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Times Of India
08 january 2013
Pune, India.

If arthritis is a crippling condition in adults, it is more so in children. Kids who are afflicted by the disorder are often at their wits' end on how to deal with the situation. They find their active life restricted and dependency on medicines increasing. Also, since dietary restrictions come into play, many kids are forced to give up their favourite chocolates and cakes.

According to doctors, juvenile rheumatoid arthritis, also known as juvenile idiopathic arthritis (JIA), is the most common type of arthritis found in children under the age of 16. It is one of the most frequent chronic illnesses among children and an important cause of shortand long–term disability.

Paediatric rheumatologist Vinaya Kunjir says that onset of JIA before six months of age is unusual. However,the age at onset is often quite early – with the highest frequency between one and three years of age. Girls are affected twice as many as boys. The condition causes a person’s immune system to attack his own body by releasing poisonous proteins which lead to degeneration, affecting the joints. If left untreated for long, it may develop into more serious complications, leading to even total disability in some cases.

JIA causes persistent joint pain, swelling and stiffness. Some children may experience symptoms for only a few months, but others have symptoms for the rest of their lives. Complications can lead to growth problems and eye inflammation. Treatment of juvenile rheumatoid arthritis focuses on controlling pain, improving function and preventing joint damages.

A mother to an 11–year–old says, "My daughter was diagnosed with arthritis at the age of eight. She didn't understand the seriousness of the issue. We as parents were more affected. With the help of the doctor and counselling sessions, we were able to make life less painful for our daughter."

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Along with timely medication and proper nutrition, it is important that children with JIA get a certain amount of therapeutic exercise. Aggressive sports like soccer or basketball may not always be recommended for children with JIA, but sports like table tennis, badminton and even hockey and cricket can be a part of the child's routine if the arthritis is under control and if the doctor so advises. Activities such as swimming and bike–riding should be encouraged as they exercise the joints and muscles.

"I encourage my daughter to swim. When she was first diagnosed with the disorder and had to forego all outdoor activities, she had begun to get depressed. Now, with regular swimming classes, not to mention counseling, I can see her confidence returning," says the mother of the child with JIA.

According to a study, there are more cases of enthesitis related arthritis (ERA) and polyarthritis (PA) in India than in the west. However, despite the alarming number of cases, there is a miserable patient–todoctor ratio in the field in India. This harms chances of right and timely diagnosis.

"We were lucky to get a good doctor. Nowadays there are many sites that educate you about the disorder. I still come across many people who think that arthritis is an age–related disorder," the mother said.

In fact, doctors say the shortage of rheumatologists and a lack of awareness about the condition drive patients to orthopaedic surgeons, who are not the right persons to treat arthritis.

Clinical symptoms

Pain and swelling in joints and morning stiffness n Anorexia, weight loss and growth failure. Children often complain of fatigue and disturbed sleep due to joint pains n Generalised abnormalities of growth and development n Inflammation of eyes, skin, muscles, liver or kidney n Chronic inflammatory diseases like arthritis can lead to tissue deposition of protein amyloid

Types of Juvenile Idiopathic Arthritis (JIA)

Systemic arthritis: Children with joint pain, swelling and daily fever of at least two weeks duration

Oligo arthritis: Affects one to four joints during the first six months of disease

Polyarthritis: Affects five or more joints during the first six months of disease

Psoriatic arthritis: Children with a close family history of psoriasis and nail abnormalities may be differentiated as having psoriasis associated arthritis

Enthesitis related arthritis: Enthesitis is characterised by inflammatory spine disorders. Sometimes causes eye inflammation. Usually boys are affected more than girls

Dos

Have balanced diet – carbohydrates, proteins and a small amount of fats

Have small frequent meals n Drink three to four litres of water and one to two 1glasses of milk daily

Drink black tea without sugar n Include green leafy vegetables, fresh fruits, eggs, soyabean in the diet

Fish, eggs and chicken liver are also good

Don’ts

Avoid heavy meals n Avoid high fat, high carbohydrate, oily food and sweets

Avoid fasting for long hours

Some patients may have to avoid red meat, paneer, cheese, butter, peanuts and tomatoes

Cut down on smoking and alcohol n Restrict bakery products

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