satu lagi artikel ttg si rematik ini. AKu pernah kena, di sendi tulang
belakang, gileeee bok rasanya, sakit sekali dipakai jalan dan berdiri, jadi
bisanya membungkuk, minum obat celebrex, langsung baikan, kapok dah kena
ginian. artikel di bawah diunduh dari mayoclinic.com
Juvenile rheumatoid arthritis Introduction
Juvenile rheumatoid arthritis (JRA) — which causes joint inflammation for at
least six weeks in children 16 years old or younger — is the most common
type of childhood arthritis. In most cases, symptoms of juvenile rheumatoid
arthritis may fade after several months or years.
Juvenile rheumatoid arthritis can be complicated. There are several types of
juvenile rheumatoid arthritis, classified based on the joints affected,
symptoms and test results.
Treatment of juvenile rheumatoid arthritis focuses on preserving physical
activity to maintain full joint movement and strength, preventing damage and
controlling pain.
Signs and symptoms
If you're a parent or caretaker, watch for signs and symptoms of juvenile
rheumatoid arthritis, particularly in young children.
Symptoms depend upon the category of JRA, and the main categories of JRA
are:
- *Pauciarticular JRA.* This affects four or fewer joints — typically
larger joints, such as the knees. This is the most common form of JRA.
- *Polyarticular JRA.* This affects five or more joints — typically small
joints, such as those in the hands and feet. Polyarticular JRA often affects
the same joint on both sides of a child's body.
- *Systemic JRA.* Also known as Still's disease, systemic JRA affects
many areas of the body, including joints and internal organs. This is the
least common form of JRA.
Signs and symptoms of juvenile rheumatoid arthritis may include:
- *Joint swelling, with pain and stiffness.* This may be more pronounced
in the morning or after a nap. Commonly it affects the knees and the joints
in the hands and feet. Children may complain of pain, or you might notice
them limping.
- *Fever and rash.* These can be associated with many medical conditions,
but if they're persistent, they may signal systemic JRA. Fever and rash
caused by systemic JRA may appear and disappear quickly.
- *Swelling of lymph nodes.* This sign may occur in children with
systemic JRA.
- *Eye inflammation.* This problem, which occurs mostly in children with
pauciarticular JRA, initially produces no signs or symptoms in most of those
affected. Routine eye examinations are recommended because eye inflammation
may result in blindness.
Like other forms of arthritis, JRA is characterized by times when symptoms
are present (flares) and times when symptoms disappear (remissions).
Causes
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Doctors believe that juvenile rheumatoid arthritis is an autoimmune
disorder. This means that the body's immune system attacks its own cells and
tissues. It's unknown why this happens, but both heredity and environment
seem to play a role.
It may be that a virus or bacterium triggers the development of juvenile
rheumatoid arthritis in children with certain genetic profiles. These
genetic profiles are detected in some children with juvenile rheumatoid
arthritis and are considered genetic markers for juvenile rheumatoid
arthritis. However, not all children with the markers develop juvenile
rheumatoid arthritis, and children without the markers can develop the
condition.
When to seek medical advice
Take your child to your primary care doctor if your child:
- Shows signs of joint swelling, stiffness or pain
- Limps for no obvious reason
Also, if your child has a fever of 102 F that persists for longer than two
or three days, take him or her to the doctor. A fever that signals juvenile
rheumatoid arthritis may come and go one or two times during a day and last
a few hours each time. It's frequently noted in the afternoons or evenings.
*After a diagnosis *
If your child has received a diagnosis of juvenile rheumatoid arthritis,
take him or her to your doctor regularly to monitor the development of the
disease and its treatment.
Children with pauciarticular JRA need regular screening for eye
inflammation. A child diagnosed before age 7 with pauciarticular arthritis
should have his or her eyes checked every three months if a blood test shows
the child is anti-nuclear antibody (ANA) positive. Anti-nuclear antibodies
are proteins generally found in people who have connective tissue or
autoimmune disorders, such as arthritis.
If your child is ANA negative, your doctor will recommend an eye screening
schedule based on your child's risk of developing eye problems.
