How Juvenile Arthritis (JIA) is Diagnosis:

Diagnosis of juvenile idiopathic arthritis can be difficult because joint pain can be caused by many different types of problems. No single test can confirm a diagnosis, but tests can help rule out some other conditions that produce similar signs and symptoms.

1. Blood tests

Some of the most common blood tests for suspected cases include:

• Erythrocyte sedimentation rate (ESR). The sedimentation rate is the speed at which your red blood cells settle to the bottom of a tube of blood. An elevated rate can indicate inflammation. Measuring the ESR is primarily used to determine the degree of inflammation.
• C-reactive protein. This blood test also measures levels of general inflammation in the body but on a different scale than the ESR.
• Antinuclear antibody. Antinuclear antibodies are proteins commonly produced by the immune systems of people with certain autoimmune diseases, including arthritis. They are a marker for an increased chance of eye inflammation.
• Rheumatoid factor. This antibody is occasionally found in the blood of children who have juvenile idiopathic arthritis and may mean there’s a higher risk of damage from arthritis.
• Cyclic citrullinated peptide (CCP). Like the rheumatoid factor, the CCP is another antibody that may be found in the blood of children with juvenile idiopathic arthritis and may indicate a higher risk of damage.

In many children with juvenile idiopathic arthritis, no significant abnormality will be found in these blood tests.

2. Imaging scans

X-rays or magnetic resonance imaging may be taken to exclude other conditions, such as fractures, tumors, infection or congenital defects.

Imaging may also be used from time to time after the diagnosis to monitor bone development and to detect joint damage.

Juvenile Arthritis (JIA) Treatment:

Treatment for juvenile idiopathic arthritis focuses on helping your child maintain a normal level of physical and social activity. To accomplish this, doctors may use a combination of strategies to relieve pain and swelling, maintain full movement and strength, and prevent complications.

1. Medications

The medications used to help children with juvenile idiopathic arthritis are chosen to decrease pain, improve function and minimize potential joint damage.

Typical medications include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve), reduce pain and swelling. Side effects include stomach upset and, much less often, kidney and liver problems.
• Disease-modifying antirheumatic drugs (DMARDs). Doctors use these medications when NSAIDs alone fail to relieve symptoms of joint pain and swelling or if there is a high risk of damage in the future.DMARDs may be taken in combination with NSAIDs and are used to slow the progress of juvenile idiopathic arthritis. The most commonly used DMARD for children is methotrexate (Trexall, Xatmep, others). Side effects of methotrexate may include nausea, low blood counts, liver problems and a mild increased risk of infection.
• Biologic agents. Also known as biologic response modifiers, this newer class of drugs includes tumor necrosis factor (TNF) blockers, such as etanercept (Enbrel, Erelzi, Eticovo), adalimumab (Humira), golimumab (Simponi) and infliximab (Remicade, Inflectra, others). These medications can help reduce systemic inflammation and prevent joint damage. They may be used with DMARDs and other medications.Other biologic agents work to suppress the immune system in slightly different ways, including abatacept (Orencia), rituximab (Rituxan, Truxima, Ruxience), anakinra (Kineret) and tocilizumab (Actemra). All biologics can increase the risk of infection.
• Corticosteroids. Medications such as prednisone may be used to control symptoms until another medication takes effect. They are also used to treat inflammation when it is not in the joints, such as inflammation of the sac around the heart.These drugs can interfere with normal growth and increase susceptibility to infection, so they generally should be used for the shortest possible duration.

2. Therapies

Your doctor may recommend that your child work with a physical therapist to help keep joints flexible and maintain range of motion and muscle tone.

A physical therapist or an occupational therapist may make additional recommendations regarding the best exercise and protective equipment for your child.

A physical or occupational therapist may also recommend that your child make use of joint supports or splints to help protect joints and keep them in a good functional position.

3. Surgery

In very severe cases, surgery may be needed to improve joint function.

