Research Scientist

Can Arthritis Occur in Children?

by Dr. Yukiko Kimura, Hackensack University Medical Center

To most people’s surprise, arthritis not only occurs in children, but arthritis is actually one of the most common chronic diseases in childhood, affecting one to four children in every 1,000. More than 300,000 children in the U.S. have the condition, making it more common than cystic fibrosis, sickle cell anemia, and muscular dystrophy combined. Arthritis can affect children as young as several months old. One of the most common types of arthritis usually begins at one to two years of age, but arthritis can occur at any age, depending on the type.

Many people are unaware that there are over 100 causes of arthritis in children, but juvenile rheumatoid arthritis (JRA) is the most common name for chronic arthritis in children. Juvenile rheumatoid arthritis is not one disease, but is a term that encompasses at least 5 different types of chronic arthritis. Some types cause arthritis in only one or two joints, while others can cause arthritis in nearly every joint in the body (and may seem similar to rheumatoid arthritis in adults). Other forms can cause high fevers, rashes, and inflammation in various parts of the body.

The most common symptoms of arthritis in children include joint pain, sometimes accompanied by swelling and warmth of the joint. Stiffness that is worse first thing in the morning and improves as the day goes on is highly suggestive of arthritis. However, since arthritis can affect very young children who can't verbalize what they are feeling, the symptoms could simply be irritability and crankiness accompanied by refusal to walk or limping first thing in the morning. "Clumsiness" and recurrent injuries, being more tired and fatiguing easily, as well as trouble running well may also be signs of arthritis in children. A surprising number of children do not complain of pain, perhaps because they don’t know how to verbalize how they feel, or because they are so used to living with the symptoms of arthritis.

Often, injuries due to sports and other activities are blamed for these symptoms. Many children who actually have arthritis are erroneously referred to orthopedists and sports medicine physicians, delaying the correct diagnosis. Many physicians are unfortunately not aware that arthritis occurs relatively frequently in children and so do not consider it a possible cause of joint symptoms. Awareness is key, because early recognition and treatment helps prevent possible damage from long-term arthritis. New treatments are now available that have dramatically changed the outlook for people with arthritis of all ages.

People often ask if changes in lifestyle, diet, exercise, or taking vitamin supplements can alleviate arthritis, but there are no special diets or supplements that have been proven at this time to prevent or treat arthritis. However, living a healthy lifestyle is always a good idea. In people with arthritis, for example, being overweight can worsen symptoms.

Exercise is often helpful, because it keeps joints limber and discourages stiffness. However, repetitive, high-impact exercise such as distance running is not recommended with arthritis in the knee or another leg joint. Swimming is highly effective, because it strengthens muscles without the impact of gravity. If a child has arthritis in the spine or the neck, anything that involves tumbling (like gymnastics or cheerleading) is not recommended. That said, we encourage children to participate in whatever sports activities they desire within reason.

It is important to note that arthritis in children can be a symptom of other autoimmune diseases such as lupus. Lupus is one of the most common autoimmune diseases that occur in children, adolescents, and adults. The body's immune system is normally designed to protect the body against foreign invaders such as viruses and bacteria, but in autoimmune diseases like lupus, the body's immune system turns on itself and begins causing damage. For example, people with lupus can suffer from rashes, arthritis, and inflammation in the kidneys and other organs. Although lupus is much more common in females after puberty, in children lupus can occur almost as often in boys as girls.

A diagnosis of lupus is based on a combination of symptoms and blood and urine test results. Unlike juvenile rheumatoid arthritis, in which blood tests are often not helpful for diagnosis, there are specific, relatively accurate tests for lupus. Treatments are also much more effective and less toxic than in previous decades. Thirty or 40 years ago patients often died from lupus, but now this is fortunately very rare and most do very well.

A recently recognized hidden problem in lupus is that the disease itself may cause accelerated atherosclerosis, or "hardening of the arteries." Although this is usually a problem seen in older age, in lupus, atherosclerosis can become a problem much earlier in life, increasing the risk of a heart attack and other problems in one’s twenties and thirties.  We are currently participating in a national research study of lupus in children, which is looking at ways to slow down atherosclerosis.

The Section of Pediatric Rheumatology at the Joseph M. Sanzari Children's Hospital is very active in research in lupus, arthritis, and other rheumatic diseases in children. This research will ultimately lead to better diagnosis, treatment, and eventually even a cure for these potentially debilitating diseases. Our goal is to allow every child with arthritis and other rheumatic diseases to thrive, be happy and have the most normal life possible, and fortunately we are very close to making this a reality for almost all of our patients.


kimuraAbout Dr. Yukiko Kimura

Dr. Yukiko Kimura is the Chief of the section of Pediatric Rheumatology at the Joseph M. Sanzari Children's Hospital of Hackensack University Medical Center. She established the pediatric rheumatology program, the first in New Jersey, in 1991. Today the program is one of the largest and busiest in the country, with 4 board certified pediatric rheumatologists, a nurse practitioner, two nurses and a multi-disciplinary team devoted to caring for and improving the lives of children with arthritis and other rheumatic diseases.

Dr. Kimura received her M.D. degree from the Albert Einstein College of Medicine, and did her residency and fellowship training at the Babies Hospital of Columbia Presbyterian Medical Center (now the Children’s Hospital of New York). She is currently an Associate Professor of Pediatrics at UMDNJ-New Jersey Medical School, a Fellow of both the American Academy of Pediatrics and the American College of Rheumatology, and is board-certified in both Pediatrics and Pediatric Rheumatology. She has written many articles and has been invited to lecture at many national and international meetings about arthritis in children. She is an active member of CARRA (Childhood Arthritis and Rheumatology Research Alliance), and is the Principal Investigator of multiple research protocols. She was awarded an NIH grant this year to plan a clinical trial in stem cell transplantation for severe Juvenile Idiopathic Arthritis. She is a co-editor of a new textbook of pediatric rheumatology called “Arthritis in Children and Adolescents: Juvenile Idiopathic Arthritis” (Oxford University Press 2006). She was awarded two honors recently by the American College of Rheumatology: a Pediatric Rheumatology Visiting Professorship Award for 2006-7 and the Clinician-Scholar-Educator Award by the American College of Rheumatology for 2007-9.


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