It has been observed that juvenile rheumatoid arthritis is the most frequently occurring form of arthritis in pediatric aged children. Most characteristic feature is the high rate of malnutrition in children with juvenile rheumatoid arthritis. Investigators suggested that intake of several nutrients in supplemental forms can help in improving the symptomatology and reduce the risk of complications.
According to latest estimates 300,000 children suffer from arthritis in United States each year, of which approximately one-sixth cases (or 50,000 adolescents) are diagnosed with juvenile rheumatoid arthritis, making it the most common type of arthritis in pediatric aged children. According to another study published in The Journal of Rheumatology (1), the incidence of juvenile rheumatoid arthritis is 11.6 per 100,000 pediatric aged children (with slightly more cases reported in females than males 16.4 vs. 7.7 per 100,000).
Symptoms of with juvenile rheumatoid arthritis (also known as idiopathic rheumatoid arthritis) are usually different from traditional varieties of arthritis.
Most cases begin with non-specific symptoms such as:
- Fever (high grade) that may mimic a viral illness
- Unexplained rash (which is diffuse in most cases)
- Swelling of joint
However once the inflammation is established, the child may experience varying intensity of disabling symptoms that may include:
- Recurring bouts of troubling joint pain (that may lead to limping while walking) especially after periods of prolonged activity or after periods of inactivity (like early morning or after a nap)
- Ongoing episodes of inflammation that is characterized by stiffness (lack of joint flexibility)
- Fever (low grade or high grade)
- Joint swelling (especially pronounced in large joints such as knee)
The symptoms may last for days, weeks, months or may evolve into permanent joint destruction and chronic symptoms that may last for years ultimately requiring joint replacement surgery.
What causes acute juvenile rheumatoid arthritis?
Unfortunately the cause of juvenile rheumatoid arthritis is not fully known. Investigators and healthcare providers believe that environmental factors, genetic mutations and other physical (or autoimmune factors) can lead to juvenile rheumatoid arthritis (suggesting a multi-factorial origin).
Parents should know about untreated or poorly managed juvenile rheumatoid arthritis can lead to permanent disability and long term complications such as inflammation of visual apparatus and even growth retardation in growing children. According to research conducted by Anthony C. Gregory II (2) and associates, the risk of several ophthalmological complications like uveitis, vision loss and other complications increases in JRA.
However, if immuno-suppressant drugs are utilized, the risk can be reduced significantly. Most treatment modalities aim at improving the severity of symptoms and reducing the pace of complications.
What are some great nutrition tips for a child with juvenile arthritis?
Consuming a balanced diet is the requirement of every human body either growing child or an adult. Child with rheumatic disease needs high nutritional diet and should consume balanced intake of nutrients (that can be achieved by consuming a wide variety of foods). The meal should be designed in accordance with the recommended serving size as suggested by US Department of Agriculture’s Food Guide Pyramid.
According to research report published in peer reviewed Journal of Microbiology, Immunology and Infection (3), investigators compared the nutritional status of 53 known patients of juvenile rheumatoid arthritis with 75 healthy subjects. The team of scientists identified that patients of JRA often have impaired nutritional status and lower body mass index as compared to normal controls.
Report also suggested that the risk of nutritional aberrations is higher in male patients and in adolescents who are older than 4 years of age. It is a well-established fact that inadequate nutrition can increase the risk of complications and immune deficits in such children many folds.
Below are some healthy nutritional tips for children with juvenile rheumatoid arthritis:
Tip # 1: Avoid high calorie foods
Typical staple foods consumed by most American families comprise of bread, corn, beans, cooked vegetables, rice and animal fats. Most typical western diets are comparatively low in proteins but high in calories. Consuming high calories diets can make a person obese and the excess weight further adds stress on lungs, joints and heart. It is seen that obesity may hasten the joint and cartilage destruction, thereby leading to osteoarthritis and other forms of joint dysfunctions.
