How Is Juvenile Rheumatoid Arthritis Diagnosed
Your childs doctor will ask about your childs symptoms and do a physical exam. It can be hard to diagnose. You doctor may do an X-ray or blood test to rule out other illnesses. X-rays also can show more severe damage or deformities. Your childs doctor may want to take a sample of fluid from an actively inflamed joint or spinal fluid. It may take a few months before your doctor makes a diagnosis. This is so he or she can watch your childs symptoms over time.
What If You Dont Respond To The Standard Disease Modifying Drugs
For some people, maybe 10% to 20% of people with RA, the disease is more aggressive and more difficult to get under swift control. But a range of injectablebiologic drugs have revolutionised treatment for people who dont respond to the standard DMARDs. Biologic drugs are a more complex form of DMARD. More recently, another class of drugs called JAK inhibitors have become available which are taken orally in the form of tablets which are as similarly highly effective as biologic drugs.
The NHS follows guidance set out by the National Institute for Health and Care Excellence about when biologics or JAK inhibitors can be prescribed. They are used after standard DMARDs havent worked sufficiently well, so theyre not usually prescribed for people who are newly diagnosed. They are also used if someone does not respond sufficiently well to the first biologic or JAK inhibitor given after standard DMARDs. In many cases, biologic drugs and JAK inhibitors are used with concomitant methotrexate therapy as an anchor drug, as mentioned earlier, as this boosts the overall benefits.
What Causes Juvenile Idiopathic Arthritis
Like adult rheumatoid arthritis, JIA is an autoimmune disease. This means the body’s immune system attacks its own healthy cells and tissues. JIA is caused by several things. These include genes and the environment. This means the disease can run in families, but can also be triggered by exposure to certain things. JIA is linked to part of a gene called HLA antigen DR4. A person with this antigen may be more likely to have the disease.
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Who Is More Likely To Get Ra As A Young Adult
As many as 8 in 100,000 people aged 18 to 34 get RA. RA may be more severe if you get it as a young adult. You may be more likely to have inflammation in the small joints of your hands and feet, and have bony erosions, than people who get RA later in life. Youre also more likely to have rheumatoid nodules.
Things People With Rheumatoid Arthritis Want You To Know
Rheumatoid arthritis is a progressive and disabling autoimmune inflammatory disease that affects 35-70 million people worldwide.1,2 Theres more to RA than just developing stiff joints as you get older read on to find out how the disease really affects those living with it and what they would like you to know.
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What Are The Symptoms
The important signs and symptoms to be aware of are:
- pain, swelling and possibly redness around your joints. Hands and feet are often affected first, though RA can start in any joint
- stiffness in your joints when you get up in the morning or after sitting for a while, which lasts for more than 30 minutes and has no other obvious cause
- fatigue thats more than just normal tiredness
Theres more information about signs and symptoms here –Have you got the S-factor
If you have any of these symptoms, go and see your GP. The sooner RA isdiagnosedand treated, the better the long-term outcomes are likely to be.
Painis a significant symptom for most people. At first, it is caused by the inflammation in the joints, and later on pain can be as a result of damage to the joints. Pain levels can also vary from day to day.
Stiffnessis most marked/severe first thing in the morning and it can last several hours if youre not taking effective medication. Theres agellingof the joints, meaning that they become difficult to move from a position after youve rested them. This also happens when you have been sitting for any length of time.
Fatiguecan be due to anaemia but it can also be due to the inflammation. It has been linked to a number of things including pain levels.
Some people getflu-like symptomswith fever and muscle pains as well as being tired, especially in the early days before or during diagnosis.
How Does Treatment Improve Life Expectancy
Early treatment greatly improves the prognosis of RA patients. If treatment begins before symptoms cause too much damage, patients can generally go on to live a better quality of life.
Ongoing treatment and monitoring can help rheumatologists provide the most appropriate and personalized care for their patients. Each patient will experience a different set of symptoms over their lifetime. Doctors look for warning signs of other complications associated with RA and work to either prevent them or treat them as they develop.
The main goal of treatment is to reduce pain and improve quality of life. Many patients experience very effective treatment plans and continue to live their lives making appropriate lifestyle adjustments along the way.
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Although Recreating Festive Traditions In Exactly The Way We Used To May Feel Like A Way To Reclaim Our Lives It Just Perpetuates Old And Dysfunctional Habits Instead Follow These Tips For Easier And Happier Holidays Says Advocate Lene Andersen
Ahh, the holidays. I love everything about this season the lights, the smell of pine, the food, the fact that everyone seems just a little bit more cheerful, and of course the love. This time of year is important to many different cultures and whatever the reason, celebrations are about bringing your family together to celebrate love, light in the winter darkness, and joy. The exuberance and lets face it overindulgence is wonderful, but its also a lot of work.
