The Cause of Chronic Pain for the Juvenile Patients Who Have Arthritis - Essay Example

Running head: JUVENILE ARTHRITIS Juvenile Arthritis Insert Insert Affiliation In past year's arthritis, specifically rheumatoid arthritis was thought to only afflict the elderly or those with bone and joint disorders. This was a misconception as there are a majority of cases of this condition which impair the lives of those in the juvenile percentile. Though there are a number of specialists of this disease for the adult population, those who specialize in this area who are certified specialists in the specifics of pediatric care have very limited capabilities to offer assistance for young children suffering with this disorder. There have been improvements with more doctors entering into this field and gaining certification so they can better treat their young patients but there are still many gaps needing filled in order to fully provide appropriate specialized care. Therefore, the information concerning this is generally found to be minimal but again, there is hope that the more the data grows about it and is gathered and found to be sufficiently accessible, then there will be a improved proportionate amount of practitioners who will be qualified to better assist many more patients. The goal of this research is to bring enlightenment into the cause of chronic pain for the juvenile patients who have this illness. Also, more detailed research will be included which will involve the causes, symptoms, the reasons for excessive pain, and the perception people have of this disease. Other factors will be included in this literature as well so that a complete validation into the various forms and stages of the illness can be expressed more accurately, as well as the physiological ramifications involved so that it can be shown that there have been improvements in the area of this disease involving juvenile patients in a highly comprehensive manner. Juvenile Arthritis Introduction: What is Juvenile Arthritis When statistics are shown into the prevalence of this degenerative disease it is found that approximately 10 out of 20 children are determined to have a form of this illness (Bolukbas 2005). Currently there are a good number of treatment options and informative classes available for this disability and some of these are: education into its effect's and causes medical intervention, physical therapy, and occupational therapy. Subsequently, it has been found that the last two options listed play the most crucial and beneficial role in order for adolescents who suffer from this chronic illness to achieve a satisfactory quality of life. Medical Intervention and Educational Courses assist in finding coping mechanisms and understanding of how the disease can progress. This disease begins in the earliest stages of life from 0-16 years of age and can possibly lead to complications, one of which can lead to blindness if not treated appropriately and in a timely manner. Concurrently, it is the most common form of chronic diseases found in early childhood and there have also been varying reasons surrounding the cause of this affliction involving young children (Bolukbas 2005). Furthermore, there are a myriad of ways that pediatric doctors go about determining whether or not a child has the disease. There has also been an abundance of research done in the area of the physiology study of this chronic illness by utilizing neonates and experimental lab rats in order to promote better ways of finding pain relief and the causes associative with juvenile arthritis. These are very important factors to classify, if in fact a proper diagnosis is going to be made. The most common of symptoms that have been verified through various studies on animals as well as human patients are listed as follows: Onset before age of 16 in humans Arthritis involving one or more joints Limitations in range of motion Tenderness or pain with joint movement Increased fever Disease persisting 6 weeks or longer Clinical features of polyarthritis which involves 5 or more joints Oligoarthritis which would be inflammation in 5 or fewer joints Systemic which is a characteristic of arthritis that includes fever Exclusion of other juvenile arthritis (Bolukbas 2005). Finally, to sum up the introduction of what this disease actually entails, first it takes a good mixture of different specialists working together if the highest quality of proper care is going to be given. These would be specialists in areas such as: pediatric rheumatologists, physiatrists, physiotherapists, physiologists for research procedures, occupational therapists, psychologists, and dieticians. These specialists all working in unison can help keep the pain that is caused from inflammation and joint damage, under a good degree of control so that it is not unbearable for the patient. Also, through physical and occupational therapies, it is hoped that joint deformities can be reduced or otherwise minimized sufficiently if entered into in a timely manner. The more in depth information involving the causes and physiological research and possible treatments sometimes used will be introduced in the subsequent section of this literary research. A Detailed Approach to Comprehending Juvenile Arthritis As was previously stated, the estimated amount of children affected by a form of arthritis