Peer Review

Richards 2

Nitara Richards

Rechelle Christie

English 1302

12 February 2019

Modern medicine verse Alternative medicine when treating arthritis in the pediatric population.

After returning home from a hard day at work, you sit with your family and friends and watch a little bit of television. There are all kinds of commercials that are advertise, some are about pain, medications and symptoms to ask your doctor about. Who really cares about half of the “garbage”, that is on TV, now of days? I am not saying that everything played on TV is not important, but there are a lot of commercials they play that no one ever thinks about. Until that one day, something on TV was said that caught your attention. It usually starts like this, “Do you have swelling, joint pain, stiffness in the morning and decrease range of motion”. That when a little light bulb appears and you think to yourself, well I don’t but my child has been waking up like this every morning. Juvenile idiopathic arthritis is the most common form of arthritis in children and adolescent, affecting approximately 1 in every 1000 young people (Brinkman p.2). Recent studies show that rheumatoid diseases are the most common disease among the population, with juvenile arthritis being the most among the children age 16 and under. Approximately 113 out of 100,000 children are diagnosed with arthritis every year (Shahzad p.1249). Now what do you do as a parent, the emotions, the shock, the fear of the unknown. All the questions you might have about treatment, what is right for my child is probably what is racing through your mind. Hearing a diagnosis of a chronic illness in a child is one of the most emotionally difficult situations a parent may face (Gomez-Ramirez p.2). The parents emotional experience seems to reflect the child’s disease outcome, so learning your choices in treatment options can be important and beneficial in the clinical outcomes for a child with juvenile idiopathic arthritis (Gomez-Ramirez p.2). This can be a lot to deal with, knowing about the different treatments available for your child can improve their quality of life significantly. Learning about the disease, dealing with your emotions and treatment options are all very important. There are so many choices that you now must make regarding your child’s health and the right decisions toward recovery or even remission. There are several very effective treatment options when using modern medicine but also alternative medicine. Parents having a child recently diagnosed with a chronic illness, like arthritis, they should be given all information on both modern and alternative therapies before deciding what options would be the best form of treatment.

Arthritis is a well-known disease by many people. As many may think, arthritis is not just one single disease. It is an informal way to referring to joint pain or joint disease (arthritis.org). From the young age group to the older age group, arthritis can occur. All though, arthritis is common, it is not well understood (arthritis.org). This is not to say that you don’t know what arthritis is but let me break down the word “arthr-itis”. Arthro is a Greek word, meaning joints, “itis”, is also a Greek word meaning inflammation, juvenile is another way of saying young or youthful and idiopathic means, of unknown cause. The most common symptoms of arthritis can include swelling, stiffness, pain and decrease range of motion. This can lead to disabling the function of daily activity and their routine. When treating arthritis, it can vary depending on the type and most important the age of the person with it. Juvenile idiopathic arthritis is the most common type of arthritis in children where the immune system mistakenly attacks the body’s tissues, causing inflammation in joints and potentially other areas of the body (arthritis.org).

Many people assume that when using alternative methods, it causes less harm to their child. You would think that when it come to your child being diagnosed with a chronic condition such as arthritis, the decision would be easy. You only want the best, the more efficient, cost effective and safest treatment, which means natural, right? Well in some instances of pediatric arthritis this is not always the case. Treatment can involve a combination of different types of care. One being alternative medicine and treatment, also known as, holistic or natural approach. When talking with your child’s Rheumatologist they would recommend daily stretches, physical therapy to help keep joints flexible and maintain range of motion and tone (MayoClinic.org) They would also recommend, warm compresses, these can provide low-level heat lasting up to 8 hours, one called Therma-Care. Parents may like this because it is portable, do not contain medication and come in variety of sizes to wrap around joints. Then there is cold application, like Icy hot it creates a cooling sensation. This can also relieve painful flare-ups but most of these products contains menthol which is a compound that has a minty taste and smell and it also is a natural analgesic. Many parents share stories of the different treatment they have tried, such as changing eating habits, regular exercise, oils and long baths of soaking in warm water with Epsom salt (kidsgetarthritistoo.org). Some agree that this does help, most of the time, not saying that these are not good ways to treat but there are some that have not had successful outcomes to only this. With all the studies and politics out now on modern medicine and how, they believe, it is causing further damage, wanting to attempt treatment with more of a natural approach seems to be the right option but this might not be the only treatment you should try with you child.

Another way is modern medicine, also called conventional medicine. This can involve treating with weekly injections or monthly IV medication to treat your child arthritis inflammation. The medications used to help children with arthritis are chosen to decrease pain, improve function and minimize potential joint damage (MayoClinic.org). NSAIDs, DMARDs, biologics and corticosteroids are among the medications they used to treat JIA. I know that these medication can be confusing but they are all used to relieve symptoms of pain, swelling and joint damage. These medications all have warning labels that a parent must pay attention to, like increase susceptibility to infection, liver problems and stomach issues. Closely monitoring of bloodwork and imaging is a must when starting these drugs. Several parents express their concerns for such an aggressive form of treatment and was hesitant about starting. After being on the medication for only two weeks, they saw major improvement with their child almost becoming symptom free (arthritis.org). It is not only the parent who is making the decision to start these medications. When the child of age and knows how they feel parent try to share the decision making with them as well. Shared decision making is a form of best practice in patient centered care. Although, some parent may think their child can’t make such a decision on what option works best because how complicated the disease process can be, this is not always the case. Studies show involving the patient and of course the parent, it allows them to share their preferences, goals and treatment outcomes (Brinkman p.2).

