Disease in focus: Juvenile Arthritis

Juvenile Arthritis

This article will explain the different types of Juvenile Arthritis and give some practical tips to Help a Child Live Well With Juvenile Arthritis. If you scroll down to the end you will find links to forums and other links relating to Juvenile Arthritis.

What Is Juvenile Idiopathic Arthritis?

Juvenile idiopathic arthritis is currently the most widely accepted term to describe various types of chronic arthritis in children.
In general, the symptoms of juvenile idiopathic arthritis include joint pain, swelling, tenderness, warmth, and stiffness that last for more than 6 continuous weeks. It is divided into seven separate subtypes, each with characteristic symptoms:
  1. Systemic arthritis (formerly known as systemic juvenile rheumatoid arthritis). A patient has arthritis with, or that was preceded by, a fever that has lasted for at least 2 weeks. It must be documented as an intermittent fever, spiking for at least 3 days, and it must be accompanied by at least one or more of the following:
    • Generalized enlargement of the lymph nodes.
    • Enlargement of the liver or spleen.
    • Inflammation of the lining of the heart or the lungs (pericarditis or pleuritis).
    • The characteristic rheumatoid rash, which is flat, pale, pink, and generally not itchy. The individual spots of the rash are usually the size of a quarter or smaller. They are present for a few minutes to a few hours, and then disappear without any changes in the skin. The rash may move from one part of the body to another.
  2. Oligoarthritis (formerly known as pauciarticular juvenile rheumatoid arthritis). A patient has arthritis affecting one to four joints during the first 6 months of disease. Two subcategories are recognized:
    • Persistent oligoarthritis, which means the child never has more than four joints involved throughout the disease course.
    • Extended oligoarthritis, which means that more than four joints are involved after the first 6 months of the disease.
  3. Polyarthritis—rheumatoid factor negative (formerly known as polyarticular juvenile rheumatoid arthritis—rheumatoid factor negative). A patient has arthritis in five or more joints during the first 6 months of disease, and all tests for rheumatoid factor (proteins produced by the immune system that can attack healthy tissue, which are commonly found in rheumatoid arthritis and juvenile arthritis) are negative.
  4. Polyarthritis—rheumatoid factor positive (formerly known as polyarticular rheumatoid arthritis—rheumatoid factor positive). A patient has arthritis in five or more joints during the first 6 months of the disease. Also, at least two tests for rheumatoid factor, at least 3 months apart, are positive.
  5. Psoriatic arthritis. Patients have both arthritis and psoriasis (a skin disease), or they have arthritis and at least two of the following:
    • inflammation and swelling of an entire finger or toe (this is called dactylitis)
    • nail pitting or splitting
    • a first-degree relative with psoriasis.
  6. Enthesitis-related arthritis. The enthesis is the point at which a ligament, tendon, or joint capsule attaches to the bone. If this point becomes inflamed, it can be tender, swollen, and painful with use. The most common locations are around the knee and at the Achilles tendon on the back of the ankle. Patients are diagnosed with this juvenile idiopathic arthritis subtype if they have both arthritis and inflammation of an enthesitis site, or if they have either arthritis or enthesitis with at least two of the following:
    • inflammation of the sacroiliac joints (at the bottom of the back) or pain and stiffness in the lumbosacral area (in the lower back)
    • a positive blood test for the human leukocyte antigen (HLA) B27 gene
    • onset of arthritis in males after age 6 years
    • a first-degree relative diagnosed with ankylosing spondylitis, enthesitis-related arthritis, or inflammation of the sacroiliac joint in association with inflammatory bowel disease or acute inflammation of the eye.
  7. Undifferentiated arthritis. A child is said to have this subtype of juvenile idiopathic arthritis if the arthritis manifestations do not fulfill the criteria for one of the other six categories or if they fulfill the criteria for more than one category.

How Can the Family Help a Child Live Well With Juvenile Arthritis?

