Stephen J. Schueler, M.D.

Overview Incidence Risk Factors Symptoms Evaluation Treatment questions for doctor specialist Home Care pain and inflammation taking control using crutches warning signs Outlook Complications Underlying Cause Types Anatomy

Rheumatoid Arthritis Juvenile Home Care

Home care for juvenile rheumatoid arthritis includes:

  • Avoid activities that cause pain.
  • Avoid prolonged standing.
  • Avoid remaining in one position.
  • Rest painful joints:
    • Use a walker.
    • Use crutches.
    • Use a cane.
    • Wear a sling.
  • Regular exercise program:
  • Acetaminophen for pain
  • Nonsteroidal anti-inflammatory medications for pain:
  • Take your prescribed medications as directed:
    • Don't skip doses of your medication. This makes them less effective.
    • Avoid running out of your medication. Refill your prescriptions early.
    • Don't stop taking your medication just because you feel better.
    • If you feel worse, talk to your doctor before you stop your medication.
    • Be aware of the common side effects that may be caused by your medication.
    • Do not stop prescription medications without talking to your doctor.
  • Use splints for joint pain:
  • Apply warm compresses for stiffness:
    • Apply for 20-30 minutes, every 1-2 hours.
  • Weight loss if you are overweight
  • Apply nonprescription pain rubs:
    • ArthriCare
    • Arthritis Pain Relieving Rub
    • Aspercreme
    • Ben-Gay
    • Capzasin-HP
    • Sportscreme
  • Learn everything you can about juvenile rheumatoid arthritis:
    • The more you know about your condition, the easier it will be to participate with your doctor in making treatment decisions.
    • Ask your doctor about good sources for information.
    • Write down questions to ask your doctor.

Rheumatoid Arthritis Juvenile Pain and Inflammation

Common medications used at home for pain and inflammation in children with juvenile rheumatoid arthritis include:


Aspirin and many of the other nonsteroidal anti-inflammatory drugs (NSAIDS) are not used in children except under a doctor's care. Ibuprofen or naproxen should not be taken along with a prescription NSAID.

Acetaminophen
  • Acetaminophen decreases fever and pain, but does not help inflammation.
  • Dosing is 10-15 mg per kilogram (5-7 mg per pound) of body weight every 4-6 hours, up to the adult dose.
  • Do not exceed the maximum daily dose.
  • Acetaminophen products come in various strengths. Always follow the package instructions.
  • Avoid this drug in children with liver disease or an allergy to acetaminophen.
  • Common acetaminophen products include Tylenol, Panadol and many others.

Ibuprofen

Naproxen

Rheumatoid Arthritis Juvenile Taking Control

The successful treatment of juvenile rheumatoid arthritis requires your participation in your child's care. Here are answers to some important questions.

Do you have control over your health and wellness?
Many people believe they have no control over their health and wellness. Many ignore personal health decisions or simply leave them to their doctors, relatives, or friends. In reality, you have the greatest potential to determine your relative health.

How is this possible? Do people really have control of their own health? The biggest killers are heart disease and cancer. Although many of these diseases seem to strike at random, our lifestyle choices greatly influence personal risk.

How can you participate in your health care?
To participate you must:

  • Learn to take responsibility for your own health.
  • Learn to partner with your doctor.
  • Learn how to make active decisions about your health.

How can you learn what you need to know?
  • Educate yourself.
  • Be skeptical: Learn to separate fact from fiction.
  • Billions of dollars are spent each year marketing dietary supplements, vitamins, and new medical treatments. Much of this is unnecessary and wasteful.
  • Be careful about where you get your health information.
    • Some of the best sources for health information on the web are professional societies and non-profit organizations.
    • Ask your doctor what he or she recommends.
  • Examine the credentials of the authors.
    • If you are reading about symptoms and disease, your best source is a licensed physician.
    • Pay attention to when the content was last updated.
    • Make sure the person is not just trying to sell you something.

Important questions you need to answer:
  • What things in your control can increase your risk for disease?
  • What can you do to decrease this risk?
  • What are vaccines and how can they help you?
  • How do your lifestyle choices increase your risk for disease?
  • How can you reduce stress?
  • What minor health problems can you treat at home?
  • When is a medical problem "serious"?
  • When should you call the doctor?

