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Rheumatoid Arthritis in children (Read 648 times)

Oldmanmatt

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Rheumatoid Arthritis in children
February 20, 2017, 06:02:59 pm
It's looking like my eldest lad is going to be diagnosed with this. He's 9 and it's only affecting his right knee at the moment.
For the past 6 weeks it was thought to be Bursitis but the Orthopaedic surgeon today sent him for an Ultrasound and he's now admitted to be hooked up for IV antibiotics (there's some sepsis involved, apparently).
Any experience of managing this out there?



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gme

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#1 Re: Rheumatoid Arthritis in children
February 20, 2017, 10:44:30 pm
My youngest was diagnosed with juvenile arthritis when he was 6 in pretty similar circumstance I.e. Swelling and fluid behind his knee. Had to have injections in his knees every 6-12 months under general which was always unplesent. He also had to have his eyes tested every 6 months.

The intervals between flare ups got longer and longer and he was eventually signed off at 11 he had to wear soles in his shoes a bit longer as it had effected the development of his left leg to a point where it was slightly shorter than his right. He was also found to be hyper mobile.

13 now and you wouldn't know a thing unless you were told. County level scrum half, decent footy player and never stops doing stuff. No sign of arthritis at all.

Fultonius

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#2 Re: Rheumatoid Arthritis in children
February 20, 2017, 11:04:45 pm
My Dad had it for 20 years. Not sure about kids but have a look into hyperbaric oxygen treatment if diagnosed - seemed to work for him. PM if you want more details.

Oldmanmatt

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#3 Re: Rheumatoid Arthritis in children
February 21, 2017, 08:13:36 am
My Dad had it for 20 years. Not sure about kids but have a look into hyperbaric oxygen treatment if diagnosed - seemed to work for him. PM if you want more details.

Thanks.

My youngest was diagnosed with juvenile arthritis when he was 6 in pretty similar circumstance I.e. Swelling and fluid behind his knee. Had to have injections in his knees every 6-12 months under general which was always unplesent. He also had to have his eyes tested every 6 months.

The intervals between flare ups got longer and longer and he was eventually signed off at 11 he had to wear soles in his shoes a bit longer as it had effected the development of his left leg to a point where it was slightly shorter than his right. He was also found to be hyper mobile.

13 now and you wouldn't know a thing unless you were told. County level scrum half, decent footy player and never stops doing stuff. No sign of arthritis at all.

That's the most positive thing I've read on the subject in the last 24.
One of the biggest gripes my lad has at the moment is he plays Forward for his (tag) team and they're through to county finals...


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Fultonius

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#4 Re: Rheumatoid Arthritis in children
February 21, 2017, 08:39:48 am
Hope the 20 years didn't sound pessimistic - from a quick read I had last night they now seem to call Juvenile RA Juvenile Idiopathic Arthritis to separate it slightly. It does seem to clear up more quickly. Again, from a quick read it seems like it's associated with synovial fluid hypoxia, so, as with RA hyperbaric oxygen treatment might speed things along. I know you're always keen for some reading in literature. You'll notice that a lot of "alternative therapy" types a big advices, which is a real pain for getting quality research done!

Bottom line is the jury is still out on it's efficacy but there's no downside so get on it!

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Oldmanmatt

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#5 Rheumatoid Arthritis in children
February 21, 2017, 02:01:23 pm
Well, 24 hrs later...

Now, it's been decided there is no Arthritis. Despite being "almost certain" yesterday.
It seems there is a rather nasty infection and Al (the Doc and a friend/climber/customer) is bemused that the lad is not incredibly ill. His knee has been sore, hugely swollen and hot to the touch for 6 weeks. Apparently it should have spread and been full blown sepsis, he's saying something about lack of circulation in the affected area?
Anyway, my lad is now the curiosity of the hospital and has a queue of consultants coming to look. The inflammation was so bad on the Ultrasound, that the technician exclaimed "Bugger me!" out loud, before apologising and saying it must be painful.
Another 48 hrs of intravenous antibiotics.

There is some serious damage to the tendons in his knee too, from the infection; apparently.

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Fultonius

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#6 Re: Rheumatoid Arthritis in children
February 23, 2017, 12:59:04 pm
I know I keep banging this drum, and I'm always concerned that I sound like a quack who believes in alternative therapies...I'm not! I am usually beholden to gold standard, double blind, placebo controlled studies. But for ligament/tendon repair where there is little to no vascular supply, Hyperbaric has been shown to massively improve the speed and quality of repair....in rats....

https://www.ncbi.nlm.nih.gov/pubmed/22951751

I'm living proof (haha, quackery...we all heal eventually, I know, I know). I had a physio look at both my knees last year, 6 years after multi-ligament knee op (because my non-op knee was hurting) and he commented:
Quote
That's the best PCL reconstruction result I've ever seen
and he's seen a lot of knees, for some of the best surgeons (he's at hampden sports injury clinic in Glasgow, so gets lots of professional athletes). Maybe I'm just lucky... or maybe I'm a rat?

https://www.researchgate.net/publication/230804328_Effect_of_hyperbaric_oxygen_treatment_on_tendon_healing_after_Achilles_tendon_repair_an_experimental_study_on_rats pg.299 is particularly interesting:

Group 2 is HBO therapy with no corticosteroids.

