Posted on: Wednesday, 2 March 2011, 20:13 CST

A full exam and patient history are vital to effectively diagnosing juvenile arthritis

While lab tests and imaging can sometimes help diagnose juvenile idiopathic arthritis (JIA), a physical examination and thorough patient history are the most valuable tools in identifying this disease. According to a new literature review from the Journal of the American Academy of Orthopaedic Surgeons (JAAOS), the rate of false positives in laboratory evaluations and imaging studies meant to screen for juvenile arthritis makes their value limited.

Juvenile idiopathic arthritis (formerly known as juvenile rheumatoid arthritis) is an autoimmune disease that affects nearly 300,000 children in the United States under the age of 18. the cause is not known, and it does not appear to be genetic, although some family members may suffer from other autoimmune disorders. Symptoms may include:

    * joint stiffness in the morning that improves later in the day;

    * pain, swelling, and tenderness in the joints;

      limping or limits in range of motion;

    * high fever and light rash;

    * weight loss;

    * fatigue or irritability; and/or

    * red eyes or blurred vision.

Depending on the type of JIA, these symptoms can vary quite a bit. In fact, some young patients may not suffer any of these symptoms, but have a swollen joint that is discovered after another incident such as an injury.

“To establish a diagnosis of juvenile idiopathic arthritis is a matter of pattern recognition,” says Marilynn Punaro, MD, a pediatric rheumatologist at Texas Scottish Rite Hospital for Children and University of Texas Southwestern Medical Center, Dallas, TX, and the author of this review. “Also, there is no lab test that can conclusively diagnose rheumatic disease—you have to rule out other common diagnoses. that is why a full physical exam is important, as well as a detailed patient history that will reveal other symptoms. if the patient has one swollen joint, the other joints should be examined because the diagnoses could be very different based on what is found in that exam.”

Review details and findings:

    * if JIA is suspected, the orthopaedic surgeon should conduct an assessment of all peripheral joints, not just the joint or joints about which the patient is complaining.

    * Exquisitely painful, tender, or red joints are not typically diagnostic for JIA.

    * Oligoarticular JIA (where just a few joints are affected) is the most common type of JIA, affecting 60 percent of children with this disorder. the onset of this type of arthritis is usually between the ages of 1 and 3.

    * Treatment of juvenile arthritis is designed to reduce swelling, maintain full movement of affected joints, and relieve pain, and includes medications and physical therapy. Surgery may be indicated in rare cases. some JIA patients’ disease can go into remission.

    * Recent clinical trials are showing that with new drug treatments, remission will soon be a realistic goal for most patients.

“It is important to try and diagnose JIA early so treatment can begin,” Punaro says. “If left untreated for months or years, there is a likelihood of long-term disability, growth problems or deformity. the disease can cause joint damage that is irreversible. the good news, though, is that when we do diagnose JIA, we have many excellent treatments available.”

On the Net:

• AAOS
• Journal of the American Academy of Orthopaedic Surgeons

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Lyme disease, the tick bite transmitted bacterial infection was initially identified in 1975, subsequent to the research work undertaken by scientists to delve into the reasons behind the unnaturally huge populace of infants being detected with juvenile rheumatoid arthritis in areas like Lyme, Conn and duo adjacent settlements.

The examiners found that a major population of children that were affected resided in the close by forested locales where ticks were believed to thrive. The researchers additionally noted that the preliminary lyme disease symptoms classically commenced during the summer season that overlapped with the peak time for the ticks.

Numerous patients cited displaying unusual kinds of rashes on the skin just prior to having symptoms of arthritis, and several patients also remembered having a tick bite at the location of the rash.

Detailed analysis lead to unravelling of the fact that the small deer ticks showed the presence of the twisted shaped bacteria known as spirochete, that soon after was named Borrelia burgdorferi, were the cause for the outburst in Lyme. Regular wood ticks and those ticks found in animals like dogs are known to not transmit the infection.

The usually Borrelia Burgdorferi- infected ticks normally nosh and copulate on the deer during the course of their life span. The latest spurt of the deer populace in the north-eastern regions and constructions of suburban expansions in the rural regions where the deer ticks are generally present, are possibly responsible for the raised numbers of cited Lyme disease cases.

Lyme disease is known to cause cardiovascular, brain and nerve ailments in addition to causing arthritis. The disease is contracted via a bite from a particular tick variety. this tick form is found on the bodies of animal forms like white-footed field mouse, chipmunk, deer, raccoon, opossum, skunk, weasel, fox, shrew, mole, squirrel and horse. a major population of ticks are been noted in countries like New York, New Jersey, Wisconsin, Connecticut and Minnesota.

In the preliminary phases of the Lyme disease, the person affected would exhibit flu-similar lyme disease symptoms which could comprise of a stiffness noted in the neck, feeling chills and feverish, swelling in the lymph nodes, weariness, soreness in the muscles, joint aches and headaches.

One might even notice an outsized, intensifying rash on the skin encircling the region of the tick bite. Pains experienced in the joints and muscles are the other initial lyme disease symptoms. in later stages of the disease, knee arthritis and nerve problems surface.