Saturday, September 24, 2011

oligoarticular JIA

I'm fairly convinced that Beth does have rheumatoid arthritis. She keeps her affected knee slightly bent, which is characteristic of the disease. She also has morning stiffness and stiffness after periods of inactivity, accompanied by nighttime pain and sleep issues and daytime neediness.

Children with the most benign and most prevalent subtype of juvenile rheumatoid arthritis, oligoarticular JIA, present as girls between the ages of 1 and 6 years old (with 1 to 3 years old most common), with one knee involved (or another weight-bearing joint).

If the disease involves four or fewer joints in the first six months of presentation, it remains a mostly benign condition with good prognosis (no long-term disease or problems), but eye involvement must be routinely tested for, as a complication of this subtype can lead to severe eye damage and blindness.

The earlier the disease is treated, the better the outcome. Judging from changes in Beth's personality, I would say she's had mild signs of arthritis for at least two to three months.

The MRI, which I don't think will show any injury, is still about two weeks away. In the meantime, to understand how best to care for her, I am taking her to see her regular doctor as soon as possible. She needs ibuprofen to control inflammation and pain if she has arthritis, and she needs daily exercise--preferably bike riding or swimming. 

The number of weeks involved, the approximate time of presentation, and the number of joints affected (a thorough physical exam can identify affected joints), all must be carefully recorded and monitored to ensure an accurate subtype diagnosis and subsequent treatment, with the goal of maintaining an active, normal lifestyle, controlling pain and inflammation, and ensuring psycho-social well-being. The sooner she can get a referral to a pediatric rheumatologist, the better, as controlling the inflammation is essential in protecting the joints from permanent damage. This starts with drugs classified as NSAIDs (ibuprofen and naproxen).  If these don't work to control inflammation, steroids have to be used, which have stronger anti-inflammatory action.

If the disease goes on to involve more than four joints after six months, or if smaller joints such as fingers are involved, the prognosis is more complicated.

I have to carefully avoid overprotecting her--something which typically occurs in parents dealing with the chronic pain of a child. The other siblings can grow resentful, and the affected child is less prepared to deal with things autonomously, as he or she grows older. 

I wish this were a case of jumping to conclusions after too many Internet searches, but the signs are too obvious, and frankly, I think the orthopedic doctor was pretty sure she was an arthritis presentation. He only ordered the MRI to completely rule out an injury.

Part of me wants to scream and cry and throw things, but I think I'm stronger than that now. The best thing for Beth (and the others) is that I take this in stride as quickly as possible--while still praying vigilantly for her and holding her through the pain. 

She will be better for this.......more sympathetic to others, softer around the edges, stronger internally.

What is God using to make you stronger these days?

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