Arthritis in Children

Male: What is arthritis? Female: Arthritis is an inflammation. It is a big puffing, swollen joint. This is what it is. Male: If a joint is a little bit painful, that means it is arthritis. Female: Not exactly. A painful joint is called arthralgia. It is just pain in the joint. It does not mean that it has to be big or puffy or swollen. Male: So there is a difference between the two terms, is this correct? Female: Yes, there is a difference between the two terms Male1: And what are the most common conditions in pediatric and adolescent medicine would you be thinking about when you hear the word arthritis. What would be the most common things? Female: If I want to describe what is the most common cause of arthritis in a group of kids or in a group of teenagers, it is going to be probably secondary to an infection. That would be the most common cause of arthritis. Male: And one particular one we always worry about, maybe it is not as common as strep infections sometimes, if it is treated, are they being treated correctly and sometimes are in the joints, and one of them is called rheumatic fever. Are we seeing that too much today or a lot less today? Female: We do not see rheumatic fever too much anymore, although, I practice in Brooklyn and Brooklyn is the highest place of incidence of rheumatic fever in the whole country. Male: Is there a reason for that? Female: I have my thoughts about what is the reason for that and eventually, people who work in epidemiology also have theories about why Brooklyn is the most common place. There is a big group of orthodox theories in Brooklyn and we think definitely that there is something genetic in the background in this group of population that are more susceptible to respond aggressively to this trend. That will be one of the reasons for it. Male: Could it also be that sometimes it is unrecognized? Female: The other reason for that is Brooklyn has a big, big population where families live like with many, many people in just one small place and that would also be a reason for—one gets strep and the other kid gets strep and one after the other, back and forth, back and forth. Male: But generally, you have to have some kind of genetic predisposition to a certain problem. That is the first thing and you have to have a strep throat and it has to be not recognized or poorly treated, is that correct? Female: Exactly. That is correct. Male: And the drug of choice to strep throat is still is penicillin, is that correct? Female: It is still penicillin. Male: Maybe first generation cyclosporine. Female: Even after all of these years, strep is still sensitive to this medication. Male: If a kid is not allergic to penicillin, you should not be using these second and third generation and certainly not macrolide which are like this Zithromax, they should not be a primary drug and there was a study a couple of years ago that said that Zithromax was as much as 48% resistant against strep and it was reported in the New Journal of Medicine—so we should go back to our basics and probably use penicillin as our drug of choice. Female: The only good reason to not use penicillin in kids with strep infections is if we have proven allergy to penicillin. Otherwise, we should not really change anything else. Penicillin for the treatment of the strep infection and even for the treatment and prophylaxis after an episode of rheumatic fever is still penicillin for everybody. Male: So good old ten dollar penicillin is much more effective than $200.00 new type of drug, is that correct? Female: That is correct. Male: And that all the insurance companies would love to hear you say that, is that correct? Maybe not the drug companies, but the insurance companies. Female: Well, yes, and it is definitely not proven that any other antibiotic like amoxicillin, even is the correct choice, penicillin is still the right choice. Male: I love what you say. I like with penicillin, it is sometimes—they do not have it in stock anymore, why? Female: Yes, the suspension is still hard to get in some pharmacies and for prophylaxis definitely, nothing else besides erythromycin and penicillin is being proven that is effective. Male: Getting on with arthritis, sometimes you have to differentiate an infection to a joint. Female: Yes. Male: From some kind of disease causing it. So we have to be very careful, and look at the joint. What would we be looking at if you think it is an infection and not maybe some kind of disease that led to arthritis? Female: So as a rheumatologist, I always come and I will be involving the patient probably after a while that the patient is already seen. Male: Worked up? Female: Yes. Male: But if you saw the kid that day— Female: I see a kid for the first time and with a history of fever, with a history of just one joint involved and the joint being very, very painful and maybe hard or maybe warm or maybe a little bit red, I will be concerned first with the main diagnosis infection in the joint and that will be my first priority to make sure that there is no infection in the joint at that time.