Joint Pain in Children: Sore Knee or Juvenile Idiopathic Arthritis – New Delhi, India

Joint Pain in Children: Sore Knee or Juvenile Idiopathic Arthritis New Delhi

, India

Juvenile idiopathic arthritis (formerly known as juvenile rheumatoid arthritis) is an autoimmune disease that affects children under the age of 18. The cause is not known, and it does not appear to be genetic, although some family members may suffer from other autoimmune disorders. Symptoms may include:

joint stiffness in the morning that improves later in the day;

pain, swelling, and tenderness in the joints;

limping or limits in range of motion;

high fever and light rash;

weight loss;

fatigue or irritability; and/or

red eyes or blurred vision.

Depending on the type of JIA, these symptoms can vary quite a bit. In fact, some young patients may not suffer any of these symptoms, but have a swollen joint that is discovered after another incident such as an injury.

If JIA is suspected, an assessment of all peripheral joints should be conducted, not just the joint or joints about which the patient is complaining.

Exquisitely painful, tender, or red joints are not typically diagnostic for JIA.

Oligoarticular JIA (where just a few joints are affected) is the most common type of JIA, affecting 60 percent of children with this disorder. The onset of this type of arthritis is usually between the ages of 1 and 3.

Treatment of juvenile arthritis is designed to reduce swelling, maintain full movement of affected joints, and relieve pain, and includes medications and physical therapy. Surgery may be indicated in rare cases. Some JIA patients' disease can go into remission.

Recent clinical trials are showing that with new drug treatments, remission will soon be a realistic goal for most patients.

It is important to try and diagnose JIA early so treatment can begin. If left untreated for months or years, there is a likelihood of long-term disability, growth problems or deformity. The disease can cause joint damage that is irreversible. The good news, though, is that when we do diagnose JIA, we have many excellent treatments available.

Certain surgical techniques may be helpful for people with severe deformities or disabilities.

Arthroscopy. Arthroscopy is performed to clean out bone and cartilage fragments that cause pain and inflammation. It is usually performed on the knee, but it also may be done on the hip:

The surgeon makes a small incision and injects a sterile solution to make the joint swell for easier viewing.

A lighted tube, called an arthroscope (which enables the surgeon to view the joint), is then inserted through another small incision.

Through a third incision, the surgeon trims, shaves, or stitches the damaged tissue. (Arthroscopy is most successful when the removal of cartilage only, and not bone, is involved.)

In many cases, the procedure can be done using local anesthetic, and the patient can go home within a day. In the case of knee operations, patients can resume mild activity in a couple of days, but full recovery can take up to 3 months.

Osteotomy. If only a certain section (the medial compartment) of the knee is damaged and deformed, the surgeon may choose to perform osteotomy:

The knee is opened.

Adebridement (removal of damaged tissue) is performed in the joint to eliminate the loose or torn fragments that are causing pain and inflammation.

The bone is then reshaped to remove the deformity.

The procedure is best used in heavier adults who are under 60 years old.

Unicompartmental Knee Arthroplasty. Unicompartmental knee arthroplasty (also called unicondylar knee arthroplasty) may be a useful procedure in some cases of limited damage in the knee. It is intended to relieve pain and preserve function as long as possible before a total knee replacement is necessary. The procedure involves a small incision and insertion of small implants. It retains important knee ligaments, which should preserve more movement than a total knee replacement. The procedure is not widely available and is somewhat controversial, since the implants may not be as reliable as those in total knee replacement.

Synovectomy. Synovectomy is a procedure whereby the diseased joint lining is removed. It is used when more conservative measures fail, particularly in the wrist. Studies are suggesting, however, that with the use of lasers for the procedure, eventually synovectomy may prove to be an alternative to DMARD treatments in reducing symptoms and achieving long-term remission.

Joint Replacement Surgery. Eventually, even after these procedures, rheumatoid arthritis may progress to the point that normal functioning is impossible. In such cases, artificial (prosthetic) replacement joint implants may be considered for knees, hips, or other joints. The prosthesis is usually made of a chromium alloy and plastic and may be attached to the adjoining bones using a cement, polymethyl methacrylate, or the prosthesis may be composed of a porous material that allows bone to grow into and eventually adhere to the device.

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