Tip # 2: Promote weight loss by diet modification
One of the common reasons why obesity is so common in children with active rheumatic joint disease is the high prevalence of steroid therapy in this group to manage ongoing inflammation. Due to steroid mediated fluid retention and weight gain, the stress and pressure on already damaged joint increase many folds.
If a child is over-weight or obese, it is highly recommended to promote weight loss by diet modification and exercise (controlled physical activity). Following golden rules are exceptionally helpful in achieving healthy weight loss without affecting normal health or growth related processes.
- Limit your unhealthy fat intake
- Divide your food in multiple small portion to enhance basal metabolic processes
- Consume controlled quantity of food
- Maintain healthy and interactive exercise regimens to maintain steady weight loss
Tip # 3: Reduce the intake of unsaturated fatty acids
Reducing the daily fat intake can be very helpful in promoting weight loss in obese or over-weight children. Try to cut down fat usage (by removing thick layers of fat during preparation of food). Another way to decrease fat is by boiling, broiling or baking instead frying foods. Sauté food in nonstick pans with vegetable oil sprays.
Use low fat alternatives ingredients for high fat ingredients. You can use skim milk instead of whole milk, non-fat yogurt instead of sour cream, whole milk instead of cream etc. Non-fat yogurt can also be used in several baking recopies as a fat substitute.
Following are some tips which you have to remember for helping your child following a low calorie and low fat diet successfully:
- Decrease the quantity of high fat red meat consumption. Instead use fish, poultry or pasta in your diet with freshly prepared vegetable sauces.
- Make low calorie and low fat snacks for your child. Some healthy choices are fresh fruits, fresh vegetables served with low calorie dip sauce, sugar free Jell O, pretzels and plain popcorn. Low fat foods are not necessarily low in calories. Cookies prepared from low fat ingredients contain same quantity of calories as cookies prepared from high fat ingredients.
- Restrict drinks with high calories such as regular soda. Instead encourage your child for lemonade and juices with low calories. Low fat or skim milk can also be given to children above 1 year age.
According to a new research published in British Journal of Nutrition, a higher intake of unsaturated fatty acids in patients of juvenile rheumatoid arthritis is directly associated with a more vigorous inflammatory response (characterized by more frequent and intense episodes of joint pain and stiffness).
Tip # 4: Moderate physical activity
Doing exercise is also an important part of weight management program. Promote your life style by keeping yourself busy in physical work and limit yourself watching too much television or doing non-physical activities such as spending too much time on computer. Children who had gained a lot of weight can also join weight reduction programs.
Tip # 5: Maintain daily intake of calcium supplements
Calcium is an important ingredient for keeping muscles and bones strong. There are many steps which you can follow as a parent to make sure that your child is consuming enough calcium daily.
- Your child should consume 3 servings per day of calcium containing foods which include milk, yogurt, cheese, dairy products and calcium added orange juice
- Refried or baked beans, broccoli, almonds, dark green leafy vegetables are good source of consuming calcium
Caution should be maintained with over-the-counter calcium supplements since intake of exogenous calcium is strongly associated with increased calcium excretion in urine that may increase the risk of calcium stone formation in the urinary tract (7).
Tip # 6: Consume iron supplements to maintain normal blood cell count
Children having rheumatic diseases often experience impaired red blood cells production (leading to iron deficiency anemia that responds very well to iron supplementation). Foods rich with iron cannot treat completely anemic children of JRA and cannot completely fulfill iron deficiency).
Sufficient amount of iron intake is necessary for children with juvenile rheumatoid arthritis. Meat, refried or baked beans, red beans, nuts, cereals, eggs, peanut butter and green leafy vegetables are good source of iron containing foods.
Tip # 7: Intake of gluten-free diet
In some adolescents with an active history of juvenile rheumatoid arthritis, intake of gluten free diet can significantly improve the symptoms of arthritis and other related complications (such as gastrointestinal symptoms).
