Management of children with arthritis depends on the disease subtype.

Dominant arthritis: These are further divided into 3 subgroups. 1) Polyarthritis (> 4 joints), 2) Pauciarthritis (< 4 joints) and 3) Systemic onset arthritis: here the patient presents with high grade swinging fever, evanescent rash and arthritis. The symptoms are often treated with NSAIDS and analgesics. Disease-modifying drugs like chloroquine, sulphasalazine and methotrexate are being effectively used in these patients. However since the treatment is long-term, these are often reserved for moderate to severe cases. Oral, intra-muscular or intravenous steroids are reserved for patients with severe polyarticular disease or systemic onset arthritis.

Growth disturbances: Since children are still growing when the arthritis afflicts them, it can lead to growth disturbances. Short stature, jaw alignment and dental problems and asymmetric growth disturbances can occur. Hence, it is important to keep a height chart in these patients. Recently, growth hormone therapy has been used with some success in juvenile arthritis children with growth retardation.

Osteoporosis: Since these disorders affect growing skeleton, it can lead to weak bones. Recent trials have shown promise as regards drug treatment for osteoporosis in these children.

Emotional problems: Since a growing child goes through various stages of mental development, these can be affected when arthritis affects them. Further, their transition from the childhood stage when parents play a dominant role to the adolescent and adulthood stages also needs to be kept in mind.

Schooling & education: These can be affected depending on the severity of the disease. The school authorities may need to be informed about the chronic nature of the condition and its tendency for remission and exacerbation. Effort should be made to ensure that genuine periods of absence from school should be treated compassionately by the management.