Rheumatology is a subspecialty of internal medicine, and doctors who specialize in rheumatology diagnose and focus on non-surgical treatment of arthritis and related rheumatic diseases such as systemic lupus, osteoporosis, and gout.
Juvenile Idiopathic Arthritis (also known as juvenile rheumatoid arthritis) can show up in your child with symptoms such as a fever, a rash, or swollen knuckles. It can be incredibly unexpected to have to diagnose your child with arthritis and you may feel overwhelmed and confused.
Why does it happen and what causes it?
Listen in as Sarah Payne-Poff, MD discusses arthritis in children and how they can find relief from this painful arthritic condition.
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Arthritis in Children
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Learn more about Dr. Sarah Payne-Poff
Sarah Payne-Poff, MD
Dr. Sarah Payne-Poff graduated from the University of Alabama School of Medicine in 2007. She works in Greenville, SC and specializes in Rheumatology and Pediatrics. Dr. Payne-Poff is affiliated with Greenville Memorial Hospital.Learn more about Dr. Sarah Payne-Poff
Transcription:
Melanie Cole (Host): Juvenile rheumatoid arthritis, also known as juvenile idiopathic arthritis, is the most common type of arthritis in children under the age of 17. Close to 294,000 children up to the age of 17 are affected with arthritis or other rheumatic conditions. My guest today is Dr. Sarah Payne-Poff. She’s a pediatric rheumatologist with Greenville Health System. Welcome to the show, Dr. Payne-Poff. Tell us, what’s a pediatric rheumatologist?
Dr. Sarah Payne-Poff (Guest): Thank you. A pediatric rheumatologist is a specialist who has first trained in general pediatrics and then gone on for specialty training in rheumatology. They deal with both autoimmune and autoinflammatory diseases that occur in children. The most common two things that we see are juvenile arthritis and lupus.
Melanie: You’re seeing juvenile arthritis and lupus, both autoimmune diseases. So, let’s discuss juvenile arthritis. You don’t think of children as coming up with arthritis, typically; you think of an older person. So, what is juvenile rheumatoid arthritis?
Dr. Payne-Poff: Juvenile rheumatoid arthritis, which is more commonly now called “juvenile idiopathic arthritis”, or “JIA”, is an autoimmune or inflammatory type of arthritis. The most common type of arthritis in adults is osteoarthritis which is wear and tear arthritis, but in kids, we see this type of autoimmune arthritis where the body’s immune system is causing the arthritis.
Melanie: How would a parent know?
Dr. Payne-Poff: The most common things that we’re looking for are really things that are in the history and the exams. So, we’re looking for joint swelling that persists for six weeks or more and that timeline is just because there are many things such as injuries or different types of infections that might cause joint swelling for just a few days. So, joint swelling after six weeks or more. And then, we also look for a history of morning sickness. If your child is walking like they are quite old in the morning and that’s lasting for at least 30 minutes in the morning, those are the main things that we look for in the history.
Melanie: Who’s at risk for this? Is there a genetic component? If one of the parents has a rheumatoid condition, is it more likely to be passed down? Who’s at risk?
Dr. Payne-Poff: We do think that autoimmune disease, in general, tends to run in families but it’s not often exactly the same thing. There are some very common autoimmune diseases, such as low thyroid. Many people know someone that has low thyroid and has to take thyroid hormones. That’s actually a form of autoimmune disease. So, we do often see in a family that there are scattered people that had different types of autoimmune disease. Maybe mom has low thyroid and there’s a grandmother or great aunt that had rheumatoid arthritis, and a cousin with Type 1 Diabetes, which is another type of autoimmune disease. So, we do often see that different people in a family have different types of autoimmune diseases. We think that is probably due to the interaction of a lot of different genes that just makes that family more prone to autoimmune diseases. But, you can also see kids that have juvenile arthritis and no one in their family has any of that history. So, there’s no one particular thing that definitely means that the child will definitely have arthritis, and no one particular thing that protects you either.
Melanie: Is there a specific test for it, an Rh factor? Do you take a blood test? How do you find out if this is actually what the child has?
Dr. Payne-Poff: The diagnosis is really a clinical diagnosis, meaning it’s really based our history and our exam in clinic. That being said, we do usually do some bloodwork because the bloodwork will sometimes give us extra clues, and we do check some antibodies that help us to figure out which subtype of arthritis the child might have and what type of side effects they may be at risk for. However, the bloodwork isn’t the thing that really makes the diagnosis. The actual diagnosis is all about the history and the exam.
