Heartbreaking (a little off topic)

[Guest guest]

I was just about in tears today. As some of you may know, I am an admissions

nurse for a rehab facility (no, NOT a nursing home, but a true rehab. We do NOT

do long term placement, ALL of our patients are working on getting home).

Anyway, the patient was referred to us because at age 44 , he could not

function. Had to move in with his mother because he could not perform any of his

daily tasks without help. Could not go to the bathroom by himself. He finally

had a fall and was in so much pain that he was bedridden. He was admitted to the

hospital and the spine xrays revealed advanced ankylosing spondylitis, a form of

arthritis that affects the large joints and the spine. His primary physician

seemed to be aware he had this, but had never referred him to a rheumatologist.

All this patient had was pain meds, had NOTHING to stop the progression of the

disease. Now all they wanted to do was refer him to rehab without treating the

disease! I could not accept him for rehab, because patients have to be able to

tolerate at least 2-1/2 hours of therapy a day, and this patient couldn't even

tolerate sitting up!!

I told the case manager that my son had this disease, and that the patient

needed a referral to a rheumatologist to get on some medication to actually

treat the disease. My suggestion went in one ear and out the other, and my guess

is the patient will be referred to a nursing home since there is 'nothing that

can be done'.

It amazes me that in this day and age there is still such ignorance in the world

by these doctors. who are not educated about arthritis and do NOT educate

themselves!!

Believe me, it is out of my scope of practice, but I will find a way,

anonymously, to help this patient and his mother.

Please please please educate people about arthritis and let them know that they

do not have to accept what one doctor has to say. A second opinion, and standing

up for real treatment, just has to happen.

I'm sorry for this long winded post, but it really upset me today to see someone

just written off at 44 years old.

, adult onset RA, mom to Rob, 21, JAS

Rheumatic Diseases in Children: Disease Patterns

>

> Disease Patterns

> http://home.t-online.de/home/rheuma-kinderklinik/rke-e002.htm

>

> Many people think of " rheumatism " still as being a disease of

> adults or

> seniors. That is not the case: For one thing, rheumatism is not

> a single

> disease but a collective term for many different illnesses. In

> the other

> hand unfortunately also children and adolescents contract the disease.

> Besides there are a few rheumatic diseases which occur almost

> only in

> children. The rheumatic diseases have in common that the immune system

> does not work properly and begins to attack not only foreign matters

> (e.g. viruses or bacteria) but also body's own tissue. Joint

> inflammations can thus arise. Also impairments in tendons, muscles,

> blood vessels and other organs can develop.

>

> Below we shall give a short survey about the most important rheumatic

> diseases of childhood and adolescence.

> 1. Transient synovitis of the hip (itis fugax)

>

> The most frequent joint inflammation in children is called transient

> synovitis of the hip. This inflammation of the hip joint involves

> chiefly children between the 3rd and 10th year of life. They suddenly

> start to limp, refuse to walk, and complain of pains. Transient

> synovitis of the hip is generally painful, but resolves completely

> without any lasting sequelae in most cases. But often at onset

> it is

> difficult to isolate it from other partly severe diseases of the hip.

> Therefore various examinations may be required before a certain

> diagnosis can be set.

>

> 2. Reactive Arthritis

>

> Many joint inflammations develop as a reaction of the body's own

> defensemechanisms to previous infections with bacteria or

> viruses. Quite

> frequently they may be observed after gastrointestinal

> infections with

> diarrhea. They are named postinfectious or reactive arthritis or

> sometimes acute rheumatism. Often swellings and warming of one

> or more

> joints are seen. These illnesses can have a lengthy course and

> be quite

> painful. Young children often report no pain at all. At a close

> look one

> can sometimes observe in the beginning a change in movement or

> gait. In

> most cases postinfectious arthritis heals completely and leaves no

> permanent injuries in the joints.

>

> 3. Lyme-Arthritis

>

> The Lyme-arthritis or borrelia induced arthritis is a special

> form of

> joint inflammation. Lyme is the name of the place in

> Connecticut, USA,

> where this type of arthritis has been first described. Borrelia are

> bacteria transmitted by tick-bites and can cause various

> diseases, among

> others also this joint inflammation. Here we often see pointed

> swellingsof single joints, quite often of the knee or ankles. In

> the blood and in

> the joint fluid of the children and adolescents concerned various

> antibodies against borrelia can be found. This identification is

> important because borrelia-arthritis can effectively be treated with

> antibiotics. There are, however, also cases in which the

> arthritis takes

> a protracted course despite of sufficient antibiotic treatment. Then

> there is the danger of lasting damage to the joints involved.

>

> 4. Juvenile chronic arthritis

>

> The term juvenile chronic arthritis (JCA) refers to a group of joint

> inflammations which are also called chronic rheumatism. Little

> is yet

> known about its origin. But it seems certain that several

> factors are

> involved in the development of these diseases. Hereditary

> predispositions as well as previous infections, accidents (traumata),

> and excessive stress may be of importance for the manifestation

> of JCA.

> But often the disease starts without any known previous illnesses.

>

> JCA lasts longer than the other forms of arthritis mentioned

> above. A

> special danger of JCA consists of the fact that the inflammatory

> processcan impair the joints permanently if one does not succeed

> in halting it

> as early as possible. This can result in lesions of the articular

> cartilage and malpositions of the joints.