is currently around 71,000. What Juvenile Rheumatoid Arthritis impairs is the synovium, which is a membrane found around the joint whose sole purpose is to assist the joints to move smoothly and pain free (Dreher 1995). However, when excess fluid gets inside the membrane it sets off a vicious cycle of stiffness, inflammation, pain, and discomfort for the individual. Under the correct medication and treatment program though, the pain from this disease normally enters into a remission phase, but depressingly, this does not mean the youth will not experience severe symptoms from the disorder again since it is a chronic illness. The positive point of this illness though is in the fact that children actually outgrow the disease 9 times out of 10 so they don't have to face any concern of carrying it over into adulthood. The disease begins in a somewhat systematic process and the causation of its initial stages is not yet for certain but rather filled with assumptions. The best description of how joints work properly and then how they become damaged is addressed in the following paragraph. Juvenile Rheumatoid Arthritis targets the body's joints, which are places where two bones come together, such as the knees, shoulders, elbows, wrists, or ankles. At the joint, the ends of the bone are covered with cartilage that keeps the bones from grating together. Lining the space around the joint is a thin membrane called the synovium, this secretes a clear, egg white like fluid that allows the cartilage to slide without friction and the joints to move (Dreher 1995). The progression of JRA impairs the natural abilities of the joints, cartilage, and this membrane. In an abnormal situation, the synovium becomes enlarged and produces an extreme amount of fluid. This is the underlying cause for the severe pain, inflammation, stiffness, excessive warmth, and a rubbish redness of the skin. Without medication and therapy the pain is stated to be totally intolerable and results in agony for the juvenile. One example that can be given is in the concept that many children of this disease suffer with a sublexiated wrist which dramatically affects the motion of their hand and sometimes their fingers as well (Ayling-Campos 1995). In relation to juvenile arthritis and the physiological implications of this chronic illness there have been quite a few possible determining factors in the reason for chronic pain and causation points. On of these has to do with the body's need for water and this specifically ties in with the physiology of this illness. It is the belief of some specialists in the study of chronic childhood diseases, such as forms of arthritis, that a need for water can cause even more pain with this illness. The cause for this has not been pinpointed but the fact remains that the physiological needs of the body play a direct part on the individual's ability to tolerate pain and what level of pain the disease poses on to the individual itself. One form of arthritis that children can develop due to biological reasons is 'Septic Arthritis' (Salzbach 1999). Research has proven that tiny infected organisms invade a child's joints directly through their bloodstream. This can occur from other bone structures being infected near the joints such as the, osteomyelitis or it can occur through an open wound on the youth. This disease use to be lethal, especially if an infant was afflicted with the illness. Statistic's point out the mortality rate for children with this form of arthritis was at 50% years ago (Salzbach 1999). What is highly unnerving about this form of arthritis is that it seems to destroy joints at a very rapid pace, for example it only takes a few days for this form of arthritis in children to totally deform and damage the sepsis of the hip area. Furthermore, this disease can affect the vascular processes of a child's body as it compresses on the blood vessels and cartilage in the femoral region and joint space. This can cause a 'vascular necrosis' due to the tremendous amount of pressure (Salzbach 1999). This type of arthritis can only be corrected by a surgical procedure and then the recovery period is relatively long and a form of antibiotics must be used so no new infections can invade the child's body. This is one of the most deadly forms of childhood arthritis if not the deadliest and it is intertwined with the biological functions as well as the physiological functions of the body which makes it especially more sensitive in regards to a time barrier for proper care. Furthermore, it has been duly recognized that children who are diagnosed with any form of arthritis also have a reduction in muscle and cardiovascular physiology as well as an incorrect level of functional performance, compared to normal children, in these specific areas (Fisher 1997-2001). Transmission of Pain Researches have found that juvenile's often have very concurrent pain with childhood arthritis. There have been a number of studies on rats to try and determine what exactly makes the disease and pain itself worsen or last longer for some children. There are some that are pointing to the possibility of potassium deficiencies, and physiological experiments have been conducted on many experimental rodents in an attempt to provide validation to this theory, however it has not presented conclusive proof as yet but there is