PEDITRIC ARTHRITIS

1. Pediatric Rhumatiod
Arthritis
Capt. Shatha W
Al Khatib

2. Out line
• Arthritis in childhood? Isn't that only an old
person's disease?
• How common is arthritis in children
• Definition
• Signs and symptomes
• Types of pediatric rhumatiod arthritis
• Diagnosis
• 5 Potential Complications of Untreated
Rheumatoid Arthritis
• Treatment
• Nursing considerations

3. Arthritis in childhood? Isn't that
only an old person's disease?
• Most laypeople and many doctors fail to appreciate
that arthritis in children exists. For the children
affected and their families, education about the
condition is essential. Many children suffer for
months or years before the diagnosis of arthritis is
thought of and proper treatment begun. But the
problem doesn't end there. Children with arthritis
frequently experience difficulty because their
teachers and schoolmates don't understand that
children can develop arthritis. They have no idea
what to expect from the child with arthritis or about
the nature of the illness. As a result, when the child is
finally diagnosed with arthritis, the family may be told
just to put them in a wheelchair because "nothing can
be done." This is entirely wrong!

4. Definition
• Arthritis (from Greek arthro-, joint + -itis, inflammation;
plural: arthritides) is a form of joint disorder that involves
inflammation of one or more joints
• There are over 100 different forms of arthritis. The most
common form, osteoarthritis (degenerative joint disease),
is a result of trauma to the joint, infection of the joint, or
age. Other arthritis forms are rheumatoid arthritis,
psoriatic arthritis, and related autoimmune diseases.
Septic arthritis is caused by joint infection.
• The major complaint by individuals who have arthritis is
joint pain. Pain is often a constant and may be localized to
the joint affected. The pain from arthritis is due to
inflammation that occurs around the joint, damage to the
joint from disease, daily wear and tear of joint, muscle
strains caused by forceful movements against stiff, painful
joints and fatigue.

5. • Juvenile arthritis (JA) refers to any form of arthritis or
an arthritis-related condition that develops in children
or teenagers who are less than 18 years of age.
Approximately 294,000 children under the age of 18
are affected by pediatric arthritis and rheumatologic
conditions

6. How common is arthritis in
children?
• Arthritis affects approximately one child in
every 1,000 in a given year. Fortunately, most
of these cases are mild. However,
approximately one child in every 10,000 will
have more severe arthritis that doesn't just go
away. Many children have what is called an
acute inflammatory arthritis following a viral or
bacterial infection. This arthritis is often quite
severe for a brief period but usually
disappears within a few weeks or months.

7. Types of pediatric rhumatiod
arthritis
• There are three main forms of juvenile rheumatoid
arthritis (JRA), which are classified by how they
begin. These forms are pauciarticular (less than four
joints affected), polyarticular (four or more joints
affected), and systemic-onset (inflamed joints with
high fevers and rash).
• Juvenilerheumatoid arthritis (JRA) is the most
common type of arthritis that persists for months or
years at a time. Juvenile rheumatoid arthritis is also
now called juvenile arthritis or juvenile arthritis of
unknown cause (juvenile idiopathic arthritis).

8. Signs and symptoms
Regardless of the type of arthritis, the common symptoms for all arthritis
disorders include varied levels of pain, swelling, joint stiffness, and
sometimes a constant ache around the joint(s). Arthritic disorders can
also affect other organs in the body with a variety of symptoms.
• Inability to use the hand or walk
• Malaise and a feeling of tiredness
• Fever
• Weight loss
• Poor sleep
• Muscle aches and pains
• Tenderness
• Difficulty moving the joint
It is common in advanced arthritis for significant secondary changes to
occur. For example, in someone who has limited their physical activity:
• Muscle weakness
• Loss of flexibility
• Decreased aerobic fitness

9. Diagnosis
• Diagnosis is made by clinical examination and may
be supported by other tests such as radiology and
blood tests, depending on the type of suspected
arthritis. All arthritides potentially feature pain. Pain
patterns may differ depending on the arthritides and
the location.

10. Diagnosis
• Abnormal blood antibodies can be found in patients with
rheumatoid arthritis. A blood antibody called "rheumatoid
factor" can be found in 80% of patients. Citrulline antibody
is present in most patients with rheumatoid arthritis. It is
useful in the diagnosis of rheumatoid arthritis when
evaluating patients with unexplained joint inflammation. A
test for citrulline antibodies is most helpful in detecting the
cause of previously undiagnosed inflammatory arthritis
when the traditional blood test for rheumatoid arthritis,
rheumatoid factor, is not present. Citrulline antibodies are
also indicators of potentially more aggressive disease.
Citrulline antibodies have been felt to represent the earlier
stages of rheumatoid arthritis in this setting.
• Another antibody called "the antinuclear antibody" (ANA)
is also frequently found in patients with rheumatoid
arthritis.

11. Diagnosis
• A blood test called the sedimentation rate (sed rate) is a
measure of how fast red blood cells fall to the bottom of a test
tube. The sed rate is used as a crude measure of inflammation
of the joints. The sed rate is usually faster from inflammation
such as during disease flares and slower during remissions.
• Another blood test that is used to measure the degree of
inflammation present in the body is the C-reactive protein. The
rheumatoid factor, ANA, sed rate, and C-reactive protein tests
can also be abnormal in other systemic autoimmune and
inflammatory conditions. Therefore, abnormalities in these blood
tests alone are not sufficient for a firm diagnosis of rheumatoid
arthritis
•

13. 5Potential Complications of
Untreated Rheumatoid Arthritis
1. Joint destruction and deformity
2. Loss of function and disability
3. Osteoporosis
4. Coronary artery disease
5. Anemia

14. Treatment
• Early Control of Rheumatoid Arthritis As
recently as 20 years ago, doctors waited until
a person with RA showed evidence of joint
damage on an X-ray to begin treating with
high-powered drugs to control inflammation.
• Today, RA treatment is guided by the
principle of early and tight control. That
means achieving the lowest possible level of
disease activity as soon as possible, and
keeping it low. Research shows that such
tight control can slow the progression of RA
and reduce damage to joints.

