Juvenile Arthritis

Juvenile arthritis (JA) is a chronic disease affecting three out of every 1,000 children in Canada. As in adults, JA is an inflammatory disease originating from the synovial membrane, the structure which allows bones to slide against each other, and may be acute or chronic. The following article discusses the occupational issues related to JA in children and outlines the role the occupational therapist (OT) plays on the patient’s multidisciplinary care team.

What causes JA?

The causes of juvenile arthritis remain unknown. However, it is known that an impairment of the immune system influences the onset of arthritic symptoms, which vary according to the type of JA (e.g. polyarticular, psoriasis, systemic, etc.) However, symptoms such as joint stiffness, inflammation, and decreased mobility are present in most types of JA. Children afflicted with JA frequently complain of joint pain during growth spurts; this is due to joint inflammation, which may accelerate the child’s overall growth.

The impact of juvenile arthritis on children

A child’s development is highly influenced by play and interactions with her/his environment. Therefore, mobility problems can significantly limit the child’s participation in sports, outdoor activities, and balance games. Engaging in playtime activities with other kids is motivating; consequently, limitations due to JA symptoms may have an impact on the child’s self-esteem. Moreover, psychosocial factors such as lower self-esteem as well as side effects from treatment (e.g. skipping activities to get treatment) may negatively impact the child’s involvement in play and leisure activities.

Moreover, research has shown that reduced mobility in children with JA negatively affects manual school tasks such as handwriting, arts and crafts, and recess activities. In terms of self-care, some children have difficulty feeding themselves due to pain upon chewing, a situation which can reduce the child’s motivation to eat.

Occupational therapy assessment and intervention

The occupational therapy assessment process allows therapists to uncover facilitators and barriers that may impact the child’s occupation, thereby enhancing the patient’s participation in various activities:

• Initial interview: the initial interview is conducted with the children and parents, thus enabling a variety of different opinions on occupational dysfunctions. The occupational therapist will ask questions related to tasks and activities the children enjoy.
• Physical evaluation: the occupational therapist will evaluate the child’s physical capacities. In JA patients, emphasis is placed on the child’s range of motion and muscle strength, dexterity and sensitivity, posture, deformations, balance and walking patterns, history of pain, and growth spurts.
• Functional evaluation: Using standardized assessments and simulated tasks, the OT will evaluate the impact of JA on the child’s activities. Parent questionnaires can help uncover and assess problems with daily activities, while assessment of school-related skills and functional mobility will enable an objective understanding of fine and gross motor skills. Moreover, psychosocial abilities will be qualified in a structured manner.

The occupational therapist will use many strategies to enhance the child’s skills or reduce the impacts of activities, in order to enable the child to participate appropriately. These strategies may include:

• Pain management: analgesics (cold, heat), education
• Energy conservation techniques: recognizing symptoms for better organization of activities
• Joint protection: postural hygiene advice, and teaching of compensation methods to reduce symptomatic impacts
• Assistive tools: non-skid devices, tools to facilitate writing
• Changes to the patient’s environment: adapting home and school environments
• Advocacy: follow-up with school and community professionals to enhance participation in activities
• Development of tailored orthotics to reduce pain or ease specific joints

Case study: how occupational therapy can support JA patients

Jérôme is 9 years old and in the fourth grade. Diagnosed with JA two years earlier, Jérôme feels pain while writing and has difficulty keeping up in class. During recess, he has trouble playing soccer with his friends because running is tough. Jérôme’s parents worry that physical activity will hurt their child and they prefer him to engage in sedentary leisure activities (e.g. draw, play video games). In recent years, Jérôme has become sadder and claims his school friends mock him due to his illness. Following an occupational therapy assessment, the OT implemented a strengthening and physical activity program tailored to Jérôme’s needs. Advice and education were provided to his parents and schoolteachers to help encourage selected activities for Jérôme. As a result, Jérôme is now able to engage in specially-adapted activities with his friends at recess, which has boosted his self-esteem. An orthosis was custom-made for his dominant hand to protect his joints and reduce pain when writing.

Contact the occupational therapists of our clinics for more information!

By Marc-André Clément, occupational therapist at Physiothérapie Universelle Deux-Montagnes clinic.

Références:

• Arthrite.ca. (2018). Arthrite juvénile.

• Hackett, J. (2003). Perceptions of Play and Leisure in Junior School Aged Children with Juvenile Idiopathic Arthritis: What are the Implications for Occupational Therapy?

• Klepper, S. E. (2011). Measures of pediatric function: Child Health Assessment Questionnaire (C-HAQ), Juvenile Arthritis Functional Assessment Scale (JAFAS), Pediatric Outcomes Data Collection Instrument (PODCI), and Activities Scale for Kids (ASK).

• Sandstedt, E., Fasth, A., Eek, M. N., & Beckung, E. (2013). Muscle strength, physical fitness and well-being in children and adolescents with juvenile idiopathic arthritis and the effect of an exercise programme: a randomized controlled trial.

• Whitehouse, R., Shope, J. T., Sullivan, D. B., & Kulik, C.-L. (1989). Children with Juvenile Rheumatoid Arthritis at School:Functional Problems, Participation in Physical Education.