***Parents or caregivers help limit the arthritis in your children by doing the following:

• Getting regular exercise. Exercise is important because it promotes both muscle strength and joint flexibility. Swimming is an excellent choice because it places minimal stress on joints.
• Applying cold or heat. Stiffness affects many children with juvenile idiopathic arthritis, particularly in the morning. Some children respond well to cold packs, particularly after activity. However, most children prefer warmth, such as a hot pack or a hot bath or shower, especially in the morning
•  Eating Well. Some children with arthritis have poor appetites. Others may gain excess weight due to medications or physical inactivity. A healthy diet can help maintain an appropriate body weight.Know adequate calcium in the diet is important because children with juvenile idiopathic arthritis are at risk of developing weak bones due to the disease, the use of corticosteroids, and decreased physical activity and weight bearing.

“Arthritis in children is called childhood arthritis or juvenile arthritis. The most common type of childhood arthritis is juvenile idiopathic arthritis (JIA), also known as juvenile rheumatoid arthritis.

Childhood arthritis can cause permanent physical damage to joints. This damage can make it hard for the child to do everyday things like walking or dressing and can result in disability.”

Centers for Disease Prevention and Control (CDC)

“Rheumatoid arthritis and osteoarthritis are different types of arthritis. They share some similar characteristics, but each has different symptoms and requires different treatment. So an accurate diagnosis is important.

Osteoarthritis is the most common form of arthritis. Rheumatoid arthritis affects about one-tenth as many people as osteoarthritis.

The main difference between osteoarthritis and rheumatoid arthritis is the cause behind the joint symptoms. Osteoarthritis is caused by mechanical wear and tear on joints. Rheumatoid arthritis is an autoimmune disease in which the body’s own immune system attacks the body’s joints.”

MyHealth.Alberta.Ca (https://myhealth.alberta.ca/Health/Pages/conditions.aspx?hwid=aa19377)

Arthritis is inflammation of one or more of your joints. (Arthro=joint / itis = inflammation)

The main symptoms of arthritis are joint pain and stiffness, which typically worsen with age. Rheumatoid Arthritis symptoms are joint inflammation that comes from pain, warmth, and swelling. The inflammation is typically symmetrical that is occurring on both sides of the body at the same time (such as hands, wrists, or knees). Other signs of Rheumatoid Arthritis include joint stiffness that is particularly in the AM upon awakening or after periods of inactivity; ongoing fatigue, and low-grade fever. Signs and symptoms come about gradually over years but can come on rapidly for some other people.

The two most common types of arthritis are osteoarthritis and rheumatoid arthritis.

Osteoarthritis is usually caused by normal wear and tear, while rheumatoid arthritis is an autoimmune disorder. Other types of arthritis can be caused by uric acid crystals, infections or even an underlying disease, such as psoriasis or lupus.

Treatments vary depending on the type of arthritis. The main goals of arthritis treatments are to reduce signs or symptoms and improve quality of life through Occupational or Physical Therapy and/or through medications, the old way.

Things that make arthritis worse: 1.) conventional medicine through doctors ordering medications (see Dr. David Brownstein’s website for his Natural Way to Health (with his book) to overcome arthritis). Drugs rarely CURE things. We are trained to believe doctors have all the answers with medications or surgeries in resolving our health problem. NOT THE CASE ALWAYS. It’s unnatural with arthritis and many other diagnoses. Natural therapies and good foods are not taken seriously by enough people in America in regards to helping a condition, like arthritis, or even prevention (which should be your first intervention, don’t wait for the diagnosis).

2.)Infection – check if a bacterial infection started your arthritis. If that is the cause antibiotics, low dose some doctors have given to people in studies and have worked. You would think this would be used more often, at least in testing for before just prescribing anti-inflammatory or analgesics meds. If its infection you need to kill the bacteria and the only way to do that it is with an antibiotic which kills a bacterial infection.

