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Assessing Arthritis

May 14, 2007

BACKGROUND: Rheumatoid arthritis is inflammation of the joints that can cause patients to experience swelling, heat, and pain. Experts say arthritis can last for weeks, months, years, and in some cases, an entire lifetime. Adults and the elderly aren't the only ones who are susceptible to this debilitating condition. Approximately 50,000 children in the United States suffer from juvenile rheumatoid arthritis, or JRA. No one knows exactly what causes this type of arthritis, but researchers suspect it is an autoimmune disorder that begins when white blood cells lose the ability to discriminate between healthy cells and harmful bacteria or viruses. As a result, researchers suggest the patient's immune system releases chemicals that damage healthy tissue, causing the patient to experience painful inflammation.

There are three basic types of JRA: polyarticular, pauciarticular, and systemic. Polyarticular JRA occurs when a child experiences swelling in five or more joints, has a low-grade fever, and has bumps or nodules scattered throughout their body. Pauciarticular JRA affects four or fewer joints and is sometimes detected early on by ophthalmologists, since a child's iris can become inflamed. Systemic JRA is denoted by swelling, stiffness, rashes, an enlarged spleen or lymph nodes, and high fevers that come and go suddenly. Most children acquire JRA when they are between 6 months and 16 years old. "The biggest challenge [in terms of diagnosis] is these children are very young [when they acquire JRA]. The peak age of onset of this arthritis is 18 months, so they oftentimes can't verbalize there is something wrong with them," says Raphael Hirsch, M.D., chief of the division of pediatric rheumatology at Children's Hospital in Pittsburgh. According to Dr. Hirsch, JRA limits a child's range of motion and sometimes makes it very difficult for them to walk.

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TRADITIONAL METHODS OF DIAGNOSIS: "We assess a patient in a very subjective way," Dr. Hirsch says. "[Patients] come in, we look at their joints and try to determine if they are abnormal." When diagnosing JRA, Dr. Hirsch says he looks for the four cardinal signs of inflammation, which include redness, warmth, swelling, and pain. Unfortunately, these symptoms can be difficult to diagnose in children. "Swelling can be a challenge in an 18-month old because they've got a lot of baby fat," he says. "Warmth is also difficult, because it's hard to get an accurate assessment by just using your hand." According to Dr. Hirsch, MRI's and X-rays can be used to diagnose JRA, but MRI's aren't routine since they require the child to be sedated, and X-rays will only show arthritis is present once damage has already been done to the bone. "Today, we have some very good medications," he says. "If you can catch these patients early, you can prevent some of the long-term damage to their joints."

NEW METHODS OF DIAGNOSIS: Now, Dr. Hirsch is using a new technology to measure key symptoms of arthritis more objectively. According to Dr. Hirsch, thermal cameras could help diagnose arthritis by alerting doctors to abnormal heat patterns beneath the skin. "What we are finding is how the temperature is distributed across the hand becomes abnormal when you have inflammation," he says. "Normally, the joints are cooler than their surrounding skin, because it's bone. There is less muscle there, whereas if you have arthritis, you get an inversion of that. The joints actually become warmer than the surrounding skin." Three-dimensional cameras are also being used to take detailed pictures of the joints that help doctors assess swelling. "We are now in the process of validating this through some research studies on patients," says Dr. Hirsch. "The idea would be, this could go into the doctor's office and become part of the routine way a patient is evaluated."

FOR MORE INFORMATION, PLEASE CONTACT: Children's Hospital of Pittsburgh University of Pittsburgh Medical Center Children’s Physician Referral Line (412) 692-PEDS (7337)

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