It’s not unusual for a parent to bring a young child in to see me because of a sore leg, or a sore arm, or a limp that seems to have appeared from nowhere. It often turns out the kid had an awkward landing on the trampoline, or a tumble off the climbing equipment at school, and it’s nothing worse than a strain. I might do an X-ray to be sure, but when the symptoms go away in short order and nothing more comes of it, we chalk it up to regular childhood stuff.
A few years ago, I saw a 3 year-old girl whose mother was concerned because of persistent complaints of sore legs. She also had intermittent fevers, and a pale rash that would come and go. The symptoms had been happening for about six weeks—off and on. Her mom really didn’t know what to make of it; she’d been to a walk-in clinic the first time her daughter had a fever and vague aches and was told it was a viral infection and would go away. Which it did. But then it came back. When she noticed her daughter had a limp after napping, she brought her in to me.
Something didn’t feel right about the whole picture. I ordered some tests and then referred her to a rheumatologist. It took a while for the rheumatologist to pin down the final diagnosis—several other conditions were being considered and had to be ruled out—but word eventually came back to me that the child was being treated for Juvenile Idiopathic Arthritis (JIA).
It may come as a surprise to you that children can develop arthritis. Most people think of arthritis as a condition that only affects adults, but that’s not the case.
Juvenile Idiopathic Arthritis affects one in 1000 children in Canada. "Juvenile" means young (16 years of age or younger) and "idiopathic" means the cause is not known. JIA is also sometimes called Juvenile Rheumatoid Arthritis (JRA). It’s four times more common in girls than in boys.
JIA, unfortunately, is not an innocent condition. It can cause great hardship, emotionally and physically, on a child and his or her family. In addition to chronic joint pain and inflammation, there can be physical complications in other parts of the body, like inflammation of the eyes. And it can also, depending on how severe and involved the arthritis, impair a child or teen’s growth.
Diagnosis can be a tricky thing, however. There can be a long delay in identifying and confirming the condition. One part of the problem is that the symptoms of JIA can mimic many other conditions. Also, many parents are unaware that children can get arthritis, and may not bring their child in when symptoms first appear.
So that’s what I’m aiming to change.
I want you to be aware of the signs and symptoms, so—as unlikely as it is—if your child does start exhibiting signs, you know what to do.
Here are the common symptoms:
JIA can affect anywhere from one to several joints in the body. Some children also experience systemic symptoms that affect the entire body, like fever, rashes, and swollen lymph nodes. It’s typical for symptoms to go through phases where they flare up and then later disappear.
If your child has any of the above: joint stiffness, pain, or swelling that lasts for a week or more—especially if there are systemic signs like rash or fever—you should bring your child to see the doctor.
There are treatments for JIA once diagnosed but, being a chronic condition, it can take a great toll on a child’s family. Parents and siblings of a child diagnosed with JIA need lots of support. The medications we use to treat arthritis are the same in all age groups—we adjust the doses for children and teens based on weight.
With my young patient, once the initial treatment had been started, I saw her and her family back in my office regularly to make sure they were well connected with the resources they needed: The Arthritis Society, specialists, clinical counsellors, and a local support group.
Connecting with your doctor early, to make the diagnosis, and often—to get the treatment and support you need as a family—is key.
Multiple Sclerosis (MS) is a disease that can affect many areas of a person’s life—not the least of which is pregnancy.
A few years ago I had a patient who had recently been diagnosed with MS. She was a young woman in her thirties who had not yet had children. As she began treatment with her neurologist, one of her first questions was: what’s going to happen when I want to get pregnant?
And the truth is, it’s a complicated issue. The answer is different for everyone. But there are certain things that are important to know. In this post I’m going to discuss some of the issues surrounding MS and pregnancy.
Did you know there are approximately 100,000 Canadians living with MS?1 As women, our risk is the highest: MS is four times as likely to occur in women. Since MS is most often diagnosed in young adults, people aged 15-40, that means it typically first appears during a woman’s child-bearing years2.
MS is an autoimmune condition of the central nervous system that is considered a progressive disease. However, the severity and rate of that progression varies widely: some people may only experience occasional flares of their MS symptoms punctuating it as an otherwise stable disease.2
Symptoms of MS can include: vision changes, muscle weakness, balance problems, unusual sensations in the limbs or face, dizziness, bladder problems, fatigue, and pain.
Sometimes MS can be a tricky disease to diagnose. But once a diagnosis is made, it’s important to start treatment right away. There are a variety of medications that can be used as disease-modifying therapy, and people living with MS today have more treatment options than ever. Early and aggressive treatment has been shown, through research, to slow disease progression and decrease relapse rates. There are many different possible treatment options for MS, and they all carry different risks and benefits.
First, it's important to know that MS itself does not affect a woman's fertility. When it comes to pregnancy, the most important thing to do is speak with your doctor. Start a conversation when you first start considering pregnancy so you can understand the issues up front. Everyone is different, and people with MS have varying degrees of severity and different types of disease, so the recommendations for you and pregnancy will be highly individual.
That said, a few things are worth considering when it comes to MS and pregnancy. Women need to stop their DMTs (disease modifying therapies) before to trying to conceive, so the medication can be completely cleared from their systems before pregnancy. However, that clear out period varies, depending on the exact medication being used. Some treatment options don’t metabolize in the liver, and only require a 24-hour washout period.
Although DMTs cannot be continued through pregnancy, there are some medications your doctor may recommend during pregnancy if your disease is particularly severe—treatments that can treat acute attacks and lessen symptoms. Again, all decisions will be highly individual, and will be made together with your team of doctors.
Research has shown that pregnancy does not appear to cause more disability in the long term for women who have MS. In fact, during pregnancy, many women with MS tend to feel better and experience fewer relapses. That improvement is short lived, however, because it's an effect of pregnancy hormones.
While all of this may sound complicated and perhaps even scary, the worst thing you could do is avoid talking to your doctor—either to get assessed and diagnosed in the first place, or to begin treatment at an early stage. Early, aggressive treatment has been shown to make a significant difference for patients with MS. Denial and avoidance are common (and understandable) reactions to a diagnosis of chronic illness like multiple sclerosis. But those reactions can be harmful to your long term health.
Since MS usually hits during child-bearing age, it can impact your family planning. But the exact shape of that impact depends on many things. If you have MS and you’re even thinking about conceiving, book an appointment with your doctor to discuss all the issues and create a plan that will work for you and your family.
For more details about the information included above please visit: MS Society of Canada.
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This is proudly sponsored by our friends at Biogen Idec Canada.
www.biogenidec.com/
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