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Rheumatology treats musculoskeletal and autoimmune diseases, including arthritis, lupus, gout, and vasculitis.
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Juvenile Idiopathic Arthritis is the most common chronic rheumatic disease in children. It is not a single disease but a group of inflammatory joint conditions that all cause arthritis lasting at least six weeks in children under sixteen, after other causes are ruled out. On a cellular level, the disease is caused by a major problem with the immune system. The main issue happens in the synovium, which is the thin lining inside the joint. Normally, the synovium helps exchange nutrients and waste between the blood and joint fluid, keeping the cartilage healthy.
In Juvenile Idiopathic Arthritis, the immune system can no longer tell the difference between the body’s own tissues and foreign invaders. Immune cells called T-lymphocytes and B-lymphocytes move into the joint lining, along with other immune cells like macrophages and neutrophils. These cells release many inflammatory chemicals, such as tumor necrosis factor-alpha, interleukin-1, and interleukin-6. This causes the cells in the joint lining to grow too much, turning the thin membrane into a thick tissue called pannus. The pannus acts like a non-cancerous growth, spreading into the joint, releasing enzymes that break down cartilage, and damaging the bone underneath.
The word “idiopathic” means the cause is unknown, but research now shows the disease has many contributing factors. Scientists believe there is a “two-hit” process, where both genetics and environmental triggers play a role. The disease involves several genes, especially those in the Human Leukocyte Antigen region, which help the immune system recognize threats. If a child with these genetic risks faces a certain trigger, like a virus, antibiotics, or stress, the immune system can lose its tolerance and start a cycle of long-term inflammation.
To help manage this complex disease, the International League of Associations for Rheumatology created a system that divides Juvenile Idiopathic Arthritis into seven subtypes. This system is important because it guides doctors on prognosis, possible complications, and treatment choices.
Today, doctors are looking at Juvenile Idiopathic Arthritis not only as a disease to control, but also as a condition where protecting and repairing tissues is important. The main goal is to reduce inflammation and help the child’s bones grow and heal naturally. Children have an advantage because their bones are still growing and their metabolism is active. However, ongoing inflammation can block these natural repair processes. Inflammatory chemicals can interfere with growth signals, which may slow down growth in certain areas or throughout the body.
Stem cell research is a new area that may help treat difficult cases of Juvenile Idiopathic Arthritis. Mesenchymal stem cells are especially interesting because they can help control the immune response and encourage tissue repair. While most treatments use medications, regenerative medicine focuses on keeping the joint’s environment healthy, including the cartilage, bone, and joint fluid. This helps children grow up with joints that work well and are not damaged.
Juvenile Idiopathic Arthritis is a major health problem worldwide, affecting children everywhere. It is a leading cause of disability in children. Because the disease is long-lasting, its effects can continue into adulthood. Ongoing disease or damage during childhood can cause early arthritis and may lead to joint replacement surgery in young adults.
The impact of this disease is complex. It includes physical problems, medication side effects, and the emotional stress of living with a long-term, unpredictable illness. Healthcare providers now focus on early diagnosis and strong treatment plans, called “treat-to-target,” aiming for full remission instead of just controlling symptoms. This approach recognizes that helping children grow and develop normally is just as important as controlling inflammation.
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Gout is a crystal-induced arthritis caused by Hyperuricemia (high levels of uric acid in the blood). When uric acid levels get too high, needle-like crystals form in the joints (often the big toe), causing severe pain. Causes include genetics (kidneys not filtering enough uric acid) and diet (foods high in purines, such as red meat, shellfish, and alcohol).
AS is a type of inflammatory arthritis that primarily affects the spine and sacroiliac joints. A classic symptom in young people is back pain that wakes them up in the second half of the night. Over time, severe inflammation can cause the vertebrae to fuse, leading to a rigid “bamboo spine.”
Biologics are advanced, genetically engineered proteins used when standard medications fail. Unlike general painkillers, biologics target specific parts of the immune system (like blocking Tumor Necrosis Factor or Interleukins) to stop the inflammatory attack at its source. They are typically administered via injection or IV infusion.
Capillaroscopy is a non-invasive diagnostic tool used by rheumatologists. A microscope is used to examine the tiny blood vessels (capillaries) at the base of the fingernail. Abnormalities in these vessels are a key indicator for diagnosing Scleroderma (Systemic Sclerosis).
This theory suggests that a combination of factors causes autoimmune diseases:
