Juvenile Arthritis Often Can Be Misdiagnosed as ëGrowing Painsí by Gina Shaw It started when I was about 5 or 6 years old. Almost every other night, it seemed, Iíd wake my parents with the complaint that my knees ached. Weíd pamper them with hot water bottles and heating pads and childrenís aspirin, but the ìknee achesî bothered me off and on for several years. ìGrowing pains,î my pediatrician told my parents. ìSheíll outgrow them.î As it turned out, he was right. Apparently they were just growing pains, and I did outgrow them. But for thousands of other kids, the assumption that aching joints can be attributed to simple growing pains may be diverting parentsí and physiciansí attention from a far more serious problem: juvenile arthritis. When you think of arthritis, you probably think of Grandma, not little cousin Billy. But according to the Arthritis Foundation, there are nearly 300,000 children in America with some form of arthritis or rheumatic disease, with juvenile rheumatoid arthritis being the most common. Put another way, one in every 1,000 children will develop some form of arthritis in a given year. Although most of these cases are mild and eventually recede, one in every 10,000 children will dev elop more severe arthritis that doesnít just go away. Growing pains are indeed fairly common in children, usually occurring between the ages of 3 and 8. According to Dr. Thomas J.A. Lehman, chief of the Division of Pediatric Rheumatology at the Hospital for Special Surgery in New York City and the author of ìItís Not Just Growing Pains,î arthritis and other serious conditions can be misdiagnosed as ìgrowing painsî for weeks or even months. So whatís the difference between growing pains and the signs of juvenile arthritis? First, remember that growing pains are a nighttime thing. They will often wake your child in the middle of the night, and when you ask her where it hurts, sheíll point to the front or back of her knee or just above it. Usually the pains will go away after 10 to 15 minutes of gentle massaging, Lehman said, and will be gone the next morning. Itís when theyíre not gone the next day that you should consider other causes. Growing pains never occur in the daytime, according to Lehman, no matter how severe the pain is at night. If your child wakes up and her knees still hurt, and sheís walking abnormallyóeven if the pain and stiffness ebbs not long afterwardótake her to the doctor. Of course, not all doctors are alert for the signs of arthritis in children. Some may believe that if thereís no swelling (which is a telltale sign of adult arthritis) and blood tests are normal, then nothing serious is wrong. But juvenile arthritis often presents itself without swelling, Lehman said, and the ìrheumatoid factorî test that is used in adults is not reliable in children. Make sure youíre able to describe your childís pain thoroughly for the doctor: Is it a sharp pain or a dull ache? Where exactly is it located? How long has the pain been going on, and how did it start? Has it been getting better or worse or stayed about the same? What eases the pain, and what makes it worse? Does the affected area hurt when touched or without being touched? Is it warm to the touch, red or swollen? Are there other symptoms, such as a rash or bumps? No single test can identify arthritis in children, so the diagnosis is often made by doing a number of different tests and also by ruling out other causes, such as viral infections or trauma to the joint. If your child does have some type of juvenile arthritis or other rheumatoid disease, the good news is that there are many options for managing it. Juvenile rheumatoid arthritis, which affects about 50,000 children in the United States alone, is often treated with a combination of medications, physical therapy and exercise. Your doctor may start your child with something mild, like a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen or naproxen, along with a physical therapy and exercise prescription. If that doesnít control the pain, doctors may want to add a ìsecond-lineî medication, such as methotrexate, a corticosteroid drug, or Enbrel. This relatively new drug, first approved by the Food and Drug Administration for use in children with arthritis in 1999, blocks whatís called tumor necrosis factor (TNF), a protein that the body produces in response to inflammation. At the 2004 meeting of the American College of Rheumatology, researchers reported that Enbrel has now been shown to be both effective and safe over four years of use in children with rheumatoid arthritis. Many major medical centers will have pediatric arthritis centers that concentrate care and therapy for children with arthritis all in one place. If you donít live near a large medical center, you can find a rheumatologist in your area by searching the American College of Rheumatologyís directory online at www.rheumatology.org/directory/geo.asp or by calling them at (404) 633-3777. Most juvenile arthritis specialists take an ìas normal as possibleî approach to managing arthritis in children. This means participation in school, extracurricular activities and family activities, as much as the child wants to and can safely do. Itís tempting to be overprotective with a child who has arthritis, experts say, but often with good physical therapy and treatments, many kids with this disease can do the same things their peers are doing. To find out more about juvenile arthritis, and for help in finding out whether your childís growing pains might be signaling something more severe, contact the Arthritis Foundation and the American Juvenile Arthritis Organization at www.arthritis.org or call (404) 965-7538. Gina Shaw is the medical writer for The Washington Diplomat.