Tuesday, March 27, 2007

Question about Anna's activity level (Nov. 11, 2006)

So how many joints are involved now, and how does that affect her daily life and activities? Is she physically active, maybe in sports? Is her JRA polyarticular? Was it always? Did it start out in only one joint and then affect more?

Officially, Anna has three joints involved. She started out with JA in her left knee, and then eventually, the pediatric rheumatologist (PRh) felt some "thickened tissue" in the right knee as well . . . that was a few years after the initial diagnosis. Then, before we went on Methotrexate, we had an appointment to see the PRh, and I was thinking it would be a routine, uneventful appointment, and he looked at her toe which was huge! Especially compared to the other one. Anna's knees have never been swollen much (except for maybe when she was an infant---her left knee looked a bit puffy then, but most infant knees look puffy and pudgy!), but there's no denying the arthritic puffiness of her left big toe.

Anna is VERY physically active. She's all the time running around and for the past four years, she took dance class. Her older brother runs cross country with our middle school, and Anna is saying now that she intends to run cross country in middle school. She is currently running every day around the playground at recess (says she's training for cross country!). Anna has told her PRh of her intention to run cross country, and he isn't discouraging that in any way! The goal of the PRh's at Hershey Med is to get kids into medicated remission as quickly as possible. Anna is basically there . . . in medicated remission (or close to it, because her toe is still puffy, but as symptomatic, since it doesn't hurt at all). She seems VERY normal (with the exception of her regular medications).

Anna's initial diagnosis was pauci-articular JA. I read Dr. Lehman's book "It's Not Just Growing Pains," and in that book he stated that when a child develops arthritis in a small joint (like the fingers or toes), he considers the diagnosis to be polyarticular. I did ask the PRh about that statement in light of the fact that Anna's toe is now affected with arthritis. He said that unless/until Anna has arthritis in other joints, we will consider her to be "atypical pauci-articular."

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