Juvenile Arthritis (JA) usually affects individuals under 16 years of age; it can affect children at any age although rarely in the first six months post birth. It is a chronic inflammatory condition which may involve one or many joints. It usually manifests in children between 1 to 3 years of age and girls are more prone than male children. Due to the lack of standard diagnostic criteria, determining the exact prevalence becomes difficult. It affects approximately 1 in 1,000 children in any given year with about 1 in 10,000 taking a severe condition.

Diagnosis and test

The term juvenile arthritis encompasses several types of arthritis that occur in children or young individuals. Diagnosis of the condition is difficult as initial symptoms may not indicate arthritic pathology. Additionally, no diagnostic test is available presently. Individuals may show low red blood cell and elevated white blood cell counts in hematological investigations, but these findings are not characteristic of JA. It is often diagnosed only at advanced stages when joint inflammation becomes visible. Criteria for diagnosis include onset before age of 16, persistent, objective arthritis in 1 or more joints for at least 6 weeks, and exclusion of other potential causes of childhood arthritis.

Symptoms and Causes

Presentation of JA may begin with repeating fever, intermittent rash etc. Apart from these symptoms, typically an individual may complain of stiffness in joints especially in the morning, difficulty performing fine motor activities etc. Joint swelling however, may not be apparent until months or years of onset of symptoms and systemic inflammation. Overtime, disability progresses to the extent that movement is completely restricted. In addition to disability, JA also has an impact on the psychological well being of the child. In mild cases however, symptoms may not progress into adulthood and quality of life may remain unaffected.

 

Immune system dysfunction has been implicated as a cause of JA. Genetic predisposition has been suggested as a factor, but the condition develops only after exposure to an infection or other triggers. Synovial membrane, which is the lining of joints is targeted by the malfunctioning immune system. The end result of the pathogenic process is joint inflammation and destruction.

Treatment

Conventional treatment for JA involves use of anti-inflammatory medications and physiotherapy rehabilitation. These agents aid in temporarily alleviating an individual of symptoms, but do not halt progression of the disease. Disease modifying anti-rheumatoid drugs or agents, steroids may also be advised, however may be associated with adverse effects when used for long durations.

 

In recent years, regenerative medicine and cellular therapy has been showing promise in treatment of conditions previously thought to be untreatable. Cellular therapy aims to harness the power of the human bodyÂs own reparative mechanisms to treat various conditions. Mesenchymal stem cells have anti-inflammatory, immune-modulatory and tissue repairing properties which are effective in treating arthritic pathology. Source of mesenchymal stem cells may be autologous (from oneÂs own body) or allogeneic. In addition, T cells which possess the ability to regulate or modulate the immune system may also be effective in treating JA.

 

This form of therapy is more effective in young individuals owing to better healing ability and general absence of co-morbid health conditions (as seen in older individuals) that may affect overall outcome of therapy.

 

The overall goal of cellular therapy and rehabilitation (physiotherapy etc.) is to control symptoms, prevent joint damage and maintain function. Being a non/minimally invasive therapy and cells being harvested from the patients own body, cellular therapy is a definitive and safe treatment modality for juvenile arthritis.

Prevention

There is no definite cause that has been implicated in disease pathogenesis. Therefore, prevention of the condition, currently, is not possible. Early identification of symptoms may aid in diagnosing the condition and planning appropriate interventions to limit disability.

 

Lifestyle and dietary modifications play an important role in autoimmune conditions as these are associated with modulating the core pathology of the disease. Moderate intensity exercises, swimming etc. can aid in maintaining strength of muscle groups and preventing disability. Additionally, maternal or paternal screening for presence of autoimmune antibodies is imperative in identifying possible manifestation of the condition in children.

Arthritis, apart from being an autoimmune condition, is also associated with our way of life. Sedentary lifestyle habits, improper dietary practices cause the condition to progress at a more rapid and severe rate. It is therefore important to follow a disciplined lifestyle along with regular monitoring of health in order to identify the condition at the earliest and plan appropriate interventions.

(The Author is Regenerative medicine researcher at StemRx)