How can you find the right doctor?
Key points:
  • Everyone should have a primary care physician or family doctor. A primary physician is usually a family practitioner, internist, or pediatrician.
  • Establish a relationship in advance with your doctor.
  • Make sure you are comfortable with your primary care physician.
  • The internet contains many resources where you can do research to locate the doctor that is best for you.
  • You may wish to schedule a brief visit with the doctor to see if he or she is right for you.
    • Be open-minded, and allow your doctor to know you well. This will improve communication.

Important information you need to make your decision:
  • Physician credentials:
    • Internship and residency training is usually best from respected institutions, universities, and major hospitals.
    • Look for board certification in the specialty.
    • Ask about membership in medical societies.
  • Community and professional reputation are also important.
    • Are other patients happy with the doctor?
    • Has the doctor been disciplined by hospitals or agencies?
    • How long has the doctor been in practice?
    • In general, more than a few malpractice suits over a 5-10 year period should trigger caution.
  • Does the doctor communicate well? Are your questions answered during busy times?
  • Does the doctor welcome you to help make decisions about your care?
  • Is the doctor available when you need care?
  • What is the doctor's after-hours coverage?
  • Is he or she a member of a large group?
    • Do the doctors' cross-cover one another?
  • Where do they admit patients?

What is shared decision making?
You and your doctor must work together to jointly decide the best course of action to manage your health. This process is called "shared decision making". Your doctor becomes a guide and teacher and helps steer you toward the best treatment. Most doctors welcome this partnership. You must learn about your illnesses for shared decision-making to work.

For any recommended test, medication, or surgery, remember to ask:
  • How will this help me?
  • How much will it cost?
  • Is it covered by your insurance?
  • What are the potential side effects and risks?
  • What are my alternatives?

For tests, remember to ask:
  • Is it done in the office or at another facility?
  • Is it painful?
  • How will the results of this test influence my care?

For surgery or other procedures, remember to ask:
  • How long will it take to heal?
  • How many cases has the doctor done?
  • What would your doctor do if he or she were the patient?
  • Where is it done?
  • Who will perform it?
  • What are the doctor's qualifications?

What should you expect?
Shared decision making becomes impossible if you do not know what to expect from your doctor.

The American Hospital Association has published a "Patient's Bill of Rights" that is a good guide. It states that you have the right:
  • To be spoken to in words that you understand
  • To be told what's wrong with you
  • To know the benefits of any treatment and any alternatives
  • To know what a treatment or test will cost
  • To share in treatment decisions
  • To read your medical record
  • To refuse any medical procedure

What should you do before an office visit?
  • Bring all important medical information with you to the visit.
  • Make sure you can answer questions about the following:
    • Allergies and side effects to medicines
    • Current medicines you are taking. This includes herbs and vitamins. Make a list if necessary.
    • Insurance information
    • Marital and sexual history
    • Past injuries and hospital stays
    • Past medical problems
    • Past surgeries and operations
    • Pre-visit questionnaires
    • Use of tobacco, alcohol and drugs
    • Work history

What should you expect from the visit?
  • You should plan to wait if you go without an appointment. Emergencies or sick patients in the hospital may interrupt your doctor.
  • Bring along a book or toys for the kids. You may also have to wait during busy times.
  • Tell your doctor about your problem in a clear manner. Start from the beginning and go through each symptom as it appeared.
  • Before the visit, think about what makes your problem better or worse. Your doctor will probably ask you questions about this.
  • Most doctors ask many questions about unrelated symptoms. These questions help assure that there are no other problems that need attention.
  • Be sure to answer all questions truthfully. This includes sensitive questions about smoking, drug use, sexual activity, and work. Your history is the most important part of deciding what is wrong with you.
  • If you have any difficulty communicating your concerns, bring a family member or friend to assist in this task.
  • Talk to your doctor and do not leave the office without asking necessary questions. Your doctor can make you more comfortable if he or she understands your concerns.

What should you know about your medications?
Every year many people become ill because of problems with medications.

Remember to ask:
  • What side effects to expect.
  • What drug interactions are possible.
    • Find out if a new medicine reacts with those that you are taking now.
    • Many over-the-counter drugs and dietary supplements can also cause serious side effects and drug interactions.
    • Some drugs interact with certain foods, vitamins, nicotine, and alcohol.
  • Make sure you can drive or operate machines safely while taking a medicine.
  • Ask your doctor how much a prescription costs.
    • Is there a less expensive option or a generic version?

What is a treatment plan?
A treatment plan is what you and your doctor decide to do for an illness. A treatment plan cannot be effective without your participation.

Three simple questions can help you get the most from your treatment plan:
  • What is my main problem?
  • What do I need to do?
  • Why is it important for me to do these things?