Juvenile arthritis affects the entire family, all of whom must cope with the special challenges of this disease. Juvenile arthritis can strain a child’s participation in social and after-school activities and make schoolwork more difficult. Family members can do several things to help the child physically and emotionally.
  • Get the best care possible. Ensure that the child receives appropriate medical care and follows the doctor’s instructions. If possible, have a pediatric rheumatologist manage your child’s care. If such a specialist is not close by, consider having your child see one yearly or twice a year. A pediatric rheumatologist can devise a treatment plan and consult with your child’s doctor, who will help you carry it out and monitor your child’s progress.
  • Learn as much as you can about your child’s disease and its treatment. (The resources listed at the end of this publication can help.) Many treatment options are available, and because juvenile arthritis is different in each child, what works for one may not work for another. If the medications that the doctor prescribes do not relieve symptoms or if they cause unpleasant side effects, you and your child should discuss other choices with the doctor. A person with juvenile arthritis can be more active when symptoms are controlled.
  • Consider joining a support group. Try to find other parents and kids who face similar experiences. It can help you—and your child—to know you’re not alone. Some organizations have support groups for people with juvenile arthritis and their families.
  • Treat the child as normally as possible. Try not to cut your child too much slack just because he or she has arthritis. Too much coddling can keep your child from being responsible and independent and can cause resentment in siblings.
  • Encourage exercise and physical therapy for the child. For many young people, exercise and physical therapy play important roles in managing juvenile arthritis. Parents can arrange for children to participate in activities that the doctor recommends. During symptom-free periods, many doctors suggest playing team sports or doing other activities. The goal is to help keep the joints strong and flexible, to provide play time with other children, and to encourage appropriate social development.
  • Work closely with your child’s school. Help your child’s school to develop a suitable lesson plan, and educate your child’s teacher and classmates about juvenile arthritis. Some children with juvenile arthritis may be absent from school for prolonged periods and need to have the teacher send assignments home. Some minor changes—such as having an extra set of books or leaving class a few minutes early to get to the next class on time—can be a great help. With proper attention, most children progress normally through school.
  • Talk with your child. Explain that getting juvenile arthritis is nobody’s fault. Some children believe that juvenile arthritis is a punishment for something they did. Let your child know you are always available to listen, and help him or her in any way you can.
  • Work with therapists or social workers. They can help you and your child adapt more easily to the lifestyle changes juvenile arthritis may bring.

Do These Children Have to Limit Activities?

Although pain sometimes limits physical activity, exercise is important for reducing the symptoms of juvenile arthritis and maintaining function and range of motion of the joints. Most children with juvenile arthritis can take part fully in physical activities and selected sports when their symptoms are under control. During a disease flare, however, the doctor may advise limiting certain activities, depending on the joints involved. Once the flare is over, the child can start regular activities again.
Swimming is particularly useful because it uses many joints and muscles without putting weight on the joints. A doctor or physical therapist can recommend exercises and activities.

See the full publication from National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) 
Hospitals known for treating childhood autoimmune conditions

Arthritis Ireland: videos for different ages
Kids Get Arthritis Too site by ARTHRITIS FOUNDATION USA 
Juvenile Arthritis Association
Juvenile Arthritis: Arthritis Foundation USA

Children with Arthritis by Arthritis Foundation of Western Australia


TREATMENTS other than medications:
Can Manual Therapy Help Kids with Arthritis 


Book written by a teenager with Juvenile Arthritis:Juvenile Arthritis: The Ultimate Teen Guide (It Happened to Me) 


Methylmercury and fish you can safely eat

 fish you can safely eat

Methylmercury is a metal that can be found in some fish and shellfish. Mercury occurs naturally in the environment and can also be released into the air through industrial pollution. It falls from the air and can collect in streams, rivers and oceans. Microorganisms transforms mercury into methylmercury. Fish absorb methylmercury as they feed. Larger fish that have lived longer have the highest levels of methylmercury because they have had more time to accumulate it. Methylmercury can be toxic, especially to unborn babies, and this is why certain fish should be avoided when you are pregnant. Research done in 2014 also found that women exposed to mercury had higher autoimmunity markers.

These fish can contain high levels of methylmercury:
  • swordfish
  • tilefish
  • king mackerel
  • shark (flake)
  • ray
  • barramundi
  • gemfish
  • orange roughy
  • ling
  • southern bluefin tuna
It's okay to eat other cooked fish/seafood as long as you select a variety of other kinds while you're pregnant or trying to become pregnant. You can eat up to 12 ounces (2 average meals) a week of a variety of fish and shellfish that are lower in methylmercury. Five of the most commonly eaten fish and shellfish that are low in methylmercury are shrimp, canned light tuna, salmon, pollock, and catfish. *

Fish that contain lower levels of mercury include:
  • Shellfish including prawns, lobsters and oysters
  • Salmon
  • Canned tuna
* U.S. Food and Drug Administration


Exposure to mercury main risk factor for autoimmunity in women

Mercury exposure and antinuclear antibodies among females of reproductive age in the United States: NHANES, Emily Somers, Martha A. Ganser, Jeffrey S. Warren, Niladri Basu, Lu Wang, Suzanna M. Zick, and Sung Kyun Park, Environmental Health Perspectives, published online 10 February 2015.

This research provides evidence that low levels of methyl mercury exposure are linked to undetected autoimmunity, among females of reproductive age in the general population.

We are mainly exposed to methyl mercury when we eat fish and shellfish that contain methyl mercury.

