Kimberly Allen R.N., Medical - Written by on Monday, April 22, 2013 12:51

Juvenile Rheumatoid Arthritis and New Treatments

by Kimberly Allen, RN

When most people think about ‘arthritis’ they think of “old” people.  It is difficult enough for them to grasp arthritis in young adults let alone that children can also be diagnosed with arthritis.  Both my brother and I were diagnosed in our 30′s and the looks on peoples faces when you explain that no, you didn’t do anything to your leg, foot or ankle that you have Rheumatoid Arthritis (RA) was usually disbelief.  Then frequently the “look” was followed by ‘but you’re not old enough to have arthritis’.  Sorry to break the news to you but yes even children develop arthritis.  In fact, the CDC estimates that in the US there are approximately 294,000 children under 18 years of age have some type of arthritis or rheumatic disorder.  Of those at least 30,000 have been diagnosed with juvenile RA or JRA.
Though most of us “older” people know the condition to be called JRA the name was recently changed to Juvenile Idiopathic Arthritis.  The reason for the name change was to emphasize that there is a difference between JRA and adult RA.  Name change or not it is the most common form of juvenile arthritis.  Though they are different they also have similarities for example girls develop JRA more frequently than boys just as women are more often affected by RA than men.  Other similarities include the possibility of joint damage as well as it may also have genetic related causes and there may also be an environmental trigger.  Children with JRA are treated with the same types of medications that are used to treat adult RA including NSAID’s, DMARD’s, as well as biologics.  Some of the main differences are that JRA is much less common than adult RA.  Another significant difference is that children frequently outgrow their JRA where as adults do not.  JRA can also affect the bone growth in children as well.  Though adults don’t always have a positive RA factor, children are even less likely to have one.  The other significant difference is that JRA/JIA is not considered to be a single disorder but a condition that encompasses many  conditions.  These conditions not only affect different areas of the body but they progress differently and frequently require different treatments.  Some symptoms may only last for a short period while others can last for years.
JIA also more accurately describes the condition as “idiopathic” which means no known cause.  Just as with adult RA researchers do not know what causes JIA/JRA.
JRA has been classified into five main types;
1. Systemic JRA is they type also know as stills disease, can also affect the organs and tends to have early symptoms of fever and rash.
2. Polyarticular JRA is the type considered to be the closest to adult RA. In this type there are five or more joints affected in the first 6 months.
3. Oligoarthritis is the most common form of JRA affecting approximately half of all children with RA as well as being the type with the mildest symptoms of all the types of JRA.
4. Psoriatic RA which is similar to adult psoriatic arthritis.
5. Enthesitis related arthritis or ERA generally affects the hips and spine.  This type is more common in boys than girls and affects the insertion points of muscles, ligaments, and tendon’s.
Treatment for JRA centers on improving and maintaining your child’s level of functioning both physically and socially as well as to prevent complications, in particular eye and growth problems.  There are several options available to your Dr that can assist with that goal.  The most common medications being used today are the NSAID’s, DMARD’s, and biologics as well as immunosuppressants and corticosteroids.  Many Dr’s also recommend that children work with a physical therapist to maintain joint range of motion and flexibility.
There are numerous studies and clinical trials taking place in search of newer and more effective treatments of RA that give new hope to both children and adults with RA.

New Treatments

There are currently over one and a half million Americans suffering with Rheumatoid Arthritis (RA).  The cost of treating RA including both direct and indirect costs are in excess of $80 billion annually.  Personally, I was stunned by the cost of the new medications on the market.  When Enbrel first came out back in 2001 I couldn’t even get on the waiting list until I had prescription insurance, that was before Medicare had prescription insurance, so I asked about the cost and almost fell down. For one month, which is 8 injections, it was almost $1,500.  Though I don’t know the current costs of Enbrel or other “biologics” like Humera or the newest one to be approved by the FDA, Xeljanz, I’m sure they’re still expensive. rheumatoid arthritis
Although the incidence of RA in men has been declining in recent years, the incidence in women has increased by two and a half percent per year. People with RA also have as much as a 70% higher mortality rate than the general population. One of the major concerns is that RA usually strikes young adults in their 20′s and 30′s.  These are very productive years for young adults.  they are generally starting careers and families.  At least half of those diagnosed with RA will be disabled and unable to work with in 10years of diagnosis, some much sooner than that, which adds to the annual cost of treating this chronic disease.
Fortunately, there have been significant advances in treatments for RA in the last decade, most notably with drugs called “biologics.”  Biologics are proteins copied from human genes that have been genetically manipulated to suppress specific elements of the immune system. The elements they target are the principle cause of inflammation, which is the chief characteristic of RA. However, some of the major problems with these medications are not only are they expensive most can only be administered by subcutaneous injection or intravenous infusion. The only exception is the newest addition to the group which is Xeljanz.  Xeljanz is a pill that is taken orally twice a day.
Now, British researchers have created what many with ra are calling real hope for a “cure.” This new and significant medication is a single infusion of BiP, otherwise known as binding immunoglobulin protein. The British researchers have started an in-human trial of this new medication that will run for 2 years.  So what is BiP?  It is a protein that previously has demonstrated strong anti inflammatory properties in collagen-induced arthritis. BiP is a natural anti-inflammatory protein. People with RA do not have adequate amounts of this natural protein. Therefore researchers believe that by giving a single dose of BiP intravenously will reset the immune system of a person with RA which can potential put that person into remission for months, maybe even years. In addition to showing great promise for those of us suffering with RA it has also shown great promise in treating brittle bone disease.
The impact of this new treatment is significant in many ways, not only in reducing the pain and inflammation of RA, but it also will extend those productive years that young adults lose due to the effects of RA as well as significantly decreasing chronic medical care costs.  And that’s just for people with RA, there are numerous possibilities in the future for this new type of treatment.

Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at  mussatti3@gmail.com.

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