3.)DIET – Too many sugars or chemical preservatives and sweeteners which is in the standard American diet. Processed Foods are BAD.  The same foods that cause obesity, diabetes and coronary artery disease can easily cause arthritis. Increase your fruits and nuts in your diet. Vitamin C and E are good for you. Pomegrante extract also.

4.) Dehydration- main causes of arthritis. Many simplify the problem. Your joints need water and if not enough it will cause an auto immune response=inflammation and get worse with processed foods.

5.) Heavy metal toxicity-Mercury, Arsenic and Nickel it includes. Not a fluke and mercury is one of the worst metals to have toxic in your body. Fish is the second worst source of heavy metal food. Few things you can do now, eat tuna occasionally. Silver malcum fillings have your dentist remove. Have your doctor do a heavy metal toxicity test on you if you never had one done and with arthritis.

6.) Low or imbalances of hormones=headache, faster aging, fatigue/lethargy, skin wrinkling sooner in life. Synthetic hormones don’t perform as well in your body and can lead to problems. Female hormones   can increase your chance to breast cancer for example.

ACT America and one way to do that is go to Dr. David Brownstein website and check out Reverse your Arthritis to deal with your arthritis naturally and reading his books with bonuses.

Diet and bodyweight impact on arthritis

Experts say that eating a well-balanced diet is vital when you have arthritis. Not only will you be receiving critical nutrients, you will also be either maintaining or arriving more quickly at a healthy bodyweight. If you are overweight you will be adding extra pressure on weight-bearing joints. Many patients have found that losing just a few pounds made a significant difference to their quality of life. Doctors and nutritionists are more frequently advising arthritis patients to keep sugary and/or fatty foods to a minimum – such as red meat, cream and cheese. You should make sure you are eating plenty of fruit and vegetables, as well as whole grains. Omega-3 essential fatty acids are thought to relieve to some extent the symptoms of arthritis. A common source of Omega-3 fatty acids is oily fish, such as sardines, herring, trout, and salmon.  The healthier our country the better our health care system will turn out for everyone.

“Helen Keller was an author, lecturer, and crusader for the handicapped.  Widely honored throughout the world and invited to the White House by every U.S. president from Grover Cleveland to Lyndon B. Johnson, Keller altered the world’s perception of the capacities of the handicapped. More than any act in her long life, her courage, intelligence, and dedication combined to make her a symbol of the triumph of the human spirit over adversity.  She went on to acquire an excellent education and to become an important influence on the treatment of the blind and deaf who as a baby younger than 2 years old was diagnosed deaf and blind!”.

History (https://www.history.com/topics/womens-history/helen-keller)

Orientation and Mobility

In addition, the child who is deaf-blind will need help learning to move about in the world. Without vision, or with reduced vision, he or she will not only have difficulty navigating, but may also lack the motivation to move outward in the first place. Helping a young child who is deaf-blind learn to move may begin with thoughtful attention to the physical space around him or her (crib or other space) so that whatever movements the child instinctively makes are rewarded with interesting stimulation that motivates further movement. Orientation and mobility specialists can help parents and teachers to construct safe and motivating spaces for the young child who is deaf-blind. In many instances children who are deaf-blind may also have additional physical and health problems that limit their ability to move about. Parents and teachers may need to include physical and occupational therapists, vision teachers, health professionals, and orientation and mobility specialists on the team to plan accessible and motivating spaces for these children. Older children or adults who have lost vision can also use help from trained specialists in order to achieve as much confidence and independence as possible in moving about in their world.

Individualized Education

Education for a child or youth with deaf-blindness needs to be highly individualized; the limited channels available for learning necessitate organizing a program for each child that will address the child’s unique ways of learning and his or her own interests. Assessment is crucial at every step of the way. Sensory deficits can easily mislead even experienced educators into underestimating (or occasionally overestimating) intelligence and constructing inappropriate programs.