Having a child who is dealing with pain and suffering from arthritis can be hard. As a parent seeing your child’s life change instantly to constant pain, weakness and unexplained joint swelling can be devastating. I read in one of the articles that this can be challenging process for parents. They express the different stage of denial as they attempted to come to terms with the diagnosis (Gomez-Ramirez p.4). “It is almost like a rollercoaster”, is what one parent explain, the up and down of emotions is what they are referring to (Gomez-Ramirez). They go on to explain the anxiety, sense of not having control and the uncertain time frame of when their child will feel relief. They feel as if they missed something or why didn’t they notice how much pain their child was really in. They become frustrate with themselves that they did not take them in sooner to see a doctor. Most of the emotions increased when pain starts to increase. Lots of parents find that pain is a common finding among patients with juvenile arthritis. Several studies show that when a child verbalize, they have pain it is valid and reliable (Metivier p.81). Another method parent and providers use to obtain how much pain a smaller child might be having, is by using a face pain scale, it uses cartoon faces with various degree of smiles and frowns to detect the pain level (Wong and Baker, 1988). As I mention before, the parents emotional experience seems to reflect the child’s disease outcome. Not having the right state of mind or blind-sided on just pain, can affect the choices made regard to treatment.

Wanting to help them feel better sooner becomes your only focus. Treatment can be tricky and sometime a tough decision for a parent. Treatment options can include simple procedures, but it can also involve more aggressive actions like intravenous medications, weekly injections and prescription medication (MayoClinic.org). Both treatment options can help and benefit your child in different ways, but which is “better”. So, when making that decision for your child on what type of treatment can be a big decision an important, to the improvement of your child condition. Understanding the concept of the disease process of this condition can be confusing. I took interest in this when I started working for a pediatric Rheumatology clinic. I used to think that arthritis was not that serious for kids, I was so wrong. Speaking with the Rheumatology doctors that I now work with and looking at several websites and resources has help me have a better understanding of juvenile arthritis and treatment options. Although I should know better, being a nurse already, that there can be so much more to pediatric Juvenile idiopathic arthritis, it took me working in this unknown environment to really start thinking to myself this is so much more then I ever thought. It is heart breaking to see the pain and the changes that this can cause on the child and their parents.

Wanting to always do what is right and the quickest way to make the child feel one hundred percent better, is the goal. Both the uses of biologic medications and applying heat and oils, to diet change, are all very beneficial. But now you must understand your child condition before really coming to the best decision. I also believe educating others that will be in your child life is helpful. When parents express their concerns that their child can no longer play sports, walk or no longer enjoy what they love to do, can be traumatic to them and the child. The complaints of teachers and peers saying, “why is your child tired”, or “Just give your child extra time in the morning since they have so much pain getting up for school”. These are the hurtful and unthoughtful comments that parents must here while they are just trying to help their little one feel better. Many of our parents get their information off the website. Families, friends and teachers involve themselves in social activities that help them to understand the disease and the treatments. Arthritis foundation holds events around the country to help families connect with the information and with new friends. These events give the child and their parent a sense of control of their condition.

It has become common today to dismiss the modern medicine, because most believe it is failing and causing more harm then good. So, having to think about treatment in other ways would lead to wanting to play safe by choosing an alternative approach. With any disease and chronic conditions, it is good to have all your options and choices to make the best and the most beneficial decision. Learning more about both modern ways to treat juvenile arthritis as well as implementing alternative methods, can help you as a parent understand that there is not just one way to treating and helping your child overcome pain from this condition. But keeping your options open to varies treatments can help your child feel better, sooner.

Work cited

Gomez-Ramirez, Oralia. “A recurring rollercoaster ride: a qualitative study of the emotional experiences of parents of children with juvenile idiopathic arthritis”. Pediatric Rheumatology. (2016). P. 2-11. DOI 10.1186/s12969-016-0073-9. Accessed 20 February 2019

Shahzad, Farhana. “Juvenile arthritis disease activity score in children with juvenile idiopathic arthritis and its association with clinical disease activity in Lahore”. Pak Armed Forces Med”. J 2018;68 (5): revised received; 08 July 2017; accepted; 11 August 2017. p 1249-1255. Accessed 20 February 2019.

Brinkman, William, “Design and implementation of a decision aid for juvenile idiopathic arthritis medication choices”. Pediatric Rheumatology. (2017). P 2-8. DOI 10.1186/s12969-017-0177-x. Accessed 19 February 2019

Metivier, Heather, MS, PT, ATC. “Use of the faces pain scale to evaluate pain of a pediatric patient with pauciarticular juvenile rheumatoid arthritis”. Physiotherapy Theory and Practice, 22(2):91-96,2006, copyright Taylor & Francis Group, LLC. Publication 7 March 2005. DOI: 10.1080/09593980600564493. Accessed 21 February 2019.

Sen, Ethan. “Cross sectional, qualitative thematic analysis of patient perspective of disease impact in juvenile idiopathic arthritis-associated uveitis”. Pediatric Rheumatology, (2017) 15:58. P 2-8. DOI 10.1186/s12969-017-0189-6. Accessed 20 February 2019.

Arthritis Foundation. Kids get Arthritis too. 2017. Website. kidsgetarthritistoo.org/living-with-ja/. Accessed 22 February 2019.

American College of Rheumatology. “Online education tools helps Teens with juvenile arthritis improve quality of life”. Rheumatology.org. 04 November 2017. rheumatology.org/About-Us/Newsroom/Press-Releases/ArticleType/ArticleView/ArticleID/845. Accessed 22 February 2019.

By Mayo Clinic Staff, “Juvenile idiopathic Arthritis”, Mayo Clinic. Mayo Foundation for Medical Education and Research. 20 December 2017.mayoclinic.org/diseases-conditions/juvenile-idiopathic-arthritis/symptoms-causes/syc-20374082. Accessed 28 January 2019.