Emily Somers and her team researched 1,352 women aged 16-49 years in the USA. They looked at mercury levels by analyzing hair, urine and blood samples.

They found that mercury exposure is associated with increased risk of high-titer ANA positivity: the women with the higher levels of mercury also had higher levels of
antinuclear antibodies or ANA's.

The immune system makes proteins called antibodies. Antibodies are made by white blood cells and they recognize and combat infectious organisms in the body. Sometimes these antibodies make a mistake, identifying normal, naturally-occurring proteins in our bodies as being "foreign" and dangerous. The antibodies that target “normal” proteins within the nucleus of a cell are called antinuclear antibodies (ANA). *

autoimmune diseases, are caused by such antibodies including Lupus, Scleroderma, Polymyositis and Sjogren's Syndrome.

The presence of ANA does not mean autoimmune disease exists but it can be a predictor of future autoimmune disease.

American College of Rheumatology


Sick and Tired of Feeling Sick and Tired

How many times have you said to yourself, 'No one can understand how I feel unless they've experienced it themselves?'  Well I am just starting a book where both the authors, a man and a woman,  have experienced an Invisible Chronic Illness and they are able to express feelings that I have experienced but have not even been able to put into words. They are both psychologists which helps and is also why there is a great
Guide to Emotional Health & Wellness in the book amongst many other things. They understand the effects of an invisible illness on self-esteem, self-concept, and the feelings of  guilt and shame, the frustrations, the lack of support and the suspicion we are often confronted with because our symptoms are not visible.

I am looking forward to reading the chapter called Getting and keeping the attention of the health care system because this is where I am at currently with my GP just saying dismissive things like "oh that's just your illness." He seems to think my health concerns are too complex, that I have been given a diagnosis and now I should be happy and go away.

The book, which I highly recommend, is called Sick and Tired of Feeling Sick and Tired: Living with Invisible Chronic Illness (New Edition) by Paul Donoghue and Mary Siegel

Find out more about this book

More on herbs to help immune system: Bee Balm or Bergamont

Monarda didyma, a flowering plant in the mint family, is known by a number of different common names including bee balm, Oswego tea and bergamot. It is native to eastern North America.  The Oswego Indians often brewed the bergamot tea. The flavonoids (rutin, hyperoside, quercitrin, luteolin, quercetin) are found in leaves and flowers of bee balm.
Monarda fistulosa, is wild bergamot or horse mint and has a beautiful fresh aroma like a mix of citrus and mint.
Bee Balm is used as:
- an antiseptic
- carminative
- diaphoretic
- diuretic
To treat:
- colds, catarrh and sore throat
- headaches
- flatulence
- nausea
- menstrual pain
- insomnia

The leaves of both Monarda didyma and Monarda fistulosa, can be dried and used as tea. Fresh leaves add a refreshing flavour to fruit salads and drinks. It is traditionally used in apple jelly. The tea is a balm for sore throats and headaches. Oil within the leaves is used to treat insect bites and relieve bronchial congestion. "The Blackfoot Indians recognized the strong antiseptic properties of these plants and used poultices of the plant for skin infections, wounds, and mouth sores." MONARDA by HSA

  • PubMed: Analysis of flavonoids in the flowers and leaves of Monarda didyma by Savickiene N, Dagilyte A, Barsteigiene Z, Kazlauskas S, VaiciĆ«niene J. Lithuanian University of Health Sciences
  • Herb Society of America HSA MONARDA


Foods to support the immune system: part 2

sweet potato and spinach support your health
Sweet Potato Salad at My story in Recipes

Fresh vegetables strengthen your immune system naturally with immune-boosting vitamins.

Virtually every fresh vegetable is good to include in your diet if you suffer from autoimmune disease. It’s absolutely crucial that you maintain a well balanced diet when you have chronic illness to ensure you are getting all the nutrients you need.  So whether you are in a flare or feeling okay you need to eat for optimum nutrition. You may feel this is difficult when you are having a low energy day but if you have some washed spinach and some left over roasted or baked sweet potato you can make a meal to support your immune system.

The beta carotene in spinach and sweet potato, transforms into vitamin A, which triggers your immune response to keep you well.

Spinach and sweet potato are 2 of my go to veggies and I am so pleased they are packed full of Vitamin A and fibre.

Other info about these immune system supporting foods:


  •  prevents cancer and heart disease 

  • is rich in the mineral zinc

  • contains vitamin C that helps fight infection 

  • has B vitamins that give you energy

Sweet potato:

  • contains beta-carotene which your body turns into vitamin A which plays a major role in the production of connective tissue, a key component of skin

  • high in vitamin A, C and E

  • high in potassium

Spinach and sweet potato just happen to work so well together in many recipes and the flavours combine well with parmesan cheese, feta cheese, chick peas or other cooked beans and roasted nuts and seeds such as pine nuts and sunflower seeds.