Melanie: Once you have made this diagnosis, then how do you treat a child who has this type of pain, which can be very debilitating and uncomfortable? And, how do you work with them on a daily basis to manage this condition?
Dr. Payne-Poff: Luckily, there have been a lot of new medications have come out over the past 20 to 30 years. And, there are always people that are still working on new medications that are continuing to be even new ones that continue to come out. So, we’ll often start with just an NSAID, the over-the-counter ones people might be familiar with, things like Motrin. There are a great many different prescription NSAIDs available. Sometimes we will also with injecting steroids into the joints, especially if the child only has one or two joints affected. That way, we can sometimes avoid having to take any meds that affect the whole body. In kids that have more joints that are affected or when NSAIDs don’t work, then we move on to medications that affect the immune system. Some of those are things like methotrexate and others are things that people might have seen commercials for on TV like Enbrel and Humira.
Melanie: Is this something that will ever go away or is it a lifelong condition?
Dr. Payne-Poff: That really depends on the subtype. Under that umbrella term of juvenile idiopathic arthritis there are seven different subtypes. Some of the subtypes such as the children that truly have juvenile rheumatoid arthritis, or kids that have things like juvenile psoriatic arthritis. We generally don’t think of those as things that you ever totally outgrow. However, there are some kids that have juvenile arthritis, especially the ones that only have a few joints, so kids that never have more than four joints involved, those children have a pretty good chance of totally outgrowing their arthritis and not having it be a problem into adulthood.
Melanie: Wow. That is great information. Do children with these types of autoimmune or arthritis have to limit activities? Is there any limitations on gym and recess and exercise, in general?
Dr. Payne-Poff: We actually encourage them to be as active as possible. At times when we’re maybe still trying to get started with treatment or if the child has a flair at some point and they are having more active symptoms, then we do need coaches and gym teachers to be sympathetic to them and let them rest if they want to rest. But, we encourage them to do as much as they feel they can do because it is important for their joint health and their bone health, in general, to stay as active as possible.
Melanie: What about the family and the parents and siblings helping this child to live as comfortably as possible with juvenile arthritis? Things they can do at home, whether it’s nutrition, or yoga, meditation—whatever. What can they do lifestyle-wise?
Dr. Payne-Poff: Good nutrition is, of course, for everybody. We don’t have a lot of very definite proof that a particular diet will definitely help arthritis, but things that are good for you like eating lots of fresh fruits and vegetables and avoiding a lot of sugar or very processed foods, those are things that are good for everyone. There is some evidence in adulthoods with arthritis that eating fish several times a week is helpful. That study has not been repeated in children, but we do often still recommend that our families either try to increase the fish in their diet or, if they feel that can’t do that, to maybe consider taking fish oil supplements. And then, of course, staying active, as we mentioned, is very important. It used to be before we had as many medicines as we have now, that swimming was actually one of the primary treatments for arthritis. So, for families that have access to pools, we really encourage them, especially in the summer time.
Melanie: Dr. Payne-Poof, tell us about your team at GHS Children’s Hospital.
Dr. Payne-Poff: There’s myself, and I am trained just for pediatric rheumatology. So, that’s what I do all the time. I have a partner name Dr. Lara Huber, who actually is trained for both adult and pediatric rheumatology. So, she spends most of her time seeing children but she does have an adult clinic one day a week and that is a great help for us for our older kids who are maybe graduating from college and need to transition into the adult world. And then, we have a great nurse named Anne who often helps us out. And then, we are in Patewood office at the GHS campus and so we also have people that work in the lab here and at the front desk answering the phone, that work for several different of the offices here. But everyone, of course, with kids all day long.
Melanie: Just wrap it up for us. It’s such great information. Give us your best advice for the listeners about parents who might have children with juvenile arthritis and how they can live their best life and come to see you if they need their care.