Screening and diagnosis
If your pediatrician or family doctor suspects that your child has juvenile
rheumatoid arthritis, he or she will refer you to a doctor who specializes
in arthritis (rheumatologist) to confirm the diagnosis and for treatment.
The diagnosis of juvenile rheumatoid arthritis usually begins with a medical
history and a physical examination. Diagnostic tests may include:
-
*Blood tests.* These may include an erythrocyte sedimentation (sed) rate
test. Sedimentation rate is the speed at which your red blood cells settle
to the bottom of a tube. An elevated rate can indicate inflammation.
Measuring the sed rate may be used to rule out other conditions, to help
classify the type of juvenile rheumatoid arthritis and to determine the
degree of inflammation.
Another blood test looks for antibodies in your child's blood. Whether
your child has anti-nuclear antibody (ANA) and rheumatoid factor in his or
her blood can help the doctor to determine the type of arthritis.
Anti-nuclear antibodies are proteins commonly produced by the immune systems
of people with certain autoimmune diseases, including arthritis. Rheumatoid
factor is an antibody commonly found in the blood of people with rheumatoid
arthritis. In many children with JRA, no significant abnormality will be
found in these blood tests.
- *Imaging.* X-rays may be taken to exclude other conditions, such as
fractures, tumors, infection and congenital defects. X-rays may also be used
from time to time after the diagnosis to monitor bone development and to
detect joint damage.
- *Joint fluid removal.* The doctor may remove some fluid from your
child's swollen joint. This can relieve pain and can help the doctor to
identify the cause of the arthritis.
Complications
Several serious complications can result from juvenile rheumatoid arthritis.
But keeping a careful watch on your child's condition and seeking
appropriate medical attention can greatly reduce the risk of these
complications:
- *Eye inflammation.* Eye diseases such as iritis (inflammation of the
iris) may occur in children with juvenile rheumatoid arthritis, especially
children with pauciarticular arthritis. Initially, this eye condition may
occur without symptoms, so it's important for children with juvenile
rheumatoid arthritis to be examined regularly by a medical doctor who
specializes in eye care (ophthalmologist). Work with your doctor to
determine the best eye screening schedule for your child. Untreated eye
inflammation can result in cataracts, calcium deposition in the cornea,
glaucoma and, ultimately, blindness.
- *Growth interference.* Juvenile rheumatoid arthritis can interfere with
the development of your child's bones and growth. Some medications used to
treat JRA, mainly corticosteroids, also can inhibit growth.
Treatment
Treatment for juvenile rheumatoid arthritis focuses on helping your child
maintain a normal level of physical and social activity. To accomplish this,
doctors may use a combination of strategies to relieve pain and swelling,
maintain full movement and strength, and prevent complications.
*Medications*
For some children pain relievers may be the only medication needed. Others
may need help from medications designed to limit the progression of the
disease. Typical medications used include:
- *Nonsteroidal anti-inflammatory drugs (NSAIDs).* These medications,
such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, Naprosyn),
reduce pain and swelling. Because children can develop side effects such as
bleeding and liver and stomach problems, be sure to use these medications
under a doctor's supervision.
-
*Celecoxib (Celebrex).* This drug is part of a class of NSAIDs known as
COX-2 inhibitors, which are believed to be gentler on the stomach. The Food
and Drug Administration has approved celecoxib for children age 2 and older
with JRA. Celecoxib hasn't been studied in children younger than 2 and in
those with the systemic form of the disease.
Side effects may include cough, cold, upper respiratory tract infection,
abdominal pain, headache, fever, nausea, diarrhea and vomiting. COX-2
inhibitors have been found to increase the risk of heart problems in adults.
Studies are being conducted to determine whether celecoxib increases heart
risks in children.
-
*Disease-modifying antirheumatic drugs (DMARDs).* Doctors use these
medications when NSAIDs alone fail to relieve symptoms of joint pain and
swelling. They may be taken in combination with NSAIDs and are used to slow
the progress of juvenile rheumatoid arthritis. Commonly used DMARDs for
children include methotrexate (Rheumatrex) and sulfasalazine (Azulfidine).