Which is why those of us who share our lives with rheumatoid arthritis or other chronic illnesses that cause pain and fatigue may dread the coming festive season more than just a little. Regardless of our best intentions, being flattened by a flare during or right after the holidays tends to be just as much of a tradition as the candles and the gifts. But it doesnt have to be that way.
My book Chronic Christmas: Surviving the Holidays with Chronic Illness is a collection of tips to get you through the holidays formatted like an Advent calendar with one idea per day. In this article, Ill be sharing some of the themes and ideas from the book to help you revel in the season, whichever celebrations you embrace. These tips can be adapted to any festive event, be it Hanukkah, Diwali, the winter solstice or even the made-up holiday Festivus from the sitcom Seinfeld.
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Who Treats Rheumatoid Arthritis
Diagnosing and treating rheumatoid arthritis requires a team effort involving you and several types of health care professionals. These may include:
- Rheumatologists, who specialize in arthritis and other diseases of the bones, joints, and muscles.
- Primary care providers, such as internists, who specialize in the diagnosis and medical treatment of adults.
- Orthopaedists, who specialize in the treatment of and surgery for bone and joint diseases or injuries.
- Physical therapists, who help to improve joint function.
- Occupational therapists, who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy.
- Dietitians, who teach ways to eat a good diet to improve health and maintain a healthy weight.
- Nurse educators, who specialize in helping people understand their overall condition and set up their treatment plans.
- Mental health professionals, who help people cope with difficulties in the home and workplace that may result from their medical conditions.
Can Ra Be Fatal
RA alone is not fatal. Fatality occurs due to complications associated with the inflammation caused by RA. In severe cases, patients can develop other medical conditions. The other medical conditions that patients need to be aware when it comes to shortened RA life expectancy include:
- Heart disease
- Respiratory conditions like Chronic Pulmonary Obstruction Disorder
Off course, these are conditions that everyone should be concerned about. Keeping your body healthy through diet, exercise, and positive habits will go a long way to reducing the risk of fatality from any of these conditions.
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When The Fingers Are Abnormally Bent
Some disorders, such as rheumatoid arthritis, and injuries can cause the fingers to bend abnormally. In swan-neck deformity, the joint at the base of the finger bends in , the middle joint straightens out , and the outermost joint bends in . In boutonnière deformity, the middle finger joint is bent inward , and the outermost finger joint is bent outward .
Swollen wrists can pinch a nerve and result in numbness or tingling due to carpal tunnel syndrome Carpal Tunnel Syndrome Carpal tunnel syndrome is a painful compression of the median nerve as it passes through the carpal tunnel in the wrist. The cause of most cases of carpal tunnel syndrome is unknown… read more .
Cysts, which may develop behind affected knees, can rupture, causing pain and swelling in the lower legs. Up to 30% of people with rheumatoid arthritis have hard bumps just under the skin , usually near sites of pressure .
Examination of joint fluid
In addition to the important characteristic pattern of symptoms, doctors follow established criteria when evaluating a person for rheumatoid arthritis. Doctors suspect people have rheumatoid arthritis if they have more than one joint with definite swelling of the joint’s lining that is not caused by another disorder. Doctors diagnose people with rheumatoid arthritis if they have certain combinations of the following criteria:
I Had No Idea What My Diagnosis Meant
When I was diagnosed, I felt scared, a bit lonely , and worried about my future. Those are pretty normal emotions after being told I was going to live with an illness for the rest of my life.
However, I had NO idea what that diagnosis meant. I just plowed through life like nothing changed. I didnt even tell anyone that I had rheumatoid disease.
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What Are The Signs And Symptoms Of Ra
With RA, there are times when symptoms get worse, known as flares, and times when symptoms get better, known as remission.
Signs and symptoms of RA include:
- Pain or aching in more than one joint
- Stiffness in more than one joint
- Tenderness and swelling in more than one joint
- The same symptoms on both sides of the body
- Weight loss
Joint Swelling And Pain
When the disease is active, affected joints become red, swollen, painful, and feel warm to the touch.
In the early stages of RA, smaller joints in the hands, wrists, and feet tend to be affected first. Over time, larger joints in the knees, shoulders, hips, and elbows may become affected.
What differentiates RA from other types of arthritis is that RA symptoms attack symmetrically. This means that if your left wrist is inflamed, your right wrist likely will be inflamed as well.
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Points To Remember About Rheumatoid Arthritis
- Rheumatoid arthritis is a chronic disease that mostly causes pain, swelling, stiffness, and loss of function in joints.