Dr. Payne-Poff: I think one of the most important things for the community in general is just to have the knowledge that children can get arthritis. So that if kids are complaining of joint pain or they’re seeing swelling that’s not going away, that we do get to see those kids and make sure they get the care that they need. And then, just remember to stay active, which we continue to emphasize. But, the thing that I try to tell parents and kids when they’re first diagnosed is, this may mean that your child needs to take some medicine in order to feel well, but it really should not inhibit anything that they would want to do, any dreams that they would have for their life. We have kids that have arthritis, for instance, that are college athletes. As long as you’re willing to take the medicine to feel good and treat the arthritis, it shouldn’t really prevent their child from doing anything that they want to do.
Melanie: Thank you so much for being with us today. You’re listening to Inside Health with Greenville Health System. For more information you can go to GHS.org. This is Melanie Cole. Thanks for much for listening.
Melanie Cole (Host): Juvenile rheumatoid arthritis, also known as juvenile idiopathic arthritis, is the most common type of arthritis in children under the age of 17. Close to 294,000 children up to the age of 17 are affected with arthritis or other rheumatic conditions. My guest today is Dr. Sarah Payne-Poff. She’s a pediatric rheumatologist with Greenville Health System. Welcome to the show, Dr. Payne-Poff. Tell us, what’s a pediatric rheumatologist?
Dr. Sarah Payne-Poff (Guest): Thank you. A pediatric rheumatologist is a specialist who has first trained in general pediatrics and then gone on for specialty training in rheumatology. They deal with both autoimmune and autoinflammatory diseases that occur in children. The most common two things that we see are juvenile arthritis and lupus.
Melanie: You’re seeing juvenile arthritis and lupus, both autoimmune diseases. So, let’s discuss juvenile arthritis. You don’t think of children as coming up with arthritis, typically; you think of an older person. So, what is juvenile rheumatoid arthritis?
Dr. Payne-Poff: Juvenile rheumatoid arthritis, which is more commonly now called “juvenile idiopathic arthritis”, or “JIA”, is an autoimmune or inflammatory type of arthritis. The most common type of arthritis in adults is osteoarthritis which is wear and tear arthritis, but in kids, we see this type of autoimmune arthritis where the body’s immune system is causing the arthritis.
Melanie: How would a parent know?
Dr. Payne-Poff: The most common things that we’re looking for are really things that are in the history and the exams. So, we’re looking for joint swelling that persists for six weeks or more and that timeline is just because there are many things such as injuries or different types of infections that might cause joint swelling for just a few days. So, joint swelling after six weeks or more. And then, we also look for a history of morning sickness. If your child is walking like they are quite old in the morning and that’s lasting for at least 30 minutes in the morning, those are the main things that we look for in the history.
Melanie: Who’s at risk for this? Is there a genetic component? If one of the parents has a rheumatoid condition, is it more likely to be passed down? Who’s at risk?
Dr. Payne-Poff: We do think that autoimmune disease, in general, tends to run in families but it’s not often exactly the same thing. There are some very common autoimmune diseases, such as low thyroid. Many people know someone that has low thyroid and has to take thyroid hormones. That’s actually a form of autoimmune disease. So, we do often see in a family that there are scattered people that had different types of autoimmune disease. Maybe mom has low thyroid and there’s a grandmother or great aunt that had rheumatoid arthritis, and a cousin with Type 1 Diabetes, which is another type of autoimmune disease. So, we do often see that different people in a family have different types of autoimmune diseases. We think that is probably due to the interaction of a lot of different genes that just makes that family more prone to autoimmune diseases. But, you can also see kids that have juvenile arthritis and no one in their family has any of that history. So, there’s no one particular thing that definitely means that the child will definitely have arthritis, and no one particular thing that protects you either.
Melanie: Is there a specific test for it, an Rh factor? Do you take a blood test? How do you find out if this is actually what the child has?
Dr. Payne-Poff: The diagnosis is really a clinical diagnosis, meaning it’s really based our history and our exam in clinic. That being said, we do usually do some bloodwork because the bloodwork will sometimes give us extra clues, and we do check some antibodies that help us to figure out which subtype of arthritis the child might have and what type of side effects they may be at risk for. However, the bloodwork isn’t the thing that really makes the diagnosis. The actual diagnosis is all about the history and the exam.
Melanie: Once you have made this diagnosis, then how do you treat a child who has this type of pain, which can be very debilitating and uncomfortable? And, how do you work with them on a daily basis to manage this condition?
