THURSDAY, Dec. 23 (HealthDay News) -- Most people think of
arthritis as a disease of old age, with people's joints growing
creaky and painful later in life.
But arthritis also affects hundreds of thousands of kids in the
United States. Children and teens with juvenile arthritis face a
lifetime of aching joints and impaired mobility if the disease
isn't caught in time.
"There are about 300,000 kids that are affected by juvenile arthritis," said Dr. Patience White, vice president of public health for the Arthritis Foundation and a professor of pediatrics and medicine at George Washington University School of Medicine and Health Sciences. "That means it's more common than kids with type 1 diabetes."
Though the disease itself isn't rare, doctors specially trained
to treat juvenile arthritis can be hard to find.
Fewer than 200 certified pediatric rheumatologists currently
practice in the United States, making it one of the smallest
pediatric subspecialties, according to the U.S. Department of
Health and Human Services. Thirteen states don't have a single
pediatric rheumatologist within their borders, including heavily
populated states such as Arizona, South Carolina and Alabama.
"There are many families who have to travel many miles -- sometimes to another state -- to see a pediatric rheumatologist," White said.
Three types of juvenile arthritis have been identified,
according to the Arthritis Foundation and the American Academy of
Any child younger than 18 can develop juvenile arthritis, but
there tend to be two age ranges when it's more likely to occur.
There's one peak at ages 2 to 4, followed by another peak at ages 8
to 12, said Dr. Harry Gewanter, a pediatric rheumatologist with
Pediatric and Adolescent Health Partners in Richmond, Va., and a
clinical associate professor of pediatrics and physical medicine
and rehabilitation at Virginia Commonwealth University School of
"Their hallmark is you have a chronic arthritis that lasts at least six weeks in one or more joints," Gewanter said. "Lots of kids will have problems with their joints that come and go for a variety of reasons, but there are very few things that are going to stick around besides something like this."
It can be difficult for parents to know there's something wrong
with their child, however, because kids lack the ability to
communicate pain effectively, White said. Most of the time, kids
with juvenile arthritis have a limp, but parents generally think
that the child hurt a leg or knee.
Parents should suspect juvenile arthritis if they notice the
child limping more in the morning or after a nap; that's because
the joint grows stiff when it's at rest. The affected joints also
will be red and swollen.
Though various laboratory tests can be used to help narrow a
diagnosis, there's no one test to identify it. "It's really more a
combination of history and the exam and lab tests, and the pattern
consistent with this illness," Gewanter said.
Doctors used to try one arthritis drug after another until they
found one that worked. These days, he said, they try to
shotgun-blast the arthritis as hard as possible after
"We've taken a page from the oncologists in terms of going after this as aggressively as we can at the start," Gewanter said. "We're trying to jump in hard to shut down all the inflammation early, then peel medications away as you can. If you take a child and treat them aggressively straight away, often you can just shut the whole thing down and change the course of the disease. That kind of an approach really has made as much of a difference as anything else."
It can be difficult for parents to find a doctor to provide such
treatment, however, because of the shortage of pediatric
rheumatologists. White said the shortage developed because the
specialists make much less money than a general pediatrician, even
though they have to undergo more extensive training.
Federal health-care reform might help solve the situation,
though, as one clause in the law creates a loan repayment program
for pediatricians who undergo training in a specialty such as
rheumatology, White said. They would be granted extensions for
their loan repayment.
"We're excited about that," White said, but he added quickly that Congress has not yet funded the program.
The Arthritis Foundation has more on
For more on juvenile arthritis, read about
one teenager's story.
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