- RA may cause you to feel unusually tired, to have occasional fevers, and to have a loss of appetite.
- Treatments can include medications, ongoing care from a doctor, and surgery.
- The goals of treatment are to help relieve pain and swelling, prevent, slow, or stop joint and organ damage, and help you take part in daily activities.
- You can do many things to help you cope with RA, including finding a balance between rest and exercise, keeping a healthy weight, taking care of your joints, talking with your doctors, family, and friends, and managing your stress.
Drug Treatments And Challenges
Your doctor will probably give you the same drugs used to treat early-onset RA. These include:
- Disease-modifying antirheumatic drugs
- Nonsteroidal anti-inflammatory drugs
You might have more challenges with your medication, especially if you take drugs for other health conditions. This boosts your chances of a bad reaction to the medicine.
You may also have a harder time with drug side effects. NSAIDs increase your chances of heart, brain, gut, and kidney problems. Corticosteroids up the odds of glaucoma, osteoporosis, and other health problems.
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What Is The Treatment
NICE guidelines for the management of RA and the RA Quality Standard recommend that a Treat to Target approach should be adopted which should include,frequent reviewof your RA,formal assessmentof your joints to see if there is still inflammation and anescalationof therapy until good control of joint inflammation is achieved. Taking medication is necessary in RA as this is the only way you are likely to be able to adequately reduce inflammation and get your disease under control. This table shows the different types of drugs used to treat RA.
When youre first diagnosed, your consultant will want to get you started straight away on Disease Modifying Anti-Rheumatic Drugs orDMARDs. These can be very effective in slowing down or even halting the progress of the disease, and preventing the severe damage to joints that people with RA used to suffer.
Disease modifying treatment might be one drug or a combination of drugs. It usually includes methotrexate. This is often used as theanchor drugin treating RA, meaning a drug that others are added to, in order to get the best effect. Not all drugs work equally well for everyone, so it may take time to find the right drug or combination for you: namely, what is most effective and has the least side effects for you.
Medical History And Physical Examination
After listening to your symptoms and discussing your general health and medical history, your doctor will examine your foot and ankle.
Skin. The location of callouses indicate areas of abnormal pressure on the foot. The most common location is on the ball of the foot . If the middle of the foot is involved, there may be a large prominence on the inside and bottom of the foot. This can cause callouses.
Foot shape. Your doctor will look for specific deformities, such as bunions, claw toes, and flat feet.
Flexibility. In the early stages of RA, the joints will typically still have movement. As arthritis progresses and there is a total loss of cartilage, the joints become very stiff. Whether there is motion within the joints will influence treatment options.
Tenderness to pressure. Although applying pressure to an already sensitive foot can be very uncomfortable, it is critical that your doctor identify the areas of the foot and ankle that are causing the pain. By applying gentle pressure at specific joints your doctor can determine which joints have symptoms and need treatment. The areas on the x-ray that look abnormal are not always the same ones that are causing the pain.
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Understanding Rheumatoid Arthritis Symptoms
Its important to understand, Dr. Hedrick notes, that there isnt any significant difference between rheumatoid arthritis symptoms in older adults and those in younger adults. Older adults, though, may have other comorbidities that may compound things, he adds.
Older adults are also more prone to having pre-existing joint issues even before the onset of rheumatoid arthritis. Dr. Hedrick points out, Theyre more likely to have the wear-and-tear of osteoarthritis, so that pain may persist despite any rheumatoid arthritis treatment they receive.
Those painful, inflamed joints
Typically, rheumatoid arthritis is a slowly progressive autoimmune condition, Dr. Hedrick says, that hones in on the joints of your body. It usually affects the smaller joints, like the knuckles and other joints in your hand and then your toes and feet.
The entire premise of rheumatoid arthritis is your body is making inflammation in the joints, he adds. And inflammation accumulates when the body is at rest.
Often, symptoms are worst first thing in the morning or later night. Youll wake up with stiffness or even swelling in those joints and that improves a little bit as the day goes on and those joints loosen up a bit, he says.
Still, that pain and inflammation can be debilitating, even for young adults, without proper care and treatment. And, fortunately, there are ways to mitigate the stiffness and pain.
Helping Your Child Live With Juvenile Idiopathic Arthritis
Help your child manage his or her symptoms by sticking to the treatment plan. This includes getting enough sleep. Encourage exercise and physical therapy and find ways to make it fun. Work with your child’s school to make sure your child has help as needed. Work with other caregivers to help your child take part as much possible in school, social, and physical activities. Your child may also qualify for special help under Section 504 of the Rehabilitation Act of 1973. You can also help your child find a support group to be around with other children with JIA.
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