Considerations in Surgical Treatment for Juvenile Arthritis

juvenile arthritis surgeryJuvenile arthritis is a puzzling disease that defies consistent categorization, yet this does not make the condition any less potentially debilitating. Surgical arthritis treatment for juvenile arthritis is rare for a number of reasons. However, to understand why this is the case, it’s first necessary to have a better concept of the condition as a whole.

Understanding JIA

Confusion over juvenile arthritis begins with its name. Sometimes called juvenile idiopathic arthritis (JIA) and also juvenile rheumatoid arthritis (JRA), the disease differs greatly from adult onset osteoarthritis, and does not always present with rheumatoid factors. Sometimes it’s referred to as juvenile chronic arthritis, and yet many cases are self-limiting. The precise cause of JIA is unknown (hence the name); although there are many possible factors that can contribute to its development, none of them as yet have proved a direct correlation between cause and effect.

To further complicate matters, diagnosis of JIA is made primarily through exclusion; that is, by ruling out any other conditions that could cause similar symptoms. There is no definitive test for juvenile arthritis, and the symptoms vary, are frequently intermittent even in the same patient, and may be mild and easily overlooked.

JIA can be further broken down to two primary specific subtypes:

  • Oligoarticular – This form of JIA affects fewer than four joints within the first six months. When the JRA designation is used instead, this subtype is more often referred to as pauciarticular. Accounting for about 50 percent of all diagnoses, oligoarticular JIA most commonly affects the larger joints (excepting the hip).
  • Polyarticular – When five or more joints are impacted within the first six months, then JIA is classified as polyarticular. Occurring more commonly in girls than boys, polyarticular JIA particularly affects the smaller joints in the hands and fingers, usually in a symmetrical pattern. About 50 percent of those diagnosed with polyarticular JIA see symptoms progress to a severe, chronic level. Aggressive treatment is recommended.

There are smaller subsets of JIA as well, although these occur far less frequently. Systemic JIA, diagnosed in between 10 to 20 percent of patients, is primarily seen in adolescents, is diagnosed equally between both sexes and may affect both large and small joints. Other forms of JIA are related to tendon inflammation, inflammatory bowel disease and psoriasis respectively.

Treatment Philosophies

The motivation in treating JIA differs from adult osteoarthritis as well. In adults, the degenerative progression of the disease places the primary focus on the joints themselves, either in mitigating symptoms or improving bone and cartilage health through joint surgery.

In children, however, concerns over growth disturbance remain the main consideration in determining the best course of treatment; for example, leg length discrepancy is a common concern for patients with JIA. Emotional strain, including clinical depression, related to diagnosis of a chronic illness is another factor seen more often in juvenile arthritis treatment compared to adult onset osteoarthritis.

A multifaceted approach is generally the most effective strategy to minimize inflammation as much as possible in order to reduce the potential for permanent joint damage and developmental impairment. A combination of non-steroidal anti-inflammatory medications and corticosteroid injections have proven effective in controlling symptoms, while anti-rheumatic drugs can suppress inflammatory response in some types of JIA. Ongoing physical therapy and regular exercise are essential.

Only the most severe JIA cases require direct joint surgery. Replacement is contraindicated prior to full physical maturity, although scar tissue excision can improve joint function.

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