Flares and JIA: What You Should Know

By Anneke Smith

As an autoimmune disease, juvenile idiopathic arthritis (JIA) symptoms can be unpredictable, ranging from mild to severe. Keeping flares, or periods of high disease activity, under control is important for your child’s long-term health. Fortunately, there are many things you can do to help your child during times of worsening symptoms.

Defining a Flare
Just like arthritis is different for every child, so are flares. Some children may only have a couple of active disease periods, while others may experience consistent on-again, off-again symptoms. Some kids may have persistent symptoms that occasionally get worse for short periods of time.

Most flares involve extra-painful and extra-swollen joints, but flares aren’t always defined by how many joints are affected or by what lab results say. Depending on your child’s type of arthritis, flare symptoms may include:

• Flu-like symptoms, such as nausea and fever
• Skin rash
• Eye problems, such as blurry vision and dry eye
• Extreme fatigue
• Depressive mood

Causes and Consequences

Some flares you can see coming. They are caused by intense physical exertion, poor sleep , missed or off-schedule medications, increased stress or the onset of a virus or cold. Other times, flares seem to come out of nowhere, but they are likely the result of worsening disease activity or ineffective medications.

Fortunately, with prompt treatment, most flares can be managed. But left uncontrolled, increased inflammation can cause serious complications like delayed growth in the limbs or the jaw, says Joseph Shanahan, MD, a rheumatologist and assistant consulting professor in the division of rheumatology, allergy and immunology at Duke University Medical Center in Durham, North Carolina.  Joint damage is another serious consequence of unchecked inflammation, he says.

“Early intervention — particularly the use of intra-articular corticosteroid injections into a joint and adjusting the dosage or timing of DMARD medications — can spare your child potentially irreversible complications of flares,” says Dr. Shanahan.

What You Can Do to Help

During a flare, your child should maintain as much normal activity as possible. These tips can also help manage your child’s flare.

• Have a flare plan. Work with you child’s doctor to come up with a plan, which should include instructions for altered medication dosages and physical activity guidelines to manage pain and minimize joint damage.
• Maintain a medication schedule. Make sure your child is taking his medicine at the same time and every day. Missed medication doses may trigger flares.
• Use heat and cold. Warm compresses, baths, showers and heating pads increase blood flow to the joints and muscles, which can help relieve stiffness and dull aches. For acutely painful or inflamed joints, use ice packs or bags of frozen vegetables; the cold constricts blood vessels and helps relieve pain. Do not apply heat or cold for more than 15 minutes at a time.
• Consider splints for pain control. Wearing a splint at night, when your child is moving less, may help with pain. Ask your child’s doctor or physical therapist about splints or braces.
• Make a doctor’s appointment. Are your child’s symptoms causing him to miss school or other activities?  If the answer is yes, it’s time to make an appointment. It’s also best to ask your child’s rheumatologist about what constitutes as a medical emergency and when to call, says Dr. Shanahan.
• Temporarily adjust your child’s activity. Your child will probably require more rest during a flare, and you may need to limit certain activities until the flare has subsided. It’s still important to balance rest with light activity to maintain her strength and flexibility.
• Keep your child’s school in the loop. During a flare, your child may miss several days of school. If teachers and administrators know about your child’s condition, accommodations can be put in place, such as emailed assignments or access to online textbooks. Plus, as a student with arthritis, your child is entitled to rights that can help him or her succeed in school. But first, you’ll have to set up a plan, like a 504 plan or Individualized Education Plan (IEP), to receive any benefits. These plans outline and ensure accommodations based on your child’s specific needs.

Encourage your child to learn about her arthritis and speak up when she notices worsening symptoms. In time, she will learn how to spot an oncoming flare so she can, with the help from you and her doctor, stop it in its tracks.