Shriners Hospitals for Children Advises No Age Restrictions on Arthritis.

Children at Risk

TAMPA, Fla. -- Just a few months after being diagnosed with juvenile rheumatoid arthritis (JRA) Christopher Herbs, 13, was able to return to the hockey rink.

Christopher, of Rexford, N.Y., is fortunate. His parents sought medical attention after they noticed that he looked uncomfortable while walking and had trouble putting on his hockey skates. While they originally attributed the problem to "growing pains," they checked with a pediatrician, who said the boy should see a pediatric rheumatologist.

There were no pediatric rheumatologists nearby, but Christopher's mother, Lauren, had heard of a specialist at Shriners Hospitals for Children in Springfield, Mass. - more than an hour away. There, Deborah Rothman, M.D., Ph.D., a pediatric rheumatologist who serves on the council board of the American Juvenile Arthritis Organization, was able to see the boy quickly and make the diagnosis of JRA.

Today, more than two years later, "Christopher can do whatever he wants," said his father, Tim Herbs.

Raising Awareness

During U.S. Bone and Joint Decade's National Awareness Week (Oct. 12-20), Shriners Hospitals for Children will work to raise awareness of JRA, especially in terms of symptoms, available treatments and the need for more pediatric rheumatologists.

Bone and Joint Decade, which continues through 2011, is a worldwide effort to increase understanding and treatment of musculoskeletal disorders and injuries through prevention, education and research. Shriners Hospitals for Children was the first hospital network to publicly support the U.S. effort, which has the support of more than 85 health care organizations, all 50 states, the federal government and more than 70 medical schools. Many organizations involved, such as the Pediatric Orthopaedic Surgeons of North America, the American Academy of Pediatrics and the Arthritis Foundation place an emphasis on pediatrics.

Understanding JRA

There are three main types of JRA: pauciarticular JRA, which involves fewer than five joints, polyarticular JRA, with at least five active joints, and systemic-onset JRA, which is associated with high fevers and a characteristic rash in addition to arthritis. The average age of onset for pauciarticular JRA, the most common form, is between 1 and 3 years of age.

Children with JRA often experience stiffness in the morning or after periods of inactivity, and may walk with a limp that improves throughout the day. The affected joints may be swollen and warm.

Pediatric rheumatologists have the expertise and education needed to diagnose and care for children with JRA and other rheumatic diseases. However, nearly half of all U.S. medical schools do not have a pediatric rheumatologist on their faculties, and there are only about 215 board certified pediatric rheumatologists in the country. This often makes it difficult for children with JRA to quickly obtain the level of care needed for early diagnosis and treatment.

Shriners Hospitals Can Help

For more than 80 years, Shriners Hospitals for Children has been a leader in efforts to understand, prevent and treat musculoskeletal problems associated with pediatric orthopaedic conditions and injuries. Most of the 19 Shriners Hospitals for Children that treat orthopaedic problems provide care for children who have JRA. Sometimes there is a pediatric rheumatologist on staff; in other cases, specialists see patients at the hospitals as needed or during regularly scheduled clinics.

Shriners Hospitals provide medical care, physical and occupational therapy, joint injections and surgery if needed to correct leg-length inequalities or replace joints. All of the hospitals also have child life therapists who provide emotional support to both children and families. Shriners Hospitals provide all care at no charge.

"Shriners Hospitals for Children is dedicated to helping children with musculoskeletal diseases, and JRA is one of the most serious of those conditions," said Donald Lighter, M.D., associate director of medical affairs for Shriners Hospitals. "Staff at our hospitals see many children with JRA, who need a number of services and the expertise of our pediatric orthopaedists, rheumatologists, orthotists and prosthetists, as well as many support services like physical and occupational therapy. Shriners Hospitals for Children is committed to ensuring that these children receive the best comprehensive care available to reduce the effect of the disease on their lives."

Shriners Hospitals for Children is committed to excellence in patient care, research and teaching. An international system of 22 hospitals in the U.S., Canada and Mexico, Shriners Hospitals provides expert, family-centered care at no charge. Children up to the age of 18 are eligible for treatment of orthopaedic problems, burns, spinal cord injuries, and cleft lip and palate, regardless of financial need or relationship to a Shriner. For more information about Shriners Hospitals, visit www.shrinershospitals.org. For additional information on JRA, also visit www.arthritisfoundation.org.