acknowledgement to the possibility of this being one of the reasons for excess problems within the disease for the child. Also, in the area of pathophysiology of juvenile arthritis, medical research has determined and proven that a high percentage of children have multiple growth disorders. These abnormalities could also produce excess pain in the joints and create more duress in the inflammation of the synovium if the excess growth is near the irritated areas (Farquharson, et al 2005). What this cause is an excess in the amount of proinflammatory cytokines. The acceleration of growth creates more pain for the child on top of the problems already ongoing. When the bones grow at different rates it can cause permanent damage to joints in the body. Again this does not help when pain is already dominant in the disease. Immune System Response to JRA As has been mentioned throughout this literary research, there has not been a definite known cause to place blame on for the occurrence of JRA. One of the medical aspects that are known is how the body's immune system reacts to the presence of JRA in the body. Since JRA is considered to be an autoimmune disease, it causes the body's immune system to accidentally attack and destroy healthy tissue which it is actually suppose to be protecting (Using: Medicine Consumer Health 2003-2005). Below is an outlined example of how systematically healthy tissue is destroyed and what transpires from this: It is assumed that due to chronic inflammation of the synovium, it is directly responsible for excess activity of the immune system The normal function of the immune system is to deter illnesses and infections and protect healthy tissue from disease carrying invaders The immune system produces specialized cells and protein, which it releases into the bloodstream to fight off invaders. An immune protein can be an antibody In autoimmune diseases, such as JRA, the immune system actually attacks the body's own tissues. In arthritis, it is the synovium being attacked which leads to the inflammation and the initial concurrent pain This inflammation continues to grow if not treated and eventually expands outside the joint which can lead to bone deformities and damaged cartilage of the joint, ligaments, and tendons Currently there is no proven reason for why the immune system responds in this type of manner (Using: Medicine Consumer Health 2003-2005). Obviously, this occurrence does not benefit the juvenile but rather complicates the timely treatment of the disease. It is crucial to intervene in this process to prevent permanent joint damages and deformities from having a chance to occur. Antibody Link to Juvenile Arthritis Scientists have utilized mice in order to try and evaluate and determine causation factors of the disease as well as ways to assist in alleviating pain and enhancing the quality of life for the patient. The best way known to accomplish these goals is of course through experimental research, best done on lab rodents. One scientific analysis that has been studied and used in mice is involving FCy receptors which are genetically designed and have been applied to develop experimental arthritis which has been introduced into mice (Matsumoto, et al 2005). Therefore it has been implied that some arthritic conditions, especially those affecting the juvenile population, might be due to causes in the pathogenesis area of the immune system. Because JRA is an autoimmune disease it is directly affected by FCy receptors because these play a crucial part in the reaction between immune complex and myeloid cells (Matsumoto, et al 2005). Furthermore, testing has also been carried out on antibodies of anti-GPI and when this type of antibody was introduced with K/BxN with mice, and a polycolonal or two monoclonal anti-GPI antibodies, it was shown to illicit symptoms of arthritis in the mice (Matsumoto, et al 2005). This confirms the possibility that these specific antibodies are intertwined with the disease of arthritis as it has been indicated that these very same antibodies have been found in numerous patients with severe forms of juvenile arthritis. The Peripheral and Central Mechanisms Throughout this presented literature there has already been verification into the fact that any form of adolescent arthritis is proven to be very painful but there are multiple ways pain is transmitted through the body. Logically, the central and peripheral nervous systems would have a large part in determining the degree of pain the child would experience. What these two specific systems do is work to alert the individual, using sensory modality, in order to express pain and then place protective responses up in alertness of a potential threat to a health problem (Kinderziekenhuis 1997). These pain signals are the common symptoms that ordinarily lead the person experiencing them to go to the doctor to find out the cause of the adverse sensations. However, once pain is being registered in these central areas, it is quite often found that the initial pain is relative to a disease that is going to be associative with chronic pain, such as the case with juvenile arthritic conditions. "In t he pathogenesis of inflammatory pain, receptors sensitive for noxious stimuli generated as a consequence of inflammation, have a detrimental role" (Kinderziekenhuis 1997). It is these direct sensors