I would appreciate some information on juvenile arthritis. I am coaching an 11 year old swimmer who may have this condition. Thank you.
As your question regarding Juvenile Chronic Arthritis was quite general, I am assuming you would like to know a little bit more about the condition itself as well as how this may play a role with you as a swimming coach.
Firstly, Juvenile Chronic Arthritis (JCA) is can be defined as arthritis that has persisted for at least three months in one or more joints in a child younger than 16 years. It typically only affects 1 in 1,000 children. There are various presentations of JCA, all of which slightly differ in their clinical presentation.
Common Forms of JCA
- Meaning few joints, typically less than four joints are affected
- Typically affects larger joint (i.e., knees)
- Typically affecting 50 percent of children suffering from JCA
- Associated problems include iritis (inflammation of the iris)
- Meaning several joints are affected, typically five or more
- Typically affects smaller joints (i.e., hands and feet)
- Typically occurs in a symmetrical pattern, affecting the same joint on both sides of the body
- Typically affecting 40 percent of children suffering from JCA
- Besides affecting the joint, there is a systemic component that may result in a fever and rash as well possibly affecting the internal organs (i.e., heart, liver, spleen and lymph nodes)
- Typically affecting 10 percent of children suffering from JCA
- Typically affects children less than five years old
JCA is an autoimmune disease where the body recognizes certain parts of itself as being foreign. The immune system which acts to protect the body from harm will then attack these cells, the result being inflammation, redness, swelling, etc. At this stage, it is unclear why the body’s immune system will act this way. Some experts believe it may be caused by a genetic component and particular environmental factors.
Diagnosing and Treating JCA
The typical presentation of JCA is joint swelling, pain and stiffness. In some cases, there may be lymph node swelling and other systemic signs and symptoms. JCA sufferers typically go through periods of being symptom free and periods of acute flare ups. It is during this stage of an acute flare up that treatment and management is most important. If the child’s condition is not managed correctly, then she is at risk of growth problems and other musculoskeletal changes. A child suffering from JCA may actually go into remission, which can last anywhere between six months to years.
The diagnosis of JCA typically starts with the local general practitioner. When children present with a history of persistent joint pain or swelling and other unexplained systemic symptoms, JCA along with other disorders will be considered. Diagnosis will often be based on a combination of factors such as clinical presentation, laboratory results and X-rays.
The current treatment for JCA consists of a combination of medication (nonsteroidal anti-inflammatory, corticosteroids etc), physical therapy, nutritional advice and exercise. It is important for anyone involved directly with the child (as a swimming coach, you form an integral part of this team) to be in regular contact with the child’s parents as well as the physical therapist or GP if you have any particular queries regarding the exercise side of things. Essentially, the main goal of treatment will be to preserve a high level of physical and social functioning and maintain a good quality of life.
Exercise forms an important component of the management of a child with JCA. Swimming is possibly one of the best forms of exercise for a child suffering from this condition as it allows for non weight bearing activity, which helps maintain muscle strength, endurance and flexibility.
The problem with all forms of exercise and those suffering from arthritis is that you must be aware of the potential problems associated with an acute flare up of the condition. During these stages, the child may be suffering from joint swelling, pain and inflammation. Over activity may actually aggravate the child’s condition and slow recovery. During these stages of acute flare up, gentle exercise in the water is preferred as it will help with maintain joint motion and maintain flexibility. The warm water may also help act as gentle muscle relaxant.
You may need to reduce exercise levels if the following signs or symptoms are noted: pain lasting for more than one hour after exercise, unusual or persistent fatigue, increased weakness, increased joint swelling and a decrease in range of motion of the joints.
- Murtagh, J. General Practice, 3rd Edition, The McGraw Hill Companies, Sydney, 2003, pp. 343