About juvenile arthritis and other rheumatic diseases

What is the difference between arthritis and other rheumatic diseases?

Arthritis, itself a group of more than 100 different diseases, is one category of rheumatic diseases. Rheumatic diseases may cause pain, stiffness, and swelling in the joints and other supporting body structures, such as muscles, tendons, ligaments, and bones. However, rheumatic diseases can affect other areas of the body, including internal organs. Some rheumatic diseases involve connective tissues (called connective tissue diseases), while others may be caused by autoimmune disorders, which are diseases involving the body's immune system attacking its own healthy cells and tissues.

What is the immune system?

The purpose of the immune system is to keep infectious microorganisms, such as certain bacteria, viruses, and fungi, out of the body, and to destroy any infectious microorganisms that do invade the body. The immune system is made up of a complex and vital network of cells and organs that protect the body from infection.
When the immune system does not function properly, it leaves the body susceptible to an array of diseases. Allergies and hypersensitivity to certain substances are considered immune system disorders. In addition, the immune system plays a role in the rejection process of transplanted organs or tissue. Other examples of immune disorders include:

• autoimmune diseases, such as juvenile diabetes, rheumatoid arthritis, and anemia
• immune complex diseases, such as viral hepatitis and malaria
• immunodeficiency diseases, such as acquired immunodeficiency syndrome (AIDS)

Who treats juvenile arthritis and other rheumatic diseases?

Arthritis and other rheumatic diseases may be treated by your child's pediatrician and/or other medical specialists and healthcare providers. Several physicians from different medical specialties may be involved in the treatment of your child at the same time. This multidisciplinary team approach is particularly important in managing symptoms of the rheumatic disease, especially as many symptoms are chronic and change in severity over time. Some of the more common medical professionals involved in the treatment of arthritis or other rheumatic diseases may include the following:

Pediatric rheumatologist

A pediatric rheumatologist is a physician who specializes in the treatment of arthritis and other rheumatic diseases that may affect joints, muscles, bones, skin, and other tissues in children. They are pediatricians who have received additional training in the field of childhood rheumatic diseases. Rheumatologists are specially trained to identify many types of rheumatic diseases in their earliest stages, including arthritis, many types of autoimmune diseases, musculoskeletal pain, disorders of the musculoskeletal system, and inflammatory diseases. In addition to medical training and three years of specialized training in pediatrics, a pediatric rheumatologist has had an additional two or three years of specialized training in the field of pediatric rheumatology. A pediatric rheumatologist may be board certified in pediatric rheumatology by the American Board of Pediatrics.

Pediatric nurse practitioner

A Pediatric Nurse Practitioner (PNP) who has specialized in the field of rheumatology may provide care for your child at a clinic appointment. PNPs have completed graduate level advanced education and clinical practice requirements. The nurse practitioner collaborates with the rheumatologist to evaluate, identify and develop a plan of care for your child.

They emphasize a holistic approach in their practice. PNPs focus on health promotion, disease prevention, early detection, and treatment of illnesses, case management, patient education, and patient advocacy. The nurse practitioner is available to assist parents by answering parent questions, addressing problems that arise concerning the child/adolescent's illness, as well as help with related school issues. 

Orthopedic surgeon

The physician who specializes in orthopedic surgery is called an orthopedic surgeon, or sometimes, simply, an orthopedist. Orthopedists are educated in the workings of the musculoskeletal system, which includes (but is not limited to) diagnosing a condition or disorder, identifying and treating an injury, providing rehabilitation to an affected area or function, or establishing prevention protocol to inhibit further damage to a diseased area or component of the musculoskeletal system.

The orthopedist may have completed up to 14 years of formal education. After becoming licensed to practice medicine, the orthopedic surgeon may become board certified by passing both oral and written examinations given by the American Board of Orthopaedic Surgery.

