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Juvenile Arthritis and Rheumatoid Arthritis Awareness

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Dr. Dawn-Elise Snipes
– Learn what juvenile and rheumatoid arthritis are
– Identify the prevalence of JA/RA
– Explore the relationship of JA/RA and affiliated medications to mental health
– Identify interventions to assist people with JA/RA achieve their highest quality of life
Autoimmune Issues and Children
– Autoimmune disorders that occur in childhood include:
– Juvenile arthritis, which affects about 1 in 1,000 children
– Type 1 (juvenile) diabetes, which affects 1 to 2 of every 400 children
– Celiac disease which impacts 1-3% of the population

What Is It-
– Juvenile arthritis (JA), or pediatric rheumatic disease, is an umbrella term to describe a set of inflammatory, usually autoimmune diseases that impact nearly 300,000 children under the age of 16.
– Some children with JIA have their disease go into permanent remission or only have one or two flare-ups
– More than 90 percent of patients with childhood RF-positive polyarthritis and more than half with RF-negative polyarthritis were diagnosed with rheumatoid arthritis (RA) as adults
– This condition is not directly inherited

What is It | JIA / JRA
– Systemic arthritis (rarest form), also called Still's disease usually starts between 5 and 10 y.o.a. can affect many systems of the body.
– High fever and a rash on the trunk, arms, and legs.
– Internal organs, such as the heart, liver, spleen, and lymph nodes, but usually not the eyes.
– Polyarthritis (>5) or oligoarthritis (<5) involves joints and sometimes uveitis or an inflammation of the middle layer of the eye. - Symptoms include redness, pain, light sensitivity, blurred vision, and dark floating spots in the field of vision. What is It | RA - Rheumatoid Arthritis is an autoimmune and inflammatory disease that occurs in adults and can lead to long-lasting or chronic pain, unsteadiness (lack of balance), and deformity (misshapenness). Symptoms of JIA and RA - Joints become red or swollen and feel stiff, painful, tender and warm, especially in the morning - Eye dryness, pain, redness, sensitivity to light and trouble seeing properly caused by chronic eye inflammation - Scaly red rash (psoriatic), light spotted pink rash (systemic), butterfly shaped rash across the bridge of the nose and cheeks (lupus) or thick, hardened patches of skin (scleroderma). - Rash - Weight loss - Fatigue - Irritability - Eye redness or eye pain - Blurred vision - Dark “floaties” in field of vision Triggers - Dietary and emotional factors do not appear to play a role in the development of JIA but may contribute to exacerbation of symptoms - Mental health comorbidities including depression in RA interact with disease processes, including dysregulation of inflammatory responses, prolonged difficulties with pain and fatigue, and the development of cognitive and behavioral responses that exacerbate the physical and psychological difficulties.  - Obesity - Most studies found obese patients had worse tender joint counts, inflammatory markers, global evaluation scores, pain scores, and physical function scores during follow-up. Triggers - Smoking - Smoking increases the severity of RA. - Maternal smoking during pregnancy increases risk of RA - Secondhand smoke increased the risk of the development of JIA and RA - Among women who never smoked at all, exposure to secondhand smoke during childhood was associated with a 43 percent higher risk of developing rheumatoid arthritis  Triggers - Chronic stress , depression and gum disease are associated with increased inflammation - Increased inflammation is associated with worsening of JIA / RA symptoms and increase in pain intensity - Increases in systemic inflammation as seen in most autoimmune diseases including JIA / RA are is associated with increased depression and oxidative stress Treatment - Most juvenile idiopathic arthritis (JIA) patients need to attend adult rheumatology centers - The primary goals of treatment are to - Eliminate active disease - Normalize joint function - Preserve normal growth - Prevent long-term joint damage - Support independent self-management - Help youth acquire skills and knowledge to manage JIA - Educate patient, SOs and community about unique challenges of JIA - Increase inclusion and social support through F2F and online interventions Treatment and Prevention - Psychosocial adjustment of youth with JRA is similar to that of non-affected youth and is impacted by: - Physical: Sleep, fatigue, nutrition (antioxidants / omega-3s), gut health, circadian rhythms, pain management, medication side effects, hormones - Affective: Mood impacts physical wellbeing - Cognitive: Psychological Flexibility, Realistic Perceptions, Living in the AND, Hardiness, Resiliency - Environmental: Reductions in “stress” triggers, - Relational: Supportive friends and family focusing on what the youth can do and encouraging resiliency Treatments - Medications that work by suppressing the immune system to prevent it from attacking the joints include - Immunosuppressives - Increased risk of infection - Corticosteroids may increase anxiety - Biologics which target tumor necrosis factors (TNF) which are cytokines that promote inflammation. - TNF Antagonists are associated with reductions in depression and insomnia although they are also associated with the development of a rare white-blood cell cancer in adolescents Interventions - Exercise is key to reducing the symptoms of arthritis and maintaining range of motion of the joints. - SMART Guidelines • Start low, go slow. • Modify activity when arthritis symptoms increase, try to stay active. • Activities should be “joint friendly.” • Recognize safe places and ways to be active. • Talk to a health professional or certified exercise specialist. - Federal and state programs may provide assistance with school accommodations or services. - Consult with your rheumatologist about support groups and camps for kids with JA Resources - Arthritis Foundation - Healthy Joints Matter - CDC-Recommended, Arthritis-Appropriate Physical Activity Programs - Juvenile Arthritis from National Institute of Arthritis and Musculoskeletal and Skin Diseases - Juvenile Arthritis: Fast Facts for Patients and Caregivers from the American College of Rheumatology - Childhood Arthritis and Rheumatology Research Alliance (CARRA) - Kids Get Arthritis Too from the Arthritis Foundation - Learn more about arthritis • Arthritis Types • Physical Activity for Arthritis