Quote
On the 11th postoperative day there were significant
differences among the four groups in terms of failure
load. The maximum force that Group 1, 2, 3, and
4 could withstand was 10.62±0.83 N, 18.5±2.66 N,
10.08±1.32 N and 12.06±1.58 N (p<0.05), respectively.
The average of maximum force in Group 2 was significantly
greater than that of the other groups. Similarly,
Group 2 showed a significant difference in terms of
stiffness. The stiffness of Group 1, 2, 3, and 4 averaged
2.55±0.80 N/mm, 4.05± 0.96 N/mm, 1.35±0.63 N/mm
and 2.73±0.77 (p<0.05), respectively (Table 7).
Hyperbaric oxygen therapy also significantly
improved the biomechanical properties of the Achilles
tendon, such as maximum allowable stress and elasticity
modules, on the 11th postoperative day. Significant
differences were observed in parameters including
maximum stress for Group 1, 2, 3, and 4 which averaged
4.57±0.36, 7.95±1.14, 4.33±0.56 and 5.18±0.68
(p<0.05), respectively (Table 7).
An assessment was performed to determine the
effectiveness of HBO therapy in terms of elastic modulus
using the Tukey’s test. The elastic moduli for
Group 1, 2, 3 and 4 averaged 12.69±1.41, 16.87±3.77,
11.83±1.01 and 15.34±1.39, respectively (Fig. 1).
Significant differences between the groups in terms of
elasticity modulus were found during biomechanical
evaluation (Table 9). Group 2 had higher elastic modulus
values than Group 1 (p<0.05) and Group 3
(p<0.05). Group 4 had higher values than Group 3
(p<0.05). Mean stress energy value in all groups is
shown in Figure 2. No significant differences were
found in strain energy between the groups (p>0.05)
(Table 7).

SA Chris

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#7 Re: Rheumatoid Arthritis in children
February 23, 2017, 01:08:52 pm
Matt, it still doesn't sound great, but I guess it's not as bad as it could have been?

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#8 Re: Rheumatoid Arthritis in children
February 23, 2017, 01:47:26 pm
Actually...

I am now approaching incandescence.

72 hrs of intravenous, broad spectrum, antibiotics; made no difference whatsoever. Then it transpires that the consultant had not referred to the Ultrasound report (not Al, the registrar, he was following orders). So the head of Orthopaedics rocked up with the head of Paediatrics and (based on the original scan from almost four days ago) have confirmed the Arthritis diagnosis. The sepsis has resolved though (based on reduced pain and todays scan).
So, he's being referred to Bristol with a suspected AIG (?) which I'm assuming is an Auto Immune disorder. The Paediatrician said "for gods sake, don't google it, because it covers a huge range of disorders and it's way too soon to even guess yet".
So, I haven't, yet.
They will be knocking him out to aspirate the joint apparently. Again, no idea what that means yet, but that will be in Bristol in a couple of weeks.

I know medicine can be as much an art as a science and a degree of intuition is essential; but sending the kid for a scan, then not bothering to read the notes (even though they were available within two hours of the scan)?
One of the ICU ward Sisters collared me on the school run this morning, telling me to make a complaint; there is a bust-up going on between the Imaging dept and the Ortho's now about this incident and most of the hospital knows. Also, the same Consultant told us, on three previous visits in the prior six weeks; that it was nothing but a Pre-Patella bursitis and (in ear-shot) told the attending nurse, that Polly was a time wasting, fussy Mum and my lad was a whiner.
Polly's dad is a GP, now, he was the Surgeon Captain RN who ran Haslar before it closed; he drove down to look last weekend and insisted we went back on Monday morning. Fortunately.


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#9 Re: Rheumatoid Arthritis in children
February 23, 2017, 02:36:11 pm
Matt, that is totally shit. Hope you find out what exactly is wrong and get some kind of plan to deal with it soon.

On the complaining front, do it. My wife is a doctor, as are many friends (marry a doctor and the buggers are everywhere) and they would say the same. Things change/get sorted when people complain.

SA Chris

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#10 Re: Rheumatoid Arthritis in children
February 23, 2017, 03:07:14 pm
Not a good scenario at all. Thinking of you guys.

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#11 Re: Rheumatoid Arthritis in children
February 23, 2017, 04:36:40 pm
That's really shit Matt. Hope he (and you/your family) is (/are?) through the worst of it. I'd complain. My dad's rheumatology consultant didn't check his lung scan one year then put him on drugs that are known to fuck up lungs, by the time they noticed it was too late. There was never an official complaint (for whatever reason) but apparently that guy is no longer a consultant so I guess there were other issues.

Luckily kids heal quickly!