15. Treatment
• RA medicines generally fall into two groups:
• Drugs that help control disease and limit joint damage, which include
disease-modifying antirheumatic drugs (DMARDs) and biologic-
response modifiers (biologics).
• Drugs that treat pain and inflammation but do not limit joint damage,
which include corticosteroids (steroids), nonsteroidal anti-
inflammatory drugs (NSAIDs), and other pain medicines.
• TNF (Tumour necrosis factor) blockers - such as entanercept and
infliximab may be used
• Joint replacement and other surgical options are used to treat some
forms of advanced joint damage.
• Rheumatologists today tend to use DMARDs and biologics as the
leads in RA therapy, with steroids and NSAIDs playing supporting
roles.

16. • DMARDs are a diverse group of drugs that all act in
some way to suppress an overactive immune system
in RA. These drugs can slow or stop progression of
joint damage. They may take from four to six weeks
to a few months to begin working and may take
longer to reach full effect
• . When only a single joint is involved, a steroid can be
injected into the joint before any additional
medications are given. Oral steroids such as
prednisone (Deltasone, Orasone, Prelone, Orapred)
may be used in certain situations, but only for as
short a time and at the lowest dose possible. The
long-term use of steroids is associated with
unacceptable side effects such as weight gain, poor
growth, osteoporosis, cataracts, avascular necrosis,
hypertension, and risk of infection.

17. Nursing Care Plan
• nurses check joints and check for deformities, immobility, inability to
perform daily activities.
They monitor vital signs and taking note of changes in weight, sensory
disturbances, and levels of pain. as well as administering analgesics, as
prescribed watching out for adverse effects.
nursing also keep a close eye on any skin problems that may occur.
they help patients understand diagnostic tests and procedures.
The duration of morning stiffness needs to be monitored by them, which
reflects disease's severity more accurately.
We apply splints carefully and observe for pressure sores if patients are
in traction or wearing splints.
they help the patient patient and the family understand that RA is a
chronic disease requiring major changes in life-style, and that there is
no cure.
We urge patient to keep moving ,control their weight as weight just put
more stress on joints.

18. Nursing Care Plan
• Nursing Diagnosis
Pain (Acute / Chronic)
Related to:
• Tissue distension by fluid accumulation / inflammation
• Joint destruction.
Can be evidenced by :
• Complaints of pain, discomfort, fatigue.
• Self-focusing / narrowing of focus
• Behavior distraction / autonomic response
• Behavior that is carefully / protect

19. Nursing Care Plan
• Expected Result / criteria for evaluation of
patients will :
• Showed pain relief / control
• Looks relaxed, sleep / rest and participate in
activities according to ability.
• Follow the program prescribed
pharmacological
• Combining the skills of relaxation and
entertainment activities into a program of pain
control.

20. Nursing Care Plan
• Nursing Interventions and Rational for Rheumatoid Arthritis :
• Assess complaints of pain, note the location and intensity (scale 0-10). Note
factors that accelerate and signs of pain non-verbal.
Rational: To assist in determining the need for pain management and
program effectiveness.
• Give a hard mattress, small pillows, bed linen Elevate as needed.
Rational: A soft mattress, large pillows, will prevent the maintenance of
proper body alignment, placing stress on joints that hurt. Elevation of bed
linen lowering the pressure in the inflamed joints / pain.
• Place / monitor the use of pillows, sandbags, splint, brace.
Rational: Resting sore joints and maintain a neutral position. Use of the
brace can reduce pain and can reduce damage to the joints.
• Suggest to frequently change positions, Help to move in bed, prop a pain in
the joints above and below, avoid jerky movements.
Rationale: Prevent the occurrence of general fatigue and joint stiffness.
Stabilize the joint, reducing the movement / pain in the joints.

21. • Instruct the patient to a warm bath or shower at the time awake and / or at
bedtime. Provide a warm washcloth to compress the joints are sick several times a
day. Monitor water temperature, water bath, and so on.
Rational: Heat increases muscle relaxation, and mobility, reduce pain and release
the stiffness in the morning. Sensitivity to heat can be removed and dermal wound
can be healed.
• Give a massage.
Rationale: Increase relaxation / pain relief.
• Encourage the use of stress management techniques, such as progressive
relaxation, therapeutic touch, biofeed back, visualization, imagination guidelines,
self hypnosis, and breath control.
Rationale: Increase relaxation, giving a sense of control and possibly enhance the
coping abilities.
• Engage in activities of entertainment that is appropriate for individual situations.
Rational: To focus attention again, provide stimulation, and increased self-
confidence and feeling healthy.
• Give the drug prior to activity / exercise that is planned as directed.
Rationale: Increase relaxation, reduce muscle tension / spasm, making it easier to
participate in therapy.
• Collaboration: Give medicines as directed.
Rational: As an anti-inflammatory and mild analgesic effect in reducing stiffness
and improving mobility.
• Give ice-cold compress if needed
Rational: The cold can relieve pain and swelling during the acute period.

22. Thank you