Helen Keller said, “Blindness separates a person from things, but deafness separates him from people.” This potential isolation is one important reason why it is necessary to engage the services of persons familiar with the combination of both blindness and deafness when planning an educational program for a child who is deaf-blind. Doing so will help a child or youth with these disabilities receive an education which maximizes her or his potential for learning and for meaningful contact with her or his environment. The earlier these services can be obtained, the better for the child.

Transition

When a person who is deaf-blind nears the end of his or her school-based education, transition and rehabilitation help will be required to assist in planning so that as an adult the individual can find suitable work and living situations. Because of the diversity of needs, such services for a person who is deaf-blind can rarely be provided by a single person or agency; careful and respectful teamwork is required among specialists and agencies concerned with such things as housing, vocational and rehabilitation needs, deafness, blindness, orientation and mobility, medical needs, and mental health.

The adult who is deaf-blind must be central to the transition planning. The individual’s own goals, directions, interests, and abilities must guide the planning at every step of the way. Skilled interpreters, family members and friends who know the person well can help the adult who is deaf-blind have the most important voice in planning his or her own future.

Inclusion in Family

Clearly, the challenges for parents, teachers and caregivers of children who are deaf-blind are many. Not least among them is the challenge of including the child in the flow of family and community life. Since such a child does not necessarily respond to care in the ways we might expect, parents will be particularly challenged in their efforts to include her or him. The mother or father of an infant who can see is usually rewarded with smiles and lively eye contact from the child. The parent of a child who is deaf-blind must look for more subtle rewards: small hand or body movements, for instance, may be the child’s way of expressing pleasure or connection. Parents may also need to change their perceptions regarding typical developmental milestones. They can learn, as many have, to rejoice as fully in the ability of their child who is deaf-blind to sign a new word, or to feed herself, or to return a greeting as they do over another child’s college scholarship or success in basketball or election to class office.

Parents, then, may need to shift expectations and perceptions in significant ways. They also need to do the natural grieving that accompanies the birth of a child who is disabled. Teachers and caregivers must also make these perceptual shifts. Parents’ groups and resources for teachers can provide much-needed support for those who live and work with children and adults who are deaf-blind. Such supports will help foster the mutually rewarding inclusion of children who are deaf-blind into their families and communities. (See section below for resources.)

Summary

Though deaf-blindness presents many unique challenges to both those who have visual and hearing impairments and to their caregivers and friends, these challenges are by no means insurmountable. Many persons who are deaf-blind have achieved a quality of life that is excellent. The persons who are deaf-blind who have high quality lives have several things in common.

First, they have each, in their own way, come to accept themselves as individuals who have unique experiences of the world, and valuable gifts to share. This fundamental acceptance of self can occur regardless of the severity of the particular sensory losses or other challenges that a person has. Second, they have had educational experiences which have helped them maximize their abilities to communicate and to function productively. Finally, these happy, involved persons who are deaf-blind live in families, communities, or social groups that have an attitude of welcoming acceptance. They have friends, relatives, and co-workers who value their presence as individuals with significant contributions to make to the world around them. For these persons with limited sight and hearing, and for those near them, deaf-blindness fosters opportunities for learning and mutual enrichment.

“Undeterred by deafness and blindness, Helen Keller rose to become a major 20^th century humanitarian, educator and writer. She advocated for the blind and for women’s suffrage and co-founded the American Civil Liberties Union.  Before Helen’s second birthday, a serious illness—possibly meningitis or scarlet fever—left her deaf and blind. She had no formal education until age seven, and since she could not speak, she developed a system for communicating with her family by feeling their facial expressions. Recognizing her daughter’s intelligence, Keller’s mother sought help from experts including inventor Alexander Graham Bell, who had become involved with deaf children. Ultimately, she was referred to Anne Sullivan, a graduate of the Perkins School for the Blind, who became Keller’s lifelong teacher and mentor.