Many orthopaedic surgeons choose to practice general orthopedics, while others specialize in certain areas of the body (i.e., foot, hand, shoulder, spine, hip, or knee), or in a specialized area of orthopaedic care (i.e., sports medicine, trauma medicine). Some orthopedists may specialize in several areas, and may collaborate with other specialists, such as neurosurgeons or rheumatologists, in caring for patients.

Physical therapist

Physical therapy is the health profession that focuses on the neuromuscular, musculoskeletal, and cardiopulmonary systems of the human body, as these systems relate to human motion and function.

Physical therapists, or PTs, are important members of the healthcare team. They evaluate and provide treatment for persons with health problems resulting from injury, disease, or overuse of muscles or tendons. Some physical therapists specialize in caring for children. PTs help patients either to achieve maximum independence and function or to live comfortable and productive lives.

Physical therapists have an undergraduate degree in physical therapy, a Master's degree, or a doctorate degree. In order to practice, all graduates must be licensed by their state by passing a national certification examination.

Physical therapy treatment and services focus on restoring the individual's mobility and function, cardiovascular endurance, muscle strength, and efficiency in the Activities of Daily Living (ADLs).

As related to arthritis and other rheumatic diseases, physical therapists provide comprehensive training that includes, but is not limited to, the following:

• home exercise programs for range of motion and strength training
• functional mobility
• balance and gait retraining
• soft-tissue mobilization
• body mechanics education
• wheelchair safety and management
• neuromuscular re-education
• exercise programming
• family education and training
• assistance with pain relief and management
• instruction in safe ambulation (may include the use of a walker, cane, or crutch)

Occupational therapist

Occupational therapy is the use of purposeful activity to maximize independence, prevent disability, maintain health, and enhance quality of life for people who are affected by physical injury or illness, psychosocial dysfunction, developmental and learning disabilities, or the aging process. Specific O.T. services address the areas of self-care, work, and leisure skills. Occupational therapy often includes the adaptation of tasks or the environment to achieve maximum independence and may include:

• Teaching of self-care activities for daily living (ADL) which includes such things as dressing, bathing, grooming, hygiene, and eating.
• Treatment for fine motor coordination, visual perceptual skills, and upper body strengthening.
• Instruction in the use of adaptive equipment to assist with activities of daily living.
• Designing, fabricating, or applying selective splints (orthotics) or prosthetic devices.
• Instruction in energy conservation and work simplification techniques.

Nurses

Nurses and nurse practitioners, specialized in the care of rheumatic diseases, may assist your child's physician in providing care. In addition, these nurses may help you learn about your child's treatment plan and can answer many of your questions.

Who is affected by juvenile arthritis and other rheumatic diseases?

Arthritis and rheumatic diseases can affect anyone, at any age, or of any race. However, certain diseases are more common in certain populations, including the following:

• Juvenile rheumatoid arthritis affects children between 2 and 16 years of age more frequently.
• In children, lupus occurs more often in females.
• Ankylosing spondylitis is more common in Caucasian boys.

What causes juvenile arthritis and other rheumatic diseases?

The cause of most types of rheumatic diseases remains unknown and, in many cases, varies depending on the type of rheumatic disease present. However, researchers believe that some/all of the following may play a role in the development or aggravation of one or more types of rheumatic diseases:

• genetics and family history (i.e., inherited cartilage weakness)
• trauma
• infection
• excessive wear and tear and stress on a joint(s)
• environmental triggers
• the influence of certain hormones on the body

What are the symptoms of juvenile arthritis and other rheumatic diseases?

The following are the most common symptoms of juvenile arthritis and other rheumatic diseases. However, each child may experience symptoms differently, and different types of rheumatic diseases present different symptoms. In general, however, symptoms may include:

• joint pain
• swelling in one or more joints
• joint stiffness that lasts for at least one hour in the early morning
• chronic pain or tenderness in the joint(s)
• warmth and redness in the joint area
• limited movement in the affected joint(s)
• fatigue
• persistent fevers

Symptoms of pediatric arthritis and other rheumatic diseases may resemble other medical conditions and problems. Always consult your child's physician for a diagnosis.