that are known as, 'nociceptors', which activate the smaller sensory nerves and then follow through with transmitting pain signals to more specific pain sensitive neurons which in turn go directly to the spinal medulla. This is the body's precise way of alerting the individual that there is a serious threat within the body. Also, children don't express pain in the same way as adults do, and the interpretation for this reasoning can be found in cases of neonates (Kinderziekenhuis 1997). Perhaps this is one of the reasons why there are many misconceptions in cases of juvenile arthritis. Even though children have pain with this disorder it is not found to be as severe for them as it is in adult patients, which was previously mentioned. Furthermore, intensive research has diagnosed that when severe inflammation is present the nociceptors are more active and the transduction of pain levels is found to be higher as well. The well known medical term for this process is, 'neurogenic inflammation' which is a complete excruciating cycle of pain and considered to be barely tolerable for the patient. The main outcome that has been discovered in regards to levels of pain with various juvenile arthritic conditions is that severe polyarticular arthritis and systemic juvenile arthritis seem to carry the higher thresholds of pain when compared to various other forms of the disease (Kinderziekenhuis 1997). The final area of output in response to signals of pain with this illness shows that the central nervous system does in fact indicate signs of initial sensitization from the effects of this disease. When studies on animals have been carried out they have shown that some TRP channels and ion channels are in fact modulated by the mediators of inflammatory disorders and do provide a cellular link between various receptor functions and hyperalgesic states (Dickenson 2003). Also, it needs to be understood that in normal circumstances the associated mediated pain of the nociceptor is activated and responds due to the presence of high intensity noxious stimuli, when studies have been involved with experimental mice and rats (Woolf 1991). Therefore, injury to the peripheral tissue initiates an inflammatory response which then creates a set of chemical signals that transmits the pain signals to various areas parts of the body. It would seem that, in order to help alleviate the pain from this disease the peripheral system would need to be desensitized if any relief is going to be obtained from pain for the individual. In conclusion, the research presented has very effectively proven that many other nerve areas within the body play a tremendous part in the levels of pain experienced by various adolescents. Although it is noted that children's' levels of pain are rather variant from adults, the research has shown that children do still experience a great deal of pain, from these discussed forms of arthritic conditions, at various stages in the disease process. It has also been found that there are many relevant areas where the peripheral and central nervous systems definitely have an impact and are directly affected by the phases of juvenile arthritis and result in the occurrence of chronic pain for the child. Medical intervention has been found to be crucial to step in early in this disease so as to prevent further joint injuries or any deformities that might occur from improper bone growth. Continuation into the study of juvenile arthritis is needed in order to try and pinpoint the exact causes and uncover further research that might be found to be beneficial in helping the patient cope while dealing with the stages of this illness. References Bolukbas, Nalan (2005) Juvenile Rheumatoid Arthritis: Physical Therapy and Rehabilitation Southern Medical Journal Retrieved on 1 January, 2006, from: http://www.highbeam.com/library Dreher, Nancy (1995) Understanding Juvenile Arthritis Current Health 2: A Weekly Reader Publication Retrived on 1 January, 2006, from: http://www.highbeam.com/library Farquharson, C., Ahmed, S.F., Macrae, V.E. (2005) The Pathophysiology of the Growth Plate in Juvenile Idiopathic Arthritis Rheumatology, Vol.45, Number1, pp. 11-19 Fisher, Nadine (1997-2001) Rehabilitation Physiology Lab Retrieved on 4 January, 2006, from: http://www.sphhp.buffalo.edu/rs/rehabphys/juvenile.html Dickenson, Anthony (2003) Central Processing of Pain Retrieved on 5 January, 2006, from: http://www.ich.ucl.ac.uk/cpap/study/abstracts/111203.pdf Kinderziekenhuis, Wilhelmenia (1997) How Painful is Juvenile Arthritis ADC Online Retrieved on 5 January, 2006, from: http://www.adc.bmjjournals.com/cgi/content/full/77/5/451 Medicine Consumer Health (2003-2005) Juvenile Rheumatoid Arthritis Retrieved on 4 January, 2006, from: http://www.emedicinehealth.com/articles/34647-2.asp Salzbach, Robin (1999) Pediatric Septic Arthritis Aorn Journal Retrived on 1 January, 2006, from: http://www.highbeam.com/library Matsumoto, Isao & Zhang, Hua & Muraki, Yoshifumi & Hayashi, Taichi & Yasukochi, Takanoii & Kori, Yuko & Goto, Daisuke & Ito, Satoshi & Tsutsumi, Akito & Sumida, Takayaki (2005) A Functional Variant of FCY Receptor III is Associated with Rheumatoid Arthritis in Individuals who are Positive for Anti-Glucose-6- Phosphate Isomerase Antibodies Retrived on 4 January, 2006, from: http://www.medscape.com/viewarticle/510819 Read More