Other important points:
  • Be sure you understand your treatment plan.
  • Stick with the treatment plan and allow time for improvement.
  • Don't stop medicines when you feel better; check with your doctor first.
  • Call your doctor if your condition is becoming worse.
  • Your doctor should tell you what to expect and when to follow-up or call the office.

Rheumatoid Arthritis Juvenile Using Crutches

Some children with juvenile rheumatoid arthritis may have difficulty walking due to hip, knee or ankle pain. A child with juvenile rheumatoid arthritis may require crutches.

Proper Adjustment for Crutches

  • The top of your crutch should be 1-1.5 inches below your armpit as you stand upright and the crutch rests on the floor.
  • The hand grips should be even with your hip joint.
  • Your elbows should bend as you use the hand grips.

Non Weight Bearing Technique
  • Stand on the good leg while using the crutches for balance.
  • Hold the bad leg off the floor.
  • Begin your step as if you are going to step on the bad leg, but do not place any weight on this leg. Instead, place both crutches in front of you and place your weight on your arms.
  • Your arms are supported by the crutches as you grip the crutch handles.
  • The crutches should be placed on the floor at an angle away from the side of your body, in a shape like the upright arms of the capital letter, "A."
  • Your elbows should bend as you support your weight.
  • Gently push off with your good leg after the crutches are firmly planted on the floor. Swing your body forward between the crutches.
  • Rest the top of the crutches tightly against each side of your chest and continue to support your weight with your arms.
  • Do not rest your armpits on the tops of the crutches. This can cause nerve damage.
  • Place your good leg on the floor and allow it to completely support your weight. Swing your crutches slightly away from your body and forward. Place the crutches on the floor to prepare for the next step.
  • Focus on where you are walking -- do not look at your feet.

Partial Weight Bearing Technique
  • Stand on the good leg while using the crutches for balance.
  • Begin to step on the bad leg, but do not place your entire weight on this leg. Instead, place most of your weight on your arms.
  • Your arms are supported by the crutches as you grip the crutch handles.
  • The crutches should be placed on the floor at an angle away from the side of your body, in a shape like the upright arms of the capital letter, "A."
  • Your elbows should bend as you support your weight.
  • Gently push off with your good leg after the crutches are firmly planted on the floor. Swing your bad leg forward between the crutches.
  • Rest the top of the crutches tightly against each side of your chest. Continue to support your weight with your arms and the bad leg.
  • Do not rest your armpits on the tops of the crutches.
  • Place your good leg on the floor and allow it to completely support your weight. Swing your crutches slightly away from your body and forward. Place the crutches on the floor to prepare for the next step.
  • Focus on where you are walking -- do not look at your feet.

Climbing Stairs with Crutches
When climbing stairs, you should climb one stair at a time, completely resting for a moment on one step before moving to the next step.

Follow these steps:
  • Start by supporting your weight with your good leg and both crutches.
  • Place your weight on both of the crutches and move your good leg up to the next step.
  • Transfer your weight to the good leg.
  • Lift the bad leg and the crutches onto the same step where you placed the good leg.
  • Support and stabilize yourself with both crutches and the good leg before moving to the next step.

Going down Stairs on Crutches
When going down stairs, you should go down one stair at a time. Stop and rest for a moment on one step before moving to the next step.

Follow these steps:
  • Start by supporting your weight with your good leg and both crutches.
  • Place your weight on the good leg and place both of the crutches onto the next lower step.
  • Transfer your weight to both crutches.
  • Place the good leg onto the same step where you placed the crutches.
  • Support and stabilize yourself with both crutches and the good leg before moving to the next step.

Rheumatoid Arthritis Juvenile Warning Signs

Notify your doctor if you have juvenile rheumatoid arthritis and any of the following:

Continue to Rheumatoid Arthritis Juvenile Outlook

Last Updated: Mar 7, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Rheumatoid Arthritis Juvenile References
  1. Garnett WR. GI effects of OTC analgesics: implications for product selection. J Am Pharm Assoc (Wash). 1996 Sep;NS36(9):565-72. [8824076]
  2. Schnitzer TJ. Non-NSAID pharmacologic treatment options for the management of chronic pain. Am J Med. 1998 Jul 27;105(1B):45S-52S. [9715834]
  3. Soeken KL, Miller SA, Ernst E. Herbal medicines for the treatment of rheumatoid arthritis: a systematic review. Rheumatology (Oxford). 2003 May;42(5):652-9. [1270954]
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