Some recipes that use both spinach and sweet potato together:
Sweet Potato Salad at My story in Recipes
Roasted Sweet Potato and Feta Salad at Leite's Culinaria
Sweet potato fennel salad at Easy Healthy Recipes for kids
Kumera, Roast Tomato & Pine Nut Salad at Soul Kitchen

You might also like to read my previous post on this topic Foods to support the immune system: part 1


Function of T helper cells

Helper T cells

Helper T (TH) cells provide help to other cells in the immune response by recognizing toxin or other foreign substances (antigens) which induce an immune response in the body.
The Helper T cells then secrete chemicals called cytokines that activate T cells and B cells.  These chemicals stimulate the immune response. They help suppress or regulate immune responses and are vital to human immune responses.

DIAGRAM: Antigen-presenting cells (APCs) present antigen on their MHC molecules (MHC2). Helper T cells recognize these, with the help of their expression of CD4 co-receptor (CD4+). The activation of a resting helper T cell causes it to release cytokines and other stimulatory signals (green arrows) that stimulate the activity of macrophages, killer T cells and B cells, the latter producing antibodies. The stimulation of B cells and macrophages succeeds a proliferation of T helper cells.

Helper T cells are called the "conductors" of the immune system because they coordinate activity like the conductor of an orchestra.

Helper T (TH) cells are critical to coordinating the activity of the immune response.

RESOURCES: Cardiff University


Autoimmune Disease in focus: Giant Cell Arteritis GCA

Outline of side of face, showing superficial temporal artery in red. (to left of ear.) Grays Anatomy 1918.
The superficial temporal artery is a major artery of the head. Arteries are blood vessels that carry blood away from the heart.

The superficial temporal artery is often affected in giant cell arteritis which is also called temporal arteritis.  Sometimes the artery is biopsied to get a correct diagnosis.

Giant-cell arteritis is also called GCA, temporal arteritis, Horton's Disease or cranial arteritis. It is more common in women than in men and in people over the age of 55.

It is inflammation of the blood vessels in the face and head. It often presents as blurred vision or sudden loss of vision to one or both eyes as the blood supply to the eye is affected

The superficial temporal artery is enlarged in Migraine attacks.


Yoga can help relieve MS symptoms

Yoga and the immune system
I want to share how yoga can help you manage your MS symptoms. If you are struggling with fatigue learning just the deep breathing techniques alone will turn on your body’s natural relaxation response and oxygenate your blood more fully. When you consciously breathe more deeply through the practice of yoga you will feel calm and relaxed but at the same time energized. In addition, when you add yoga postures that move your body you will have less muscle spasticity and increased muscle strength leading to greater balance. 
A recent study conducted by Evan Cohen and David Kietrys, physical therapists and associate professors in the School of Health Related Professions at Stratford showed the following results: "…at the end of an eight-week trial those who participated were better able to walk for short distances and longer periods of time, had better balance while reaching backwards, fine motor coordination, and were better able to go from sitting to standing. Their quality of life also improved in perceived mental health, concentration, bladder control, walking, and vision, with a decrease in pain and fatigue." These findings were presented on September 26 at the Symposium on Yoga Research at the Kripalu Institute in Massachusetts. "This study, I hope, is one of many that will give us the clinical information we need," said Fogerite. "Yoga is not currently being widely prescribed for people with MS, although it might turn out to be a very helpful treatment."

One of the study participants had the following to say about her experience…

"What was so nice about this experience was that although everyone was at a different level of the disease, we felt like we were all together, so I think the camaraderie helped," said Meltzer. "And it wasn’t just about gaining more mobility and balance in our legs but our arms and necks felt stronger as well."

I have MS myself and yoga is a big part of why I am so mobile and strong in my body. I want to share yoga with everyone I know, but especially those people with MS, because it can change their lives. I offer several chair yoga classes and also work one on one with people to help them develop a home practice. If you are interested in learning more feel free to contact me at

Janet Golownia RYT, PYT, Certified Health Coach

Janet Golownia is passionate about unlocking the body’s ability to heal itself through a variety of yoga tools and nutrition.  She has learned from healing her own health issues of hypothyroidism, depression and multiple sclerosis that healing takes place not only on the physical level but also the energetic and emotional levels.  As a Yoga Therapist and Certified Health coach she will develop a personalized plan of healing for each client based upon their goals.  Some of the many benefits experienced by her clients are relief of chronic pain, greater core strength, increased flexibility and range of motion, greater body awareness and mental clarity.

Read more about Janet's personal story and mission with health 
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