Despite years of research, aspirin is still the main weapon against this insidious disease. But gold injections are attracting new interest. Most people think of arthritis as a disease of advancing years. But it can occur in children too.
Commonly it begins when a child is between one and three years of age. It is often called Still's disease if the child is under 16 years and when at least four joints are affected. Fortunately, in many cases, as the youthful patient grows the disease declines and eventually disappears. But a number of patients develop into adult arthritis.
A small proportion of children with arthritis develop ankylosing Spondylitis. This disease produces a stiffening of the lower back and affects the hip joints. Like typical rheumatoid arthritis, it usually grows worse with time.
Still's disease affects boys and girls equally. Its development is insidious and usually affects several joints at one time. In only about one case in 10 does the disease affect only one joint. In that case it is often the knee.
The disease may first be noticed after a rash of symptoms including a high fever, a spotty rash and a feeling of being generally unwell, or "malaise" as it is termed by some doctors.
The child's skin may become clammy, the muscles ache and tremors may develop. The young patient frequently becomes depressed as he is overwhelmed by symptoms which he cannot understand and which severely limit his normal life. He may show symptoms of considerable anxiety.
The small lymph glands of the body may become tender and enlarged. But it may be some weeks before the typical swollen joints appear.
In some patients, the heart, spleen and other organs are affected by the disease. Once it has become established the disorder progresses much as adult rheumatoid arthritis.
The small joints of fingers and toes may be involved. The bones of the neck, and the joints of the hip and lower back may all become affected.
The "apophyseal joints," the growing points of a child's bone, may fuse prematurely. This is a major problem in growing children as the result may be to limit further growth in the affected bones. The bones of the feet and hands may be shortened, the neck and jawbones may be affected and limbs may grow to irregular length. All this can persist into adult life.
Unlike adult arthritis, one child in 10 who develops Still's disease will also develop eye disorders. If left unrecognized and untreated it may develop into permanent blindness. For this reason, doctors are usually alert to the danger and regularly check the eyes of patients.
The complaint requires complete medical treatment. Symptoms may persist for a few months or they may continue for many years into adulthood. Treatment may be long term. Even after many years of intensive research aspirin is still claimed to be the cornerstone of therapy. Renewed interest is being shown in the use of gold by injection. It fell into disfavor some time ago but appears to be making a medical comeback.
When cortisone-type drugs called steroids became available some years ago, some people believed that a panacea had arrived. This is not the case and steroids are rarely used in treatment today except in severe cases or where the eyes have been severely affected. In fact steroids may further stunt growth in children.
Many anti-inflammatory drugs have been produced over the past few years. Their results are variable according to individual patients. A favorable response to aspirin treatment usually occurs within three or four days. It is not so dramatic as with rheumatoid fever but is quite satisfactory.
This treatment can safely be continued for as long as symptoms persist, provided certain safeguards are maintained. A ringing in the ears, nausea and vomiting are indications of overdose and it may be necessary simply to reduce the dosage.
Many doctors believe that exertion only worsens the symptoms so rest is an important part of therapy. But this is best not taken in bed for some degree of exercise is essential.
Too much bed rest may aggravate the formation of deformity and weaken the muscle system. Therefore, besides any physiotherapy that may be ordered, periods of exercise once or twice a day are recommended.
Heat and hydrotherapy still play an important part in treatment. Weight bearing on affected joints - such as lower limbs - should be avoided. Diet is unrestricted. But it should include a variety of nourishing foods.
The doctor will be alert to superimposed infections which can be treated with antibiotics. Viral infections, however, cannot so easily be treated with antibiotics. Once it has passed, the chances of the disease recurring are well below 50 percent.
Henry K. Silver, professor of paediatrics of the School of Medicine at the University of Colorado, USA, states in his book on paediatrics: "With good medical management, one can expect that more than 70 percent of patients will have complete functional recovery, and less than 10 percent will have any severe disablement."
Many doctors suspect that there is an hereditary factor in childhood arthritis. A parent may also be suffering from arthritis. But the connection is unproven. The real cause of the disease is unknown and there are usually no predisposing factors in a patient.