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22 January 2008

'Old person's' arthritis afflicts thousands of kids

By Kathleen Fackelmann, USA TODAY
Breanne Watterson was just 4 when the hip pain began.

The preschooler went through periods in which she limped to school or had to be carried, says her mom, Victoria Watterson.

Doctors dismissed the attacks as "growing pains," but the girl suffered through five years in which she had spells of fever and pain in her hip and arms. "She couldn't play at all," Watterson says.

In 2004, doctors finally confirmed what Watterson had feared all along: Breanne, then age 9, was diagnosed with a potentially crippling form of arthritis.

Breanne is just one of an estimated 300,000 children in the USA who have some form of arthritis, according to a report released last month by the Centers for Disease Control and Prevention, the first to quantify arthritis in kids.
FIND MORE STORIES IN: Doctors | Rheumatism

The CDC report, along with other evidence, helps dispel the myth that arthritis strikes only in old age.

The 'old person's disease'

"People think of arthritis as an old person's disease," says Patience White, the chief public health officer for the Arthritis Foundation. "We now know that one in 250 U.S. children have arthritis."

Experts say children with arthritis face a number of problems, including a delay in getting a proper diagnosis and a shortage of pediatric rheumatologists.

Arthritis refers to 100 different conditions that all cause joint pain. Breanne has one of the most serious forms: juvenile rheumatoid arthritis. Fifty thousand to 100,000 children have juvenile rheumatoid arthritis, a disease in which the body's immune system attacks the tissue that lines the joints, White says.

A pediatrician might not recognize a child's joint pain as arthritis, says Suzanne Bowyer, a co-author of the CDC study, which was published in Arthritis & Rheumatism. She says many doctors don't think of arthritis when they're examining a child. "Usually by the time a kid gets to me they've been to see three or four doctors," she says.

For Breanne, it took years to be diagnosed. In 1999, the Watterson family was living on a naval base in Japan when she first started to experience hip pain. She saw a series of doctors, but most said nothing was wrong.

Five years later, a doctor recognized the symptoms as serious: The girl was sent to a military hospital in Hawaii for tests that revealed the potentially crippling disease. "It was a relief when someone finally listened to me," Watterson says now.

Children with this type of arthritis who don't get treatment can suffer irreversible damage to the joints. Bowyer has seen children who ended up in a wheelchair because they didn't get drugs that can slow or stop the disease.

And even when children are diagnosed, they can bounce from doctor to doctor without getting the right treatment, White says.

Searching for a doctor

In 2004, the Watterson family moved to Simpsonville, S.C.; within a month, Breanne's father, who was in the Navy, was sent to Iraq.

Victoria searched for a doctor nearby and discovered there were no pediatric rheumatologists in the entire state. The Arthritis Foundation says there are fewer than 200 practicing pediatric rheumatologists in the USA and, as of 2008, 10 states have no specialists at all who can handle kids like Breanne.

Watterson found a rheumatologist nearby, but he mostly treated adults. He gave Breanne steroids that quelled the attacks but also stunted her growth.

Watterson kept searching and in 2006 switched to a pediatric rheumatologist in Charleston, S.C. His office was a four-hour drive, one way. Watterson, who works from home as a medical transcriptionist, would get back from the doctor's office at about 9 p.m. and then start to make up her lost time. "I'd be up all night typing," she says.

They kept the grueling routine in place for a year, but in February 2007, a pediatric rheumatologist set up shop in Columbia, S.C. — a three-hour round trip.

Getting the right medicine calibrated to a child's body has made all the difference, Watterson says. Breanne is taking methotrexate, a drug that dampens the immune attack on joints, and a non-steroidal anti-inflammatory drug. She has gone from a child who collapsed in bed after school to an active 13-year-old, taking violin lessons and after-school art classes.

In 2006, Breanne tried to go door-to-door on Halloween but collapsed after a block. Her father had to carry her home.

"This year, she went out with her friends for three hours," Watterson says. "It's great to see her becoming so independent."

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