Side effects of methotrexate may include nausea, mouth sores and liver
problems. Methotrexate may also lower the number of white blood cells in
your blood, leading to an increased risk of infection. Side effects of
sulfasalazine may include gastrointestinal problems, such as nausea,
vomiting and diarrhea, as well as headache and sore throat.
-
*Tumor necrosis factor (TNF) blockers.* These biologic response modifiers
block an immune system protein called tumor necrosis factor, which acts as
an inflammatory agent in some types of arthritis. By targeting this protein,
TNF blockers can help reduce pain, morning stiffness and swollen joints. Two
TNF blockers used for treating JRA are etanercept (Enbrel) and infliximab
(Remicade).
Some people experience side effects during or shortly after these drugs
are injected, including chest pain, dizziness and difficulty breathing, as
well as redness, itching and swelling at the injection site. Additional side
effects of biologic response modifiers may include abdominal pain, headache,
respiratory infections such as tuberculosis, and other infections. These
medications may also increase your risk of demyelinating disorders,
conditions that damage the protective covering (myelin sheath) that
surrounds nerves in your brain and spinal cord.
- *Corticosteroids.* These prescription medications are for children with
more severe juvenile rheumatoid arthritis. They're used to control symptoms
until a DMARD takes effect or to prevent complications, such as inflammation
of the sac around the heart (pericarditis). Corticosteroids, such as
prednisone, may be administered by mouth or by injection. But they can
interfere with normal growth and increase susceptibility to infection, and
generally should be used for the shortest possible duration. Stopping
long-term use of corticosteroids suddenly can be dangerous, so it's
important to follow a doctor's instructions on usage.
*Therapies*
Your doctor may recommend that your child work with a physical therapist to
help keep joints flexible and maintain range of motion and muscle tone. A
physical therapist or an occupational therapist may make additional
recommendations regarding the best exercise and protective sports equipment
for your child. A therapist may also recommend that your child make use of
special supports or splints to help protect joints and keep them in a good
functional position.
Self-care
Caregivers can help children learn self-care techniques that help limit the
effects of juvenile rheumatoid arthritis. Techniques include:
- *Getting regular exercise.* Exercise is important because it promotes
both muscle strength and joint flexibility. Swimming is an excellent choice
because it places minimal stress on joints.
- *Applying cold or heat.* Stiffness affects many children with juvenile
rheumatoid arthritis, particularly in the morning. Although some children
respond well to cold packs, most children prefer a hot pack or a hot bath or
shower.
-
*Eating well.* Some children with arthritis have poor appetites. Others
may gain excess weight due to medications or physical inactivity. A
well-balanced diet can help maintain an appropriate body weight.
Adequate calcium in the diet is important because children with juvenile
rheumatoid arthritis are at risk of developing osteoporosis due to the
disease, the use of corticosteroids, and decreased physical activity and
weight bearing.
Coping skills
Family members can play critical roles in helping a child cope with juvenile
rheumatoid arthritis. As a parent, you may want to try the following:
- *Don't set your child apart. *Treat your child, as much as possible,
like other children in your family.
- *Allow your child to express anger* about having juvenile rheumatoid
arthritis. Explain that JRA isn't caused by anything he or she did.
- *Encourage your child *to participate in physical activities, keeping
in mind the recommendations of your child's doctor and physical therapist.
-
*Work with your child's teachers* and school administrators to make any
necessary modifications in his or her schedule or responsibilities.
These modifications may include giving your child extra time to move from
class to class, providing him or her with an extra set of textbooks so that
these books won't need to be carried home, and making arrangements for
assignments to be sent home when your child misses school because of his or
her condition.
*Connecting with others*
Also think about how you can cope with the challenges of raising a child who
has juvenile rheumatoid arthritis. Connecting with other parents in similar
circumstances and tapping into community resources may help.
The Arthritis Foundation has a council called the American Juvenile
Arthritis Organization (AJAO), devoted to serving the special needs of
children with arthritis and their families. The organization sponsors
support groups and conferences.
