Arthritis—disease of the ‘old which strikes the young

Press, 22 June 1978, Page 10

Arthritis—disease of the ‘old which strikes the young

The Arthritis and Rheumatism Foundation, this year’s Telethon beneficiary, wants to make parents more aware of the problems and treatment associated with arthritis in children. Contrary to popular belief, arthritis is by no means rare in children. Hundreds of anguished New Zealand parents have watched their young children suffer excruciating pain and limb deformities. Like adults, children are struck by various forms of arthritis and rheumatic diseases in general. In children, depending on their age when arthritis strikes, there are significant differences in the pattern of disease and its long-term effects, some being more troublesome than others. Although the Western world generally has seen a most marked decline in rheumatic fever it persists as a major problem in New Zealand, especially in some rural communities. Improved housing conditions and hygiene usually lead to a decline in the number of cases — worldwide the incidence was dropping in developed countries before the advent of antibiotics. The arthritis suffered with rheumatic fever is often very painful and usually involves the larger joints, lasting a few days at a time in each joint. Fortunately, permanent joint damage is never seen. Bed rest and simple analgesics are all that is

needed in the acute phase, but it is important to prevent recurrences by the use of regular preventive antibiotics.

The principal symptom to look for is a throat infection in children between the ages of five to 15. For this reason, “sore throats” should always be checked by a doctor, particularly if the patient has suffered from rheumatic fever previously. The fever sometimes affects the heart and can lead to permanent heart damage which can be particularly disabling in later life. The most common form of chronic arthritis in children is juvenile rheumatoid arthritis, sometimes known as Still’s disease, and now often given the name juvenile chronic polyarthritis. It can closely resemble the adult form of rheumatoid arthritis but most children show different symptoms. One pattern that comes on abruptly affects joints and other areas such as the liver, spleen and lymph nodes, with a rash and a swinging type of fever.

The joints involved may be the larger ones, or all joints can be involved with time. In some of these children there is serious involvement of the neck and hips, and children may face major hip problems in early adult life. In another example the child shows persistent in-

volvement of only one or two joints (oligoarthritis) with few other upsets but occasionally serious trouble with the eyes.

Treatment of Still’s disease has changed enor mously from former total immobilisation to the modern programmes emphasising the maintenance of activity. Drugs are of importance, particularly in the control of stiffness and to a lesser extent, pain, for in many children the stiffness and joint deformity are more a problem than pain.

It is important to try to foster the normal interests of the child; and education is particularly valuable. School should be continued despite the presence of joint activity. These days, most children are. not kept in hospital for any length of time.

One condition which is seen almost entirely in children and which is not yet adequately understood is “irritable hip.” While there are many theories, no-one knows why an otherwise healthy child

suddenly develops a painful hip. These cases usually settle without treatment with simple bed rest; and the follow-up of these children — usually boys — does not usually demonstrate chronic problems in later life. In all cases of arthritis in childhood, an accurate diagnosis is important and early treatment vital.

It is also essential that the normal development of the child —physical, mental, social and emotional — is not impeded by the medical problem, which in some cases of juvenile - chronic polyarthritis continues through the school years and beyond.