Sullivan married Harvard instructor and social critic John Macy in 1905, and Keller lived with them. During that time, Keller’s political awareness heightened. She supported the suffrage movement, embraced socialism, advocated for the blind and became a pacifist during World War I. Keller’s life story was featured in the 1919 film, Deliverance. In 1920, she joined Jane Addams, Crystal Eastman, and other social activists in founding the American Civil Liberties Union; four years later she became affiliated with the new American Foundation for the Blind in 1924.

After Sullivan’s death in 1936, Keller continued to lecture internationally with the support of other aides, and she became one of the world’s most-admired women (though her advocacy of socialism brought her some critics domestically). During World War II, she toured military hospitals bringing comfort to soldiers.

A second film on her life won the Academy Award in 1955; The Miracle Worker.”

National Women’s History Museum (https://www.womenshistory.org/education-resources/biographies/helen-keller)

Today, many children who are born deaf or blind have access to amazing support to help them navigate the world. Similarly, those who suffer loss of hearing or sight later in life have numerous resources to help them overcome communication barriers introduced by their new reality. It’s unlikely that those in this situation would be cut off completely from communicating with others. In the 1880s, Helen Keller wasn’t so fortunate. Despite all of the barriers that she faced because of her deafness, her blindness and her gender, she was able to do impressive work with Anne Sullivan to move care of the deaf-blind population forward

Those unfortunately born with no sight and hearing face many challenges.

It may seem that deaf-blindness refers to a total inability to see or hear. However, in reality deaf-blindness is a condition in which the combination of hearing and visual losses in children cause “such severe communication and other developmental and educational needs that they cannot be accommodated in special education programs solely for children with deafness or children with blindness” ( 34 CFR 300.8 ( c ) ( 2 ), 2006) or multiple disabilities. Children who are called deaf-blind are singled out educationally because impairments of sight and hearing require thoughtful and unique educational approaches in order to ensure that children with this disability have the opportunity to reach their full potential.

A person who is deaf-blind has a unique experience of the world. For people who can see and hear, the world extends outward as far as his or her eyes and ears can reach. For the young child who is deaf-blind, the world is initially much narrower. If the child is profoundly deaf and totally blind, his or her experience of the world extends only as far as the fingertips can reach. Such children are effectively alone if no one is touching them. Their concepts of the world depend upon what or whom they have had the opportunity to physically contact.

If a child who is deaf-blind has some usable vision and/or hearing, as many do, her or his world will be enlarged. Many children called deaf-blind have enough vision to be able to move about in their environments, recognize familiar people, see sign language at close distances, and perhaps read large print. Others have sufficient hearing to recognize familiar sounds, understand some speech, or develop speech themselves. The range of sensory impairments included in the term “deaf-blindness” is great.

As far as it has been possible to count them, there are over 10,000 children (ages birth to 22 years) in the United States who have been classified as deaf-blind (NCDB, 2008). It has been estimated that the adult deaf-blind population numbers 35-40,000 (Watson, 1993). The causes of deaf-blindness are many. Below is a list of many of the possible etiologies of deaf-blindness.

Major Causes of Deaf-Blindness
Syndromes-Like Down Syndrome, Trisomy13 Syndrome & Usher

Multiple Congenital Anomalies- Like CHARGE Association, Fetal alcohol syndrome, Hydrocephaly, Maternal drug abuse and Microcephaly.

Prematurity=Congenital Prenatal Dysfunction.  Like AIDS, Herpes, Rubella, Syphilis and Toxoplasmosis.

Post-natal Causes- Like Asphyxia, Encephalitis, Head injury/trauma, Meningitis and Stroke.

The one major CHALLENGE these patients face:

Communication

The disability of deaf-blindness presents unique challenges to families, teachers, and caregivers, who must make sure that the person who is deaf-blind has access to the world beyond the limited reach of his or her eyes, ears, and fingertips. The people in the environment of children or adults who are deaf-blind must seek to include them—moment-by-moment—in the flow of life and in the physical environments that surround them. If they do not, the child will be isolated and will not have the opportunity to grow and to learn. If they do, the child will be afforded the opportunity to develop to his or her fullest potential.

