Rheumatism in children: New therapy? The hope of the doctors
Cornelia Werner (Source: abendblatt.de/ratgeber/wissen/medizin)
They have pain, are restricted in their movements - and cannot do many things that children do as well. Because they suffer from rheumatism. How joint disease manifests itself in very small children and how it can be treated.
Rheumatism in children: Symptoms
He had just taken the first steps of his life, slowly, on shaky legs and marveling at the fact that walking is also a way of getting around. And then came the pain. It was hot, cutting - something he had never experienced before. And unbearable: rheumatism. Even small children can develop it. They immediately instinctively try to avoid the pain and avoid standing or walking, simply sitting down again. "This kind of behavior can be the first sign of a rheumatic disease," says Dr. Elisabeth Weissbarth-Riedel, a specialist in paediatric and adolescent medicine and paediatric rheumatologist at the Children's Hospital at Eppendorf University Hospital.
Rheumatism in children: The most common form
It is only when the children get older that they also complain about symptoms. Even typical signs of joint inflammation such as redness, swelling and overheating may be absent in young children. Rheumatism can have many manifestations, just like in adults. Chronic rheumatoid arthritis in children, so-called juvenile idiopathic arthritis, is the most common form. It can affect only one joint, but it can also affect several joints. Every year, about 1,400 children in Germany contract the disease.
Rheumatism in children: immune system malfunction
The mechanism underlying this disease is a malfunction of the immune system. "The immune system reacts oversensitively or takes the wrong path, resulting in a chronic inflammatory reaction," explains the pediatric rheumatologist. This dysregulation can concentrate on one joint, in which case it is referred to as arthritis. But there are also other more severe forms that can affect the whole body. "The more pronounced the general symptoms such as fatigue and fever are in addition to the joint pain, the more likely it is that a systemic disease is involved."
Rheumatism in children: arthritis
In arthritis, all joints can be inflamed. "There is a subtype in which mainly large joints, most commonly the knee joint, are affected, especially in pre-school children, predominantly girls. In another variant, the inflammation is concentrated on the tendon insertions, for example on the Achilles tendons, so that the children have pain in their heels. This form mainly occurs in school-age children, especially boys," says Weissbarth-Riedel. The temporomandibular joints or the spine can also be affected.
Rheumatism in children: Hereditary predisposition?
How the disease develops is still unclear. "Although there is a hereditary predisposition, this alone is not enough to trigger rheumatism. Several factors have to come together. This could be a banal viral infection, for example. Environmental factors, such as maternal smoking during pregnancy, also lead to an increased risk," says Weissbarth-Riedel. Chronic rheumatoid arthritis is suspected if a child has symptoms in a joint for longer than six weeks. The child is then usually referred to a specialist by the pediatrician. "When the boys and girls come to us, they are first examined from head to toe - because in addition to the affected joint, there are often other indications of the disease, such as changes to the skin and nails. We also send the children to an ophthalmologist to rule out rheumatoid eye inflammation," says the rheumatologist. This is the beginning of an intensive search for clues. This is because there are no clear laboratory tests to prove the disease in childhood rheumatism. "The diagnosis is based on the course of the disease and which joints are affected," emphasizes the paediatric rheumatologist, who uses ultrasound to examine the affected joints. Further examinations such as X-rays or magnetic resonance imaging may also be necessary.
Rheumatism in children: What is the right therapy?
Once a diagnosis of rheumatism has been made, the next step is to find the right treatment.
"All therapies are aimed at suppressing the rheumatic inflammation," explains the pediatrician. The therapy follows a step-by-step approach. First, the children are given medication that has both an anti-inflammatory and pain-relieving effect. Ibuprofen, for example, belongs to this group. If only one or a few joints are affected, cortisone can also be injected directly into the joint. "If this is not enough, a so-called basic therapy would be started, with slow-acting rheumatism medication. The standard medication from this group is methotrexate. Many parents are afraid of it because it is also used in cancer therapy. But the dose administered for rheumatism is about one thousandth of that used in cancer therapy. The side effects are correspondingly lower."
Rheumatism in children: What are Biologica?
If the disease remains active even under this therapy, there are so-called biologics. "These are new drugs that have a completely different mode of action. They block inflammatory messengers in the body. One such substance is TNF alpha, for example. The disadvantage of these TNF-alpha blockers is that they have to be injected under the skin. However, the therapy is very successful in around 80 percent of patients," says Weissbarth-Riedel. All of these medications should be taken under regular medical supervision. As rheumatism comes in attacks, the medication is used when an attack begins. "But since you don't know how long such an episode will last, the therapy is always long-term. As soon as a patient needs basic therapy, treatment must be expected to last at least a year," says the pediatric rheumatologist. The therapy, which also includes physiotherapy and occupational therapy, aims to suppress the inflammation so that the children are pain-free and can move normally. "Because if they have pathological movement patterns, there is a risk that they will retain joint changes in the long term, such as tendon shortening, which will continue to cause them problems later when the disease has come to a standstill.
Rheumatism in children: forecasting
"Overall, the prognosis is much more favorable compared to adult rheumatism: 50 percent of affected children no longer have any symptoms in adulthood if they receive early treatment and do not need to take any medication," says Weissbarth-Riedel.
