Juvenile arthritis is a condition which causes inflammation of the synovial joint amongst children aged 15 years or younger however it may develop later in life as of age 16 years, Synovial is the tissue present in the joints. It is an autoimmune disorder that the body antibodies attack it. It is characterised by swelling, pain and stiffness that don’t fade away. Its development is dependent on the interaction of the disease with other environmental factors which its abortion is impossible. Environmental factors loosely associated with the diseases include smoking and occurrence of infectious diseases, and (Hessein, Emara, Dawood and Mostaffa, 2014), genetic factors, (Hersh & Prahaland, 2015). It has been researched to account to 50% of all the cases. The interaction of the gene and environmental factors has a correlation with occurrence of the disease. The immune system has been thought to affect the immune system in combinations with causing mutations in a number of genes. The genetic predisposition portrays itself in the form of family member being diagnosed with rheumatoid arthritis and its transference to the siblings.
Juvenile arthritis is common among children, with the female gene more likely to be affected than the male counterpart. With this concern sex hormones may have been associated with the condition, through the process of modulating arthritis , however studies conducted have not shown proof that sex hormone therapy nor deficiency can improve or worsen the disease, (Pichi, Carrai and Lowder, 2016). It has been associated with psychological stresses which are worsening by the symptoms. However insufficient knowledge stills cloud this association due to when emotional stress is managed under control, the symptoms don’t fade away.
Pharmacological approach with regard to arthritis involves pain management. In selection of appropriate plan there is need for self efficacy care, adverse side effects, dosing frequency patterns, patient’s status and cost determining the treatment plan, (Hinze, Gohar and Foell, 2015). At initial stages of the disease development, when patient develops inflammatory disease priority is to take care of the pain and symptoms. Thus inflammatory arthropathy like juvenile arthritis, non steroidal treatment or analgesics are not sufficient enough, due to damage the disease causes to the joints. Aims of treatment involve reduction of inflammation and modulating the immune response and alter the pain response. This drugs include, simple algesics, none steroidal drugs, disease modifying anti rheumatic drugs and steroids. The current therapeutic care strengthens step up approach that in cooperates several classes of agents mentioned above.
Non steroidal drugs, selective cyclo oxygenise and glucorticoids are essential in offering quick relief and used mainly as adjunctive therapies. The drugs which modify the disease and biological have been successful in altering the diseases outcome and slowing the radiographic progression, (Ravelli, 2016). The efficiency and safety of these agents in clinical trials are essential management of the arthritis. Hence the role played by the pharmacological management is crucial in managing the disease. Physical therapeutic care and the rehabilitation services work with patients who have rheumatoid arthritis.
Currently there is no controlled evidence that supports use of alternative medicines with specificity on the daily exclusion, homeopathic treatment, in terms of dietary modification, increased consumption of omega 3 fatty acids have proven to be beneficial, (Perretti, Cooper, Dalli and Norling, 2017). Other known therapies have included physical and occupational therapies, which can make protective equipment. The child may require the use of special assistance support, ambulatory devices or aiding splints which them in ambulatory functionalities. Surgery option has been implemented to treat severe cases, in removal of scars and improve joint functions. Home remedies such as physical exercise has been shown to be beneficial in managing muscle strengthen and joint flexibility.
Juvenile arthritis is the most prevent among the children. It is often associated with group of diseases that produce inflammations in one or more of the joints. It has been linked to autoimmune pathogenesis which includes immune histological, antibodies present and T cell presence in the cells. Juvenile rheumatoid arthritis subtypes have significant difference in their manifestation prognosis and care plan. The features outlined for immunogenic predisposition have been found to be involved primarily and not solely, despite these contributions in these disease risks, familial juvenile rheumatoid arthritis is rare. Genetic susceptibility with little evidence may be linked to this primarily cause; the lack of definitive association can be caused by the low odds ratios for most individuals. The risks allele for juvenile arthritis have shown that gene to gene interactions have been glued with insufficient information to link with the disease. No single gene has been conclusively linked to disease; built interaction with more factors can contribute in the occurrence of the diseases. The link between juvenile arthritis and genetic predispositions are relevant in understanding the genetic basis of the disease.