The most important challenge for parents, caregivers, and teachers is to communicate meaningfully with the child who is deaf-blind. Continual good communication will help foster his or her healthy development. Communication involves much more than mere language. Good communication can best be thought of as conversation. Conversations employ body language and gestures, as well as both signed and spoken words. A conversation with a child who is deaf-blind can begin with a partner who simply notices what the child is paying attention to at the moment and finds a way to let the child know that his or her interest is shared.

This shared interest, once established, can become a topic around which a conversation can be built. Mutual conversational topics are typically established between a parent and a sighted or hearing child by making eye contact and by gestures such as pointing or nodding, or by exchanges of sounds and facial expressions. Lacking significant amounts of sight and hearing, children who are deaf-blind will often need touch in order for them to be sure that their partner shares their focus of attention. The parent or teacher may, for example, touch an interesting object along with the child in a nondirective way. Or, the mother may imitate a child’s movements, allowing the child tactual access to that imitation, if necessary. (This is the tactual equivalent of the actions of a mother who instinctively imitates her child’s babbling sounds.) Establishing a mutual interest like this will open up the possibility for conversational interaction.

Teachers, parents, siblings, and peers can continue conversations with children who are deaf-blind by learning to pause after each turn in the interaction to allow time for response. These children frequently have very slow response times. Respecting the child’s own timing is crucial to establishing successful interactions. Pausing long enough to allow the child to take another turn in the interaction, then responding to that turn, pausing again, and so on—this back-and-forth exchange becomes a conversation. Such conversations, repeated consistently, build relationships and become the eventual basis for language learning.

As the child who is deaf-blind becomes comfortable interacting nonverbally with others, she or he becomes ready to receive some form of symbolic communication as part of those interactions. Often it is helpful to accompany the introduction of words (spoken or signed) with the use of simple gestures and/or objects which serve as symbols or representations for activities. Doing so may help a child develop the understanding that one thing can stand for another, and will also enable him or her to anticipate events.

Think of the many thousands of words and sentences that most children hear before they speak their own first words. A child who is deaf-blind needs comparable language stimulation, adjusted to his or her ability to receive and make sense of it. Parents, caregivers, and teachers face the challenge of providing an environment rich in language that is meaningful and accessible to the child who is deaf-blind. Only with such a rich language environment will the child have the opportunity to acquire language herself or himself. Those around the child can create a rich language environment by continually commenting on the child’s own experience using sign language, speech, or whatever symbol system is accessible to the child. These comments are best made during conversational interactions. A teacher or a parent may, for example, use gesture or sign language to name the object that he or she and the child are both touching, or name the movement that they share. This naming of objects and actions, done many, many times, may begin to give the child who is deaf-blind a similar opportunity afforded to the hearing child—that of making meaningful connections between words and the things for which they stand.

Principal communication systems for persons who are deaf-blind are these:

• touch cues
• gestures
• object symbols
• picture symbols
• sign language
• fingerspelling
• Signed English
• Pidgin Signed English
• braille writing and reading
• Tadoma method of speech reading
• American Sign Language
• large print writing and reading
• lip-reading speech

Along with nonverbal and verbal conversations, a child who is deaf-blind needs a reliable routine of meaningful activities, and some way or ways that this routine can be communicated to her or him. Touch cues, gestures, and use of object symbols are some typical ways in which to let a child who is deaf-blind know what is about to happen to her or him. Each time before the child is picked up, for example, the caregiver may gently lift his or her arms a bit, and then pause, giving the child time to ready herself or himself for being handled. Such consistency will help the child to feel secure and to begin to make the world predictable, thus allowing the child to develop expectations. Children and adults who are deaf-blind and are able to use symbolic communication may also be more reliant on predictable routine than people who are sighted and hearing. Predictable routine may help to ease the anxiety which is often caused by the lack of sensory information.

Stay tune for Part II tomorrow on other challenges.