What is rheumatic fever?
This is a form of arthritis, which, occurs after specific streptococcal infection of the throat. It is characterized by fever, flitting and fleeting arthritis (completely improves in one joint before involving the other joint), erythematous rash (in some), subcutaneous nodules (in some) and inflammation of the heart or its covering membrane (pericarditis, myocarditis and endocarditis). It is this cardiac involvement which if not treated adequately leads to valvular involvement later. The short-lived joint involvement, propensity to involve the heart and its association with specific streptococcal throat infection differentiates this disorder from juvenile idiopathic arthritis described earlier. Hence this is an important disease to be excluded when a child presents with joint problems.

What to do when arthritis is suspected?
As and when your general practitioner suspects arthritis he would more often than not send you to a specialist who has experience in treating these disorders.

What would the specialist do?
After confirming the clinical suspicion, the specialist would organize relevant blood tests to diagnose the type of arthritis and the presence and absence of complications. After having assessed the investigations, the specialist would start treatment with appropriate medications.

What are the common investigations done in children with arthritis?
These may be divided into a few subgroups:

To assess disease activity: CBC, ESR & CRP are common tests done to assess activity.
To assess damage: Radiographs of relevant joints are done for this.
To assess for drug side effects: Routine tests (blood and other) are done on a regular basis to assess for side effects due to drugs.
To assess complication of the disease: Since these arthritis’ can affect other organ system, if a particular organ system is suspected to be affected, relevant investigations to assess that particular system.  

What are the types of medications that are given in arthritis?
There are 3 or 4 types of medications that are given in juvenile arthritis.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDS): These are normally given to reduce the pain, swelling and inflammation in children with arthritis. These act within a few hours. Although in very mild arthritis NSAIDS alone may be enough to control the disease, more often than not other medications (to be discussed) are required. It should be noted that there is no specific NSAID that is better than the others as regards efficacy. Often the NSAID, which, helps the child and at the same time does not cause side effects should be used. Gastrointestinal side effects are the commonest cause why these drugs are either changed or stopped.
Disease Modifying Anti-Rheumatic Drugs (DMARDS): These are slow acting drugs which can control the disease in the long run. These do not control the pain immediately. The commonly used DMARDS are chloroquine, methotrexate, salazopyrine etc. The specialist will explain the beneficial effects and the side effects of these medications and then start it. Regular monitoring of tests is a must on this drugs.
   Apart from the above-mentioned 3 DMARDS there are others which are more often than not used when the above 3 fail or there are contraindications to them. These have not been discussed in detail here.
Steroids: Corticosteroids are much-maligned drugs. Although like any other drug they have side effects, when used in an appropriate manner, they are extremely beneficial, especially in patients with severe polyarticular arthritis and systemic onset arthritis.
Calcium & Vitamin D: These supplements are given routinely in children with arthritis to prevent weakness of bones and to help the child achieve optimal bone strength in the future.
Iron supplements: Children with arthritis often have concomitant iron deficiency and anemia. Iron supplements on routine basis take care of this deficiency. Last updated on 24-12-2001