the vast majority of arthritis patients are adults, many children suffer from the condition as well. In the US, for instance, data from the Centres for Disease Control and Prevention (CDC) show that 52.5 million adults have arthritis, while 70,000 to 100,000 cases are estimated among children under the age of 16.

“Most patients with JA are two or older,” says Dr Cham Weng Tarng, paediatric rheumatologist at Sunway Medical Centre in Malaysia. “However, the condition can affect even very young babies between one and two years old.”

Arthritis causes inflammation and pain to any of the joints in the body. In the elderly it is often an age-related problem due to the degeneration of the cartilage in the joint. In children, instead, it arises because the immune system attacks the joint tissue by mistake.

Dr Cham explains that JA can impair children’s daily movements, such as walking, if it is not treated early. He adds that “when the small joints of the hand are affected the child will not be able to write and will feel a lot of pain.”

Parents need to stay vigilant

“The most important thing to fight JA is to identify the condition as early as possible,” according to Dr Cham.

This means that parents have to spot any potential alarm bell by monitoring their kids carefully if they complain of any discomfort in their joints such as stiffness or pain.

Children often fall down and experience pain in their legs, says Dr Cham, hence parents may jump to the conclusion that joint pain is not a serious problem. However, “if the pain lasts for more than six weeks, you have to take into account that something is not right.”

Young toddlers who cannot express their pain verbally will tend to cry when the limb affected by JA is touched or moved.

“If parents are concerned about their child, they should see a paediatrician, who in turn can refer them to a paediatric rheumatologist,” says Dr Cham.

Treatment modality

More than half of the children with JA may go into remission with adequate treatment, however, Dr Cham stresses that this is a long process as JA is a chronic condition. Those with the milder forms of JA, whereby only four or less joints are affected, can be treated with targeted steroid injections and they can improve within two to four weeks.

If more joints are affected, steroid injections alone are insufficient to put JA under control, hence they need to be administered in combination with disease modifying antirheumatic drugs (DMARD). Thanks to this combination treatment, more than 50 percent of patients will see an improvement and will be able to carry out pain-free daily activities.

“DMARDs help control the inflammation so that children can live a normal life,” says Dr Cham.

This treatment usually lasts for around one to two years, during which doctors have to carefully monitor patients to see how they progress.

“If patients improve we can slowly cut down on the medication, but if they don’t we will have to give them new agents called biologics,” according to Dr Cham.

These are very potent drugs that reduce the inflammation by suppressing the immune system, but they also expose children to an increased risk of developing infections like tuberculosis.

“When children who are treated with biologics get an infection they have to see a doctor immediately,” advises Dr Cham.

Dr Cham Weng Tarng is a paediatric rheumatologist with Sunway Medical Centre. His areas of expertise include autoimmune diseases like juvenile idiopathic arthritis, juvenile dermatomyositis and juvenile systemic lupus erythematosus as well as chronic pain in children and adolescents associated with idiopathic pain syndrome or juvenile fibromyalgia. 

Sunway Medical Centre
5, Jalan Lagoon Selatan, Bandar Sunway
46150 Petaling Jaya, Selangor, Malaysia
Tel: 603-7491 9191
sunwaymedical.com