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Improved Standard of Care for Children with Arthritis
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Posted on: 11/30/1999
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Children with rheumatologic diseases such as arthritis are living longer and better thanks to a team approach to patient care. Combining the knowledge and efforts of the patient, family, and many health care professionals makes all the difference. New disease-modifying drugs are available. Death rates are down. Function is up.
But what is the child's responsibility versus the parents or the specialists who are part of the team? That's the focus of this article reviewing the latest advances in the care and feeding of children with juvenile arthritis.
One big change has been what we call these diseases. The term juvenile rheumatoid arthritis (JRA) has been replaced by juvenile chronic arthritis (JCA) and juvenile idiopathic arthritis (JIA).
This classification scheme still recognizes the three major types of arthritis in children: 1) systemic, 2) polyarticular, and 3) pauciarticular. The name change reflects efforts to standardize research, so that everyone is talking about the same thing when reporting new findings.
The physician's role is to diagnose the problem as early and as accurately as possible. From there, a specific treatment plan of appropriate medications is next. The new disease-modifying antirheumatic drugs (DMARDs) can be used along with nonsteroidal antiinflammatory drugs (NSAIDs) and/or biologic response modifiers (BRMs). The physician takes into account the risks and benefits of each drug, the needs of the child, and the proper dosage for the best results with the fewest side effects.
Flare-ups of arthritis symptoms require careful medical evaluation. Often the primary care physician and rheumatologist consult together to decide what changes are needed in the treatment plan. Other team members such as the physical and occupational therapist, psychologist, dietician, and nurse provide skills and services to improve overall health, function, and quality of life.
More than ever before, children with arthritis can attend school on a daily basis with few absences. And they can participate in after school activities of all kinds. These are major milestones from even just 10 years ago.
What are the responsibilities of the child in all this? Compliance is the key word. This refers to the child's willingness and follow-through when it comes to abiding by the recommendations of the team. They must take their medications as prescribed, get regular rest and sleep, and eat healthy foods. There's plenty of research to support the effectiveness of each of these routines in chronic diseases like arthritis.
Weight control and exercise go hand in hand. Joints are stressed by the disease. Adding extra load from being overweight combined with poor muscle strength puts an added burden on already compromised joints and soft tissues around the joints.
Here's where the family comes in. Family members can (and should) join in on the fun. They can exercise together: walk, bike, swim, play tennis, or engage in other activities everyone enjoys. Parents or guardians can provide nutritious snacks and limit the availability of unhealthy food items and snacks kept on the shelf.
Everyone benefits with improved health -- now and in the future. Proper diet and nutrition ensures good bone health for years to come. Fewer fractures, less back pain, and improved immune system function are just a few examples of the positive outcomes from following a plan of this type.
The authors offer some specific tips for children with rheumatologic disease (and their caregivers) including:
Don't wait to report fever, sore throat, cough, or other symptoms of illness to the physician
See your rheumatologist for flare-ups that last more than two weeks
Take your medications everyday on schedule and as prescribed (e.g., with food or water)
Stay active; exercise every day; avoid long periods of immobility (e.g., in front of the TV or computer)
Weight training is not advised because of its high impact on the joints. Stretching, biking, swimming, or other low-impact activities are encouraged
Go to bed at the same time every night -- even on the weekends and during holidays whenever possible
Find ways to manage your stress -- this could be relaxation tapes, music, sports, counseling
Eat a healthy and balanced diet of fruits, vegetables, proteins, and carbohydrates; consult with a nutritionist for specifics
Supplements such as a multivitamin, Vitamin D, omega 3 fatty acids, and other supplements may be helpful; consult with your physician about your child's specific needs
It may take a while to find a program that works best and fits the child's temperament and family lifestyle. Changes in the program may be needed over time, so children and their families are advised to stay flexible. The team approach can help take some of the burden for decision-making off the shoulders of the caregivers. Staying connected with all team members can help with times of transition and change.
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References:
Nancy Y. Olson, MD, and Carol B. Lindsley, MD. Advances in Pediatric Rheumatoloty Paving the Way to Better Care. In The Journal of Musculoskeletal Medicine. November 2008. Vol. 25. No. 11. Pp. 505-512.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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