Pediatric arthritis is not just one condition; symptoms and their severity vary from one person to another, and the condition may last a short while or be chronic. The most common type of pediatric arthritis is oligoarthritis (less than five affected joints). Pediatric arthritis is typically a small children’s disease, which means approximately half of the patients develop the condition under the age of 5 and on average at the age of 7. In Finland, about 150-200 children are diagnosed with pediatric arthritis annually, and 60-80 of them are referred to HUCH New Children's Hospital. In addition to treating pediatric arthritis patients from the HUS area, the arthritis clinic of the New Children’s Hospital also treats patients with other juvenile musculoskeletal disorders such as pain and connective tissue diseases. The clinic offers consultation nationally in connective tissue disease cases.
When treating pediatric arthritis, the objective is to control the inflammation, to ensure normal growth and development, and to prevent permanent damage. In children, the inflammation may subside for a long time, or even resolve completely before adulthood.
About one-fifth of all pediatric arthritis patients may develop an inflammation of the iris, or iritis, in the first few years following diagnosis. The condition may develop without any symptoms, which is why it is important to have regular check-ups with an ophthalmologist.
Medication given to pediatric arthritis patients is largely the same as that given to adults. In long-term medical care, methotrexate is most commonly used. It is used in conjunction with other drugs as necessary. The newer biologic drugs have been highly effective in children and they are used whenever traditional care is not sufficiently effective. Some of the biologic drugs are administered intravenously, which means patients must visit a day hospital regularly for treatment. Arthritis medication is also effective in the treatment of iritis.
In addition to drug therapy, arthritis is commonly treated with cortisone injected into the joints. Injections to children are usually given in a day surgery room under short-term general anesthesia. Physiotherapy and occupational therapy are also provided as necessary, as well as orthopedic services.
Treatment of pediatric arthritis is provided by a multidisciplinary team: in addition to a doctor, a nurse, a physiotherapist and an occupational therapist, the team includes the ward secretary, a rehabilitation counselor, a social worker and a psychiatric nurse. Patients require close monitoring by an ophthalmologist. Other specialists such as an orthopedist, a psychologist or a psychiatric team, or other HUS specialists, most commonly a nephrologists, a dermatologist or a pulmonary specialist, are consulted as the need arises.
The treatment of pediatric arthritis has changed radically over the past 15 years. In the past, the most severe conditions resulted in disability; patients were very ill, and the inflammation caused permanent damage. Today, thanks to treatment provided by specialists, combined with effective medications and the new biologic drugs, the majority of children are symptom-free, they can be treated in outpatient care, and permanent disability is highly unlikely. The objective is to enable children to live a normal life without the disease causing any specific limitations. For most patients this is already the case, and in the future the majority of patients are expected to have a fairly normal life thanks to multidisciplinary work and new, more tailored treatment options.
Patient organizations:
The Finnish Rheumatism Association
Uudenmaan lapsireuma ry (only in Finnish)