What Happens Now?
Treatment and Health Outcomes of Rheumatic Conditions in Children
After determining that your child has juvenile arthritis or another rheumatic condition, it is important to become familiar with members of your child’s healthcare team and the outcomes of rheumatic diseases.
Treating Juvenile Arthritis and Rheumatic Conditions
Treatment is determined by the type and severity of your child’s rheumatic disease. Treatment focuses on controlling pain, improving function, and preventing joint damage. In many cases, rheumatic conditions are treated with a combination of medication, physical therapy, and exercise. Health care providers, including the pediatric rheumatologist, ophthalmologist, nurse, and physical or occupational therapist, will work together to develop the best method of treatment. Pediatric rheumatologists are pediatricians who are Board Certified in pediatric rheumatology. Board certification demonstrates that a physician has exceptional expertise in a particular specialty and/or subspecialty of medical practice.
Pediatric rheumatologists are experts in the care of children arthritis and other rheumatic disease. Their job is to help diagnose and treat your child’s illness and to make sure that your child can participate in regular school and afterschool activities. When you meet with the pediatric rheumatologist, you will discuss what each medication is meant to do and what side effects the medications can cause. With many of these medications, it is very important for your child to continue taking the medication until the doctor says to stop. Your doctor may also work with you to create a pain management plan, which can include home treatments, exercise, and cognitive- behavioral therapy.
Your child may need to see an ophthalmologist. It is important to see an ophthalmologist because eye inflammation (uveitis) is associated with various forms of juvenile arthritis. However, frequent eye exams can identify inflammatory problems early and reduce the potential for permanent loss of vision. The frequency of eye exams will depend on your child’s risk for developing eye problems, which will be determined by your child’s pediatric rheumatologist. Please note that an ophthalmologist is a physician that has completed specialty training in eye care. An ophthalmologist is different from an optometrist, who can provide some vision services, but is not a physician and cannot monitor your child’s eyes for uveitis.
It is also very important that your child continues to see their pediatrician. All children need a pediatrician who looks after regular health. Your child’s immunizations, general health concerns, and normal childhood illness are cared for by the pediatrician, not the pediatric rheumatologist, who is a specialist. Your pediatrician will also help you make decisions and will see your child for urgent problems. If your child needs referrals to other specialties, it is often the responsibility of your primary care physician to coordinate this process.
When joints are sore or painful to move, it is natural to want to rest. However, it is very important to maintain a regular exercise program. Strong and healthy muscles can help support and protect affected joints. Exercise also helps to maintain range of motion in the joints. Physical therapy and occupational therapy is very important in treating conditions that affect the joints. These therapists will help in creating exercises for your child. If your child sees a physical therapist, the physical therapist will help your child to improve their mobility. If your child sees an occupational therapist, the occupational therapist will help your child with activities of daily living. Both types of therapists will give your child therapeutic exercises. These exercises are critical for your child to routinely practice. In addition to therapeutic exercise, sports and recreational activities are important for your child. Recreational activities help the joints and muscles, build social skills, and are fun! Work your child’s pediatric rheumatologist, physical and occupational therapists, and sports coaches to find safe activities for your child.
Rheumatic conditions can be unpredictable and there is no way for your doctor to offer a fixed prognosis. Some children will only have one joint affected throughout periods when the condition is active. Other children may start with one joint affected, but the disease may spread. Some children may have a mild disease, while others have a more severe disease that is difficult to control. Approximately half of the patients will still have active arthritis after 10 years, and the disease may return or persist into adulthood. Prognosis is different for different forms of arthritis and other rheumatic conditions. Physicians at Rady Children’s Hospital-San Diego are committed to maintaining complete integrity of the joints, so that when your child’s disease goes into remission, their joints will not be damaged.
Most forms of juvenile arthritis and rheumatic conditions are manageable. Treatments are always improving and have especially improved over the last decade. With a communicative, positive healthcare team and adherence to medical treatments, care is particularly enhanced. All children can finish school and can have productive careers, marriages, and families. You and your family must remain optimistic that your child will have a wonderful, positive outcome.