HOPE FOR CHILDHOOD ARTHRITIS
We think of arthritis as something that hits when we get old. But it can strike kids, too. One type can leave kids in constant pain, and there hasn't been an effective treatment, until now.
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She hops, sings, and dances like other three-year-olds. But last year, little Avril spent her days in bed at the hospital.
It started with a fever and rashes that wouldn't go away and pain that spread to every part of her body.
Avril Sutherland-Wagner (Sr.)
Avril's grandmother
"She would complain her neck hurt. Her fingers hurt, her knees hurt, and they kept saying it was symptoms of the flu."
But Avril's widowed grandmother and great-aunt knew it wasn't the flu.
Avril Sutherland-Wagner (Sr.)
"She had almost quit eating because she had it in her jaw bones."
Finally, they found a doctor who knew what "it" was.
Pediatric rheumatologist Phillip Hashkes diagnosed Avril with systemic Juvenile Idiopathic Arthritis, or JIA , and put her on the drug Kineret.
Philip Hashkes, MD
Pediatric Rheumatologist
Cleveland Clinic
Cleveland, OH
"It was literally a miracle drug. The day after she got this medicine, all her other symptoms were gone."
Every day nurses come to house to give Avril an injection of Kineret.
It hurts, but it's worth it.
Avril Sutherland-Wagner (Sr.)
"She doesn't complain of any pains, of any aches. She laughs; she jokes, she marches, she dances. And that's what being a child is."
Kineret is approved for adult rheumatoid arthritis, although it's not the best treatment for that disease. Doctor hashkes says it works best for a child recently diagnosed who hasn't responded to other treatments. Side effects include colds, headaches and a risk for infection because kineret works on the immune system.
BACKGROUND: Juvenile idiopathic arthritis (JIA) was previously known as juvenile rheumatoid arthritis. JIA, which affects one in 1,000 kids, refers to a group of different types of arthritis in children younger than 16 years old. It is characterized by chronic arthritis that lasts for at least six weeks, and there is no explanation for the cause. There are several types of arthritis included in this disease, one being systemic disease, which accounts for 20 percent of all JIA cases.
SYSTEMIC JIA: Systemic JIA starts with a fever and a rash. It doesn't respond very well to therapy. Patients may have heart and lung involvement, where other organs in the body are involved in addition to the arthritis. It sometimes takes a long time for the actual arthritis in the joints to develop, and kids are often hospitalized and undergo many tests before they are correctly diagnosed. It is often confused with infections because it usually starts with a fever and a rash like many infections. It is also sometimes confused with various types of cancers, such as leukemia. When the arthritis does develop, patients find difficulty getting out of the bed in the morning. They have significant pain and limb stiffness. Even getting dressed and going to the bathroom is difficult. Walking and climbing stairs is sometimes nearly impossible, and children's school days are often cut short by a developing fever.
TREATMENTS: Until recently, there haven't been particularly effective medications for JIA. Kids were treated with drugs like aspirin, naproxen or ibuprophen, which were not especially helpful, according to Philip Hashkes, M.D., a pediatric rheumatologist out of the Cleveland Clinic. He says kids have traditionally been treated with very high doses of steroids, which would have a lot of side effects like preventing kids from growing. But, he says: "In the last two or three years, there's been a marked revolution in the treatment of this type of arthritis, and now, there's some hopeful medicines, which sometimes we call biologic medicines, and these are medicines that target the molecules that are actually causing the inflammatory process."
KINERET: One such biologic medicine is a drug called Kineret. It is FDA-approved for treating adult rheumatoid arthritis; however, it is not the best treatment for it. However, for treating systemic JIA, Dr. Hashkes says it can work as a "miracle drug" -- as seen with one of his patients, three-year-old Avril Sutherland-Wagner. Dr. Hashkes says the day after she was treated with it her arthritis symptoms were gone, her rash was gone, and she was, for the first time after developing the disease, able to live like a normal kid -- with the exception of taking a daily injection of the drug. Dr. Hashkes emphasizes that the drug is not a "cure," and patients will have to take them for a long time. Kineret works best for patients recently diagnosed with systemic JIA who haven't responded to traditional therapy.
Shirley Wells
Cleveland Clinic
(216) 444-3250
wellss@ccf.org
Copyright © 2006 Ivanhoe Broadcast News, Inc.
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