Juvenile Rheumatoid Arthritis: Other Treatment

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Other Treatment

Physical and occupational therapy are vital to the successful management of juvenile rheumatoid arthritis (JRA). Maintaining good joint function and range of motion and being able to do daily tasks help a child who has JRA develop normally.

Other Treatment Choices

Physical and occupational therapy

The purpose of physical therapy is to decrease pain and increase strength and range of motion, to allow your child to resume or continue normal activities. Occupational therapy works to help a child live as independently as possible.

• Physical conditioning may include aerobic exercise, range-of-motion exercises, and strength and stretching exercises.
• Splinting at night will help keep the wrist, hand, knee, and/or ankle joints straight, which may prevent pain, morning stiffness, and contractures. Working splints can help support a joint and relieve pain when writing or doing other hand tasks.
• Serial casting of the knees, ankles, wrists, fingers, and/or elbows is a temporary straightening and casting of the affected joint. The cast is then removed, the child goes through some physical therapy, and a new cast is applied with the joint stretched a bit more.
• Shoe lifts or inserts help to equalize leg lengths for children in whom one leg grows at a different rate than the other.

Nutrition

Healthy eating means eating a variety of foods so that your child gets the nutrients he or she needs for growth and development. Good nutrition will also help fight the effects of JRA. Important nutrients include protein, carbohydrate, fat, vitamins, and minerals. Your child can eat all types of food as long as his or her weekly intake is balanced and varied.

• As part of a healthy diet for a child with JRA, your child's doctor may recommend vitamin D and calcium. These nutrients can help control bone loss that is often linked with inactivity and with corticosteroid treatment.

Some nutrients are thought to help reduce inflammation, so they may help decrease some symptoms of JRA.

• Vitamin C is an antioxidant that may help reduce inflammation in the body. Vitamin C is found in citrus fruits, tomatoes, berries, broccoli, cabbage, and brussels sprouts.
• Omega-3 fatty acids in fish oil have been shown to mildly reduce inflammation in adults with rheumatoid arthritis and may have the same effect in children with JRA. The best sources of omega-3 fatty acids are cold-water fish and flaxseed oil.¹²

Pain management

• Breathing and relaxation techniques to relieve chronic pain include distraction, progressive muscle relaxation, and meditative breathing exercises.
• Heat, cold, or water therapy may reduce muscle spasms around joints, which can cause significant pain and movement problems.
• Stretching and strengthening exercises can help a child maintain strength and a normal range of motion.

Complementary medicine therapies for pain management

• Massage is used to promote relaxation, relieve pain, and restore normal joint movement.
• Guided imagery may be used to promote relaxation and manage pain.
• Acupuncture is mildly effective in relieving pain in adults who have rheumatoid arthritis and may help relieve pain in children who have JRA.

What To Think About

Physical therapy is a vital component of the successful management of juvenile rheumatoid arthritis. If possible (depending on age), help your child to understand the importance of physical therapy exercises and to keep an upbeat attitude about twice-or-more daily stretching and strengthening sessions. Working closely with a pediatric physical therapist can be especially helpful.

Last updated:	June 25, 2008
Author:	Shannon Erstad, MBA/MPH
Reviewed By:	Michael J. Sexton, MD - Pediatrics, Stanford M. Shoor, MD - Rheumatology
Editors:	Kathleen M. Ariss, MS, Pat Truman, MATC