The incidences of occurrences vary with different ethnic and geographical areas among the population of the world, (Thierry, Fautrel, Lemelli and Guillemin, 2014). Early onset of the diseases makes up of half newly diagnosis cases among the Caucasians and occurs rarely among the African and Asian populations, (Consolaro & Ravelli, 2016). The differential occurrence has been observed to be occurring more in women than in man. Familial disease occurrence has measured in laboratory for autoimmunity based evidence as the presence of antibodies, family juvenile arthritis members have been found to have an increased risk. Genetic component in juvenile arthritis in relation to auto immune disorders have been associated with in heritance patterns that have differing characteristics with the Mendelian Laws. The familial risk attributed van be a measure of genetic component in aetiology even when not identified as Mendelian in its own characteristics, (Post & Ehrlich, 2005).
Therapy management has been fronted for management of Juvenile arthritis, and it involves multi sectorial approach of practitioners which include rheumatologist, occupational therapists, physical therapists, nurse and social workers, (Nugent, 2010) . The aim of therapy care is to maximise quantity of life . The role of therapist is to work with parents and children to come up with individualized plan. It is facilitated with the ongoing assessments of child ability and functioning. The plan may involve the use of several assistive devices such as splints and encouraging the use of involved joints. Provision of educational support to families about the disease strategies for managing it is crucial. Interventions will be changed with depending on the progression of disease and remission of juvenile arthritis for provision of age appropriateness self sufficiency. Therapy care can help the child to adapt to adjunct to challenges of juvenile arthritis in the lifeline.
In Assesment of the treatment of juvenile arthritis, the aim was to review the best evidence for the treatment option. With this search of evidence trials review studies were conducted with the study selection being randomised trials and open studies incorporating latest 10 patients for medications process. Fronted medical treatment found effective for children was the use of Corticosteroids. The effects of the disease destroy bone growth and the paediatric rheumatologist tries to minimise the usage for Juvenile arthritis. , however no evidence has linked corticosteroids use as diseases modifying. Main indications are severe fever, serosis and macrophage activation. Medication plan involves the use of 30mg/kg per dose instead of the common high dose, and with use their no controlled studies showing fewer adverse effects in children, (Baeck & Goossens, 2012).
The use of corticoid is efficient enough for intra carticular injections with the drug especially with the patients with oligoarthrities. Imaging pictures of radiographic and magnetic resonance have shown decrease in the synovial volume after injection without presence of harmful effects on the cartilage area. Adverse effects of the drug are few and commonly observed is the development of particular subcutaneous atrophy, however it is prevented with the use of injection of small amounts of saline into joint cartilages. The use of long acting triamcinolone hexacetonides is more effective and has more effect on the other forms of inject able corticosteroids. The use among the children requiring multiple injections, require the administration of sedations injections, (Ravelli et al., 2017).
Juvenile arthritis is a collective name for several diseases associated with joint, its occurrence and prevalence Australia have been shown to affects less that 1 % of children and is more prevalent among female gender compared to male gender. It is characterised with significant pain and disability. With lack of national data , its evaluation of the overall prevalence has been impossible. Few studies conducted have given prevalence rate for children within the age bracket of 0-15 years.
Hospitalisation rates have identified with power of 2.3 for children with the diseases from the year 2005-06 to 2014-15, with significant increase among the children, as shown below
(AIHW, 2017)
The rates represent 1-5 children in a group of 500 in Australia. Early detection of the diseases is beneficial in managing the disease. Worldwide prevalence of juvenile arthritis has been reported to be between 0.07 -4.01per 1000 children. While the incidence is reported at 0.008-0.226 per 1000 children, variations occurring due to undiagnosed cases
The Victorian Admitted Episodes Dataset, are comprehensive tools utilised in analysis of effects of illness and health care access to the residents of Victoria. This tool helps in planning for health services and prevalence of a disease in the state of Victoria.
In accessing Juvenile Arthritis, the bar graph below offers general epidemiology of the disease among the residents of the Victoria.
The above pie chart shows the distribution of prevalence of Juvenile Arthritis among children at Victorian region. 69% of the children are affected by the disease which conforms to research done, which have shown higher occurrence among the female gender. The male gender has prevalence rate of 31% of occurrence.
The interpretation of the above diagram signifies that the juvenile arthritis affects an average of male and female children below the age of 12 years. And admission rates and length of stay averages 1 day for both genders. Both gender shows significant average on the length of days and the average number of years across the genders, showing no significant difference across the gender.
General global prevalence of Juvenile Arthritis is that it occurs more prevalently among females and affects children between preschool and early teenage years, which conforms with this study findings. It affects between 8-150 children in every 100,000 children, (Azab, 2016).
References
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