Dr. Payne-Poff: Luckily, there have been a lot of new medications have come out over the past 20 to 30 years. And, there are always people that are still working on new medications that are continuing to be even new ones that continue to come out. So, we’ll often start with just an NSAID, the over-the-counter ones people might be familiar with, things like Motrin. There are a great many different prescription NSAIDs available. Sometimes we will also with injecting steroids into the joints, especially if the child only has one or two joints affected. That way, we can sometimes avoid having to take any meds that affect the whole body. In kids that have more joints that are affected or when NSAIDs don’t work, then we move on to medications that affect the immune system. Some of those are things like methotrexate and others are things that people might have seen commercials for on TV like Enbrel and Humira.
Melanie: Is this something that will ever go away or is it a lifelong condition?
Dr. Payne-Poff: That really depends on the subtype. Under that umbrella term of juvenile idiopathic arthritis there are seven different subtypes. Some of the subtypes such as the children that truly have juvenile rheumatoid arthritis, or kids that have things like juvenile psoriatic arthritis. We generally don’t think of those as things that you ever totally outgrow. However, there are some kids that have juvenile arthritis, especially the ones that only have a few joints, so kids that never have more than four joints involved, those children have a pretty good chance of totally outgrowing their arthritis and not having it be a problem into adulthood.
Melanie: Wow. That is great information. Do children with these types of autoimmune or arthritis have to limit activities? Is there any limitations on gym and recess and exercise, in general?
Dr. Payne-Poff: We actually encourage them to be as active as possible. At times when we’re maybe still trying to get started with treatment or if the child has a flair at some point and they are having more active symptoms, then we do need coaches and gym teachers to be sympathetic to them and let them rest if they want to rest. But, we encourage them to do as much as they feel they can do because it is important for their joint health and their bone health, in general, to stay as active as possible.
Melanie: What about the family and the parents and siblings helping this child to live as comfortably as possible with juvenile arthritis? Things they can do at home, whether it’s nutrition, or yoga, meditation—whatever. What can they do lifestyle-wise?
Dr. Payne-Poff: Good nutrition is, of course, for everybody. We don’t have a lot of very definite proof that a particular diet will definitely help arthritis, but things that are good for you like eating lots of fresh fruits and vegetables and avoiding a lot of sugar or very processed foods, those are things that are good for everyone. There is some evidence in adulthoods with arthritis that eating fish several times a week is helpful. That study has not been repeated in children, but we do often still recommend that our families either try to increase the fish in their diet or, if they feel that can’t do that, to maybe consider taking fish oil supplements. And then, of course, staying active, as we mentioned, is very important. It used to be before we had as many medicines as we have now, that swimming was actually one of the primary treatments for arthritis. So, for families that have access to pools, we really encourage them, especially in the summer time.
Melanie: Dr. Payne-Poof, tell us about your team at GHS Children’s Hospital.
Dr. Payne-Poff: There’s myself, and I am trained just for pediatric rheumatology. So, that’s what I do all the time. I have a partner name Dr. Lara Huber, who actually is trained for both adult and pediatric rheumatology. So, she spends most of her time seeing children but she does have an adult clinic one day a week and that is a great help for us for our older kids who are maybe graduating from college and need to transition into the adult world. And then, we have a great nurse named Anne who often helps us out. And then, we are in Patewood office at the GHS campus and so we also have people that work in the lab here and at the front desk answering the phone, that work for several different of the offices here. But everyone, of course, with kids all day long.
Melanie: Just wrap it up for us. It’s such great information. Give us your best advice for the listeners about parents who might have children with juvenile arthritis and how they can live their best life and come to see you if they need their care.
Dr. Payne-Poff: I think one of the most important things for the community in general is just to have the knowledge that children can get arthritis. So that if kids are complaining of joint pain or they’re seeing swelling that’s not going away, that we do get to see those kids and make sure they get the care that they need. And then, just remember to stay active, which we continue to emphasize. But, the thing that I try to tell parents and kids when they’re first diagnosed is, this may mean that your child needs to take some medicine in order to feel well, but it really should not inhibit anything that they would want to do, any dreams that they would have for their life. We have kids that have arthritis, for instance, that are college athletes. As long as you’re willing to take the medicine to feel good and treat the arthritis, it shouldn’t really prevent their child from doing anything that they want to do.
Melanie: Thank you so much for being with us today. You’re listening to Inside Health with Greenville Health System. For more information you can go to GHS.org. This is Melanie Cole. Thanks for much for listening.
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