>

> JCA is usually classified into various subgroups:

>

> 4.1 Systemic Juvenile Chronic Arthritis

>

> The systemic juvenile chronic arthritis (SJCA) concerns about

> 10% of the

> children with chronic arthritis. Often the onset is already in infant

> age. High fever is apparent in the beginning, recurring over several

> weeks, especially in the morning and afternoon, and does not

> respond to

> antibiotics. A rash is partly seen, especially during the febrile

> phases. Enlargement of liver and spleen is possible. Every 3rd

> to 4th

> child incurs a pericarditis. An inflammation of the pleura and

> peritoneum can join the condition.

>

> At onset of disease fever as well as muscle and joint pain are

> often in

> the fore without joint swellings. Later on these conditions mostly

> retreat and an arthritis develops. In some children the arthritis

> remains limited to few joints, often, however, are many large

> and small

> joints involved.

>

> 4.2 Early Onset Oligoarthritis (Type I)

>

> This form of JCA is also called " young girls' type " because it

> concernsabout 70-80% girls and only about 20-30% boys. Disease

> onset is usually

> between the first and sixth year of life. As a rule only a few

> (up to 8

> maximally) joints are affected. Knee joints and ankles are mostly

> involved, but inflammation may also be found at elbow, hand and

> finger,or toe joints. The distribution is mainly asymmetric,

> i.e. the joints

> are not equally strong involved on both sides of the body.

>

> An essential danger of the oligoarthritis type I is the chronic

> uveitis.This is a matter of an eye inflammation causing no

> discomfort in the

> beginning, however producing grave eye injuries if undetected.

> Thereforeespecially patients with oligoarthritis type I must see the

> ophthalmologist regularly!

>

> 4.3 Juvenile Polyarthritis

>

> Polyarthritis means that there is an inflammation (arthritis) of many

> (poly) joints. At least there are five joints affected, in most

> patients, however, eight to ten or even more. While the pattern in

> oligoarthritis is asymmetric, it is mostly symmetric in polyarthritis:

> The joints of the body's right and left side are equally afflicted.

> There may be an arthritis in large joints like shoulders, hips,

> or knees

> as well as small ones like finger- or toe-joints. Often there is not

> only an inflammation of the joints but of the tendon sheaths too.

>

> Onset of disease can be at any age and concerns girls slightly more

> often than boys. It means a considerable handicap for the

> children as

> due to the disease they are greatly hampered in their natural

> urge for

> motion.

>

> The juvenile polyarthritis is also named seronegative

> polyarthritis as

> the rheumatoid factor is not present in the serum.

>

> 4.4 Chronic Polyarthritis of the Adult Type

>

> In contrast to the juvenile polyarthritis can the rheumatoid

> factor in

> the adult type be identified. Therefore it is called seropositive

> polyarthritis. It affects mostly girls from the 11th year of

> life on and

> presents similar to the seronegative polyarthritis. However, the

> finger-end joints are often spared. Beside the arthritis inflammations

> of the blood vessels (vasculitis) can also develop.

>

> Since the seropositive polyarthritis can progress rather fast and

> produce damage on the joints if untreated, it is important to

> recognizeit early and treat it correctly.

>

> 4.5 Oligoarthritis Type II ( " Big Boys' Type " )

>

> As the name " big boys' type " says mostly boys from school age on are

> confronted with this form of arthritis. As in the oligoarthritis

> type I

> mainly large joints are affected, the distribution pattern is

> asymmetric.

> Mostly involved are knee- and ankle-joints, but also the hip

> joints or

> joints of the upper extremity. Typical for the disease pattern

> is an

> inflammation of the tendon appendages, so e.g. in the area of

> the heel,

> beneath the patella or on the crista iliaca.

>

> Also in the oligoarthritis type II eye inflammations can occur. This

> acute uveitis presents itself, however, with pain, reddening and

> shunning of light, so that it cannot be overlooked. With proper

> treatment it heals quickly and resolves without any consequences.

>

> If in addition an inflammation of the sacroiliacal joints

> develops one

> does not speak of oligoarthritis type II but of juvenile

> spondarthritis. From this at later age a Morbus

> Bechterew may turn up. If this happens

> it might be after about the 20th year of life.

>

> 4.6 Psoriasis Arthritis

>

> Psoriasis is a chronic skin disease. About one third of the patients

> develop joint problems, many of them arthritis. While in adults

> usuallythe skin symptoms appear first and the arthritis follows,

> we see in

> children often the arthritis before distinct skin lesions lead

> to the

> diagnosis psoriasis.

>

> The psoriasis arthritis mostly proceeds like oligoarthritis and rather

> benign, but can also spread to many joints. Typical is the involvement

> of single fingers and toes.

>

> 4.7 Others

>

> Chronic arthritis is also observed in inflammatory bowel disease like

> Morbus Crohn and colitis ulcerosa. Inflammatory diseases of the

> connective tissue may also be accompanied by arthritis.

>

> 5. Rheumatic Fever

>

> Before antibiotic treatment was established, rheumatic fever was

> a quite

> common disease. Nowadays it is hardly ever seen. Rheumatic fever

> followsan infection with certain bacteria (streptococcus). It causes

> inflammations in the joints and of the heart. In order to prevent

> lasting heart injuries effectively an antibiotic treatment is

> indispensable.

> Lately a rising number of patients with rheumatic fever was reported

> from the USA. This statement, however, is not secured. In

> Western Europe

> such observations have not been made.

>

>

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