K Aalto (4) and associates enrolled 4 pediatric aged children with active juvenile rheumatoid arthritis to determine the efficacy of gluten free diet. The research team subjected the children (in the age range of 5 to 12 years) to gluten free diet for a period of 3 months.
After the completion of study period, investigators identified that symptoms of arthritis and gastrointestinal upset improved significantly suggesting a possible association of gluten protein in the pathogenesis of juvenile rheumatoid arthritis. Research team also identified a reduction in the serum concentration of anti-gliadin antibodies (that indicates immune-reactivity to food allergens).
Tip # 8: Intake of fish oil supplements
A number of research studies suggested that intake of omega-3 fatty acids (or fish oil supplements) is extremely helpful in improving the overall health and wellness in JRA patients. Most healthy sources of fish oil supplements are herring, salmon, and mackerel. Caution should be maintained in avoiding excessive intake of fish products (due to risk of mercury toxicity) and over-the counter supplements that are associated with diarrhea and upper gastrointestinal upset.
Tip # 9: Increase the intake of antioxidants
Research report by V. Araujo (6) and associates suggested that high degree of inflammation in the JRA patients increases the requirement of antioxidants which is why antioxidant supplements are fairly helpful in the management of chronic and poorly managed JRA. Author also suggested that children with active juvenile rheumatoid arthritis have lower concentration of β-carotene and Vitamin E levels as compared to normal children.
Tip # 10: Consume multi-vitamin and mineral supplements
There is no effective dietary restriction or dietary supplement which can treat childhood rheumatic disease. Consuming mineral supplement and multi-vitamins daily is suitable for children with unbalanced daily diet. Consuming iron and calcium daily in diet are helpful for children with juvenile rheumatoid arthritis. Research suggests that deficiency of major nutrients like folic acid, vitamin E, folic acid, vitamin D, vitamin B6, magnesium, vitamin C, zinc, vitamin B12, calcium and selenium is fairly common in JRA children as compared to normal controls.
1. Harrold, L. R., Salman, C., Shoor, S., Curtis, J. R., Asgari, M. M., Gelfand, J. M., … & Herrinton, L. J. (2013). Incidence and prevalence of juvenile idiopathic arthritis among children in a managed care population, 1996–2009. The Journal of rheumatology, 40(7), 1218-1225.
2. Gregory II, A. C., Kempen, J. H., Daniel, E., Kaçmaz, R. O., Foster, C. S., Jabs, D. A., … & Thorne, J. E. (2013). Risk factors for loss of visual acuity among patients with uveitis associated with juvenile idiopathic arthritis: the Systemic Immunosuppressive Therapy for Eye Diseases Study. Ophthalmology, 120(1), 186-192.
3. Shin, S. T., Yu, H. H., Wang, L. C., Lee, J. H., Lin, Y. T., Yang, Y. H., & Chiang, B. L. (2010). Nutritional status and clinical characteristics in children with juvenile rheumatoid arthritis. Journal of microbiology, immunology and infection, 43(2), 93-98.
4. Aalto, K., Lahdenne, P., & Kolho, K. L. (2011). Gluten-Free Diet in Juvenile Idiopathic Arthritis. Rheumatology, 1(102), 2161-1149.
5. Henderson, C. J., & Lovell, D. J. (1991). Nutritional aspects of juvenile rheumatoid arthritis. Rheumatic diseases clinics of North America, 17(2), 403-413.
6. Araujo, V., Arnal, C., Boronat, M., Ruiz, E., & Dominguez, C. (1998). Oxidant—antioxidant imbalance in blood of children with juvenile rheumatoid arthritis. Biofactors, 8(1‐2), 155-159.
7. Stapleton, F. B., Hanissian, A. S., & Miller, L. A. (1985). Hypercalciuria in children with juvenile rheumatoid arthritis: association with hematuria. The Journal of pediatrics, 107(2), 235-239.