Ask most people about arthritis, and they’ll picture someone elderly. That’s why plenty of parents think their child couldn’t possibly have it. Others figure it only shows up if it already runs in the family. It doesn’t work that way. A child can get arthritis even if nobody in the family has ever had a problem with their joints.
If a child has joint pain, swelling or stiffness that hangs around, a paediatric orthopaedic doctor would want to see them, family history or not. Once parents know what the early signs are and what might be behind them, it’s much easier to ask for help at the right time and protect their child’s joints.
Why can children develop arthritis without a family history?
Juvenile idiopathic arthritis, or JIA, is among the most common forms of arthritis in children. It’s really a group of inflammatory conditions, and it starts before a child turns 16. Doctors still don’t know the exact cause. Genes and environmental factors both seem to have a role.
What happens in JIA is that the immune system turns on the joints by mistake and inflammation follows. Children can end up with pain, swelling and stiffness, and everyday movement gets harder. Genes may make a child more prone to it, but they don’t determine whether it will happen.
So yes, arthritis can appear in a child with no family history at all. Having no relatives with joint problems doesn’t rule out inflammatory arthritis.
What other conditions can cause joint pain?
A child with sore joints doesn’t necessarily have arthritis. Quite a few other problems cause similar symptoms, and they’re treated differently.
Some infections bring on joint symptoms that pass quickly, or set off reactive arthritis. A knock from sport, play or a fall can leave a joint sore and puffy too. Now and then the joint itself gets infected. That causes serious inflammation and needs treatment straight away.
Certain other inflammatory conditions can involve the joints as well. Childhood lupus is one, and so is arthritis connected with psoriasis or inflammatory bowel disease.
Only a proper medical check can sort out which one it is. If the pain keeps going, parents shouldn’t write it off as too much running around or growing pains.
Warning signs parents should recognise
Children often struggle to say what’s bothering them. Watching how they move and act can tell you a lot.
Parents should look out for:
● Morning stiffness: Moving stiffly or uncomfortably after waking up or after being still for a while.
● Joint swelling: Swelling that won’t go down, or a joint that feels warm. Knees, ankles and wrists are the usual places.
● Unexplained limping: Walking awkwardly or avoiding putting weight on one leg when there’s no injury to explain it.
● Reduced movement: Having trouble bending a joint, going up stairs or taking part in things they used to do without a fuss.
● Unusual fatigue: Ongoing tiredness that comes along with the joint symptoms.
None of these automatically means arthritis. Still, if they last or keep coming back, the child needs to see a doctor. A joint that’s hot and swollen, especially with fever, severe pain, or a child who can’t put weight on the leg, should be seen urgently because it could be a joint infection.
How is childhood arthritis diagnosed?
It begins with the doctor taking a full history and examining the child. The specialist looks at how well the joints move, checks for swelling and tenderness, watches the child walk and asks how long the symptoms have been there.
Blood tests can reveal inflammation or give hints about a specific condition. But no one test can confirm or exclude every kind of JIA. If the doctor needs a closer look, an ultrasound or an MRI scan may be suggested.
Depending on the results, the paediatric orthopaedic specialist might refer the child to a paediatric rheumatologist, who will take over further assessment and treatment.
Why does early treatment matter?
Childhood is when bones are growing, and joints are still developing. When inflammation isn’t kept under control, it can damage the joints and sometimes interfere with growth.
The treatment depends on what the diagnosis is. It may include anti-inflammatory medicines, disease-modifying treatments, biologic medicines and physiotherapy. With regular monitoring, inflammation stays under control, the joints keep working well, and the child can get on with everyday life.
Children with JIA may also need their eyes checked regularly. The eyes can become inflamed without giving any obvious sign that something is wrong.
What should parents do?
Right now there’s no known way to prevent JIA, since its cause isn’t fully understood. Even so, parents can do a lot simply by noticing symptoms early and getting medical advice without delay.
Write down what you see: joint swelling, morning stiffness, any fever, and changes in how your child walks. Specialists can judge the situation more accurately with those details in hand.
Childhood arthritis can develop without any family history. Don’t brush off symptoms that keep showing up because your child is young or because everyone else in the family has healthy joints. Early assessment, the right diagnosis and proper treatment give children the best chance of an active, happy childhood.
The author is a consultant pediatric rheumatologist at Madhukar Rainbow Children's Hospital.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
