Doctor Shortage Adds to Pain of Juvenile
THURSDAY, Dec. 23 (HealthDay News) -- Most people think of
arthritis as a disease of old age, with people's joints growing
creaky and painful later in life.
But arthritis also affects hundreds of thousands of kids in the
United States. Children and teens with juvenile arthritis face a
lifetime of aching joints and impaired mobility if the disease
isn't caught in time.
"There are about 300,000 kids that are affected by juvenile arthritis," said Dr. Patience White, vice president of public health for the Arthritis Foundation and a professor of pediatrics and medicine at George Washington University School of Medicine and Health Sciences. "That means it's more common than kids with type 1 diabetes."
Though the disease itself isn't rare, doctors specially trained
to treat juvenile arthritis can be hard to find.
Fewer than 200 certified pediatric rheumatologists currently
practice in the United States, making it one of the smallest
pediatric subspecialties, according to the U.S. Department of
Health and Human Services. Thirteen states don't have a single
pediatric rheumatologist within their borders, including heavily
populated states such as Arizona, South Carolina and Alabama.
"There are many families who have to travel many miles -- sometimes to another state -- to see a pediatric rheumatologist," White said.
Three types of juvenile arthritis have been identified,
according to the Arthritis Foundation and the American Academy of
- Pauciarticular juvenile arthritis typically affects four or
fewer joints. About half of the children with juvenile arthritis
have this type. It usually affects the large joints, including the
knees, ankles or wrists, and often strikes a joint on one side of
the body while leaving the corresponding joint alone.
- Polyarticular juvenile arthritis affects five or more joints.
About 30 percent of children with the disease have this type, girls
more often than boys. It most often affects the knees, wrists and
ankles but also can affect other joints such as the hips, neck,
shoulders and jaw.
- Systemic onset juvenile arthritis causes inflammation
throughout the body. The child typically suffers from swelling,
pain and limited motion in at least one joint, and the disease very
often affects the small joints of the hands, wrists, knees and
ankles. Internal organs such as the heart, liver and spleen as well
as lymph nodes also may become inflamed, and children can develop
rashes and fevers of 102 degrees or higher for weeks at a time.
About 20 percent of children with juvenile arthritis develop this
type, and it affects boys and girls equally.
Any child younger than 18 can develop juvenile arthritis, but
there tend to be two age ranges when it's more likely to occur.
There's one peak at ages 2 to 4, followed by another peak at ages 8
to 12, said Dr. Harry Gewanter, a pediatric rheumatologist with
Pediatric and Adolescent Health Partners in Richmond, Va., and a
clinical associate professor of pediatrics and physical medicine
and rehabilitation at Virginia Commonwealth University School of
"Their hallmark is you have a chronic arthritis that lasts at least six weeks in one or more joints," Gewanter said. "Lots of kids will have problems with their joints that come and go for a variety of reasons, but there are very few things that are going to stick around besides something like this."
It can be difficult for parents to know there's something wrong
with their child, however, because kids lack the ability to
communicate pain effectively, White said. Most of the time, kids
with juvenile arthritis have a limp, but parents generally think
that the child hurt a leg or knee.
Parents should suspect juvenile arthritis if they notice the
child limping more in the morning or after a nap; that's because
the joint grows stiff when it's at rest. The affected joints also
will be red and swollen.
Though various laboratory tests can be used to help narrow a
diagnosis, there's no one test to identify it. "It's really more a
combination of history and the exam and lab tests, and the pattern
consistent with this illness," Gewanter said.
Doctors used to try one arthritis drug after another until they
found one that worked. These days, he said, they try to
shotgun-blast the arthritis as hard as possible after
"We've taken a page from the oncologists in terms of going after this as aggressively as we can at the start," Gewanter said. "We're trying to jump in hard to shut down all the inflammation early, then peel medications away as you can. If you take a child and treat them aggressively straight away, often you can just shut the whole thing down and change the course of the disease. That kind of an approach really has made as much of a difference as anything else."
It can be difficult for parents to find a doctor to provide such
treatment, however, because of the shortage of pediatric
rheumatologists. White said the shortage developed because the
specialists make much less money than a general pediatrician, even
though they have to undergo more extensive training.
Federal health-care reform might help solve the situation,
though, as one clause in the law creates a loan repayment program
for pediatricians who undergo training in a specialty such as
rheumatology, White said. They would be granted extensions for
their loan repayment.
"We're excited about that," White said, but he added quickly that Congress has not yet funded the program.
The Arthritis Foundation has more on
For more on juvenile arthritis, read about
one teenager's story.
Copyright © 2010
. All rights reserved.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.