Mom, can I go outside and play soccer? 

How can you answer this question, if your kid has arthritis?

by Marcin Gornsiewicz, M.D.

Juvenile idiopathic arthritis (JIA), also known as juvenile rheumatoid arthritis (JRA) is the most common form of arthritis in children. There are several subtypes of JIA and the clinical presentation varies. Unfortunately, pain is a common denominator, and is a major factor preventing children with arthritis from being more active. They fear the pain and injury due to a flare up of the disease by simply running, jumping or playing tag. Typical symptoms and components of JIA include joint swelling, stiffness, anemia, muscle atrophy, weakness and fatigue and contribute to decreased exercise level. The disease often results in a sedentary lifestyle and poor fitness even in kids with clinical remission when the joint inflammation is under good control. JIA may be carried on into adolescent and adult life.

We all know that physical activity is good for healthy kids, but parents often ask important questions, such as whether children with arthritis should exercise, is it safe to exercise, or does it lead to additional joint damage, and are competitive sports safe and to what degree?

Several studies have shown that regular physical exercise, in addition to pharmacotherapy, is the primary treatment recommendation for children with JIA. It reduces pain, fatigue, disability, and leads to improved quality of life, sense of well-being. It makes every day activities less difficult.

There are several different types of exercises that a child with JIA can do. Arthritic joints are painful and swollen, and a child may tend to hold them in the position that is most comfortable. This can lead to a loss of joint motion when bending called flexion contracture. Range of motion (flexibility) exercises reduce the risk of this complication and can be done safely even if the joint is inflamed. They are most effective when performed on daily basis. It is sometimes easier to perform them while bathing in hot water, helping to loosen the muscles.

Strengthening exercises work muscles, as they move against resistance. These exercises can be divided into two groups: isometric and isotonic (see graphic).
In isometric there is no movement of the joint, and the length of the muscle does not change. You can think of this as a static or still exercise. An example would be pushing against a wall. The wall doesn’t move but a significant force is generated at the joints and muscles, and this increases strength at the joints.
In isotonic exercises, the muscle changes length and takes a joint through a specific range of motion against a fixed resistance. Raising and lowering a weight is an example.

What about free time and sport activities in children with JIA?

There are no specific guidelines for what kids should and shouldn’t do. Basically, any activity that is tolerated and acceptable to the child with JIA should be appropriate, if there is adequate supervision and monitoring. Swimming is especially recommended. It works all muscle groups in the body, and it does not put stress on the joints. Bicycling and walking are great additions as well.

For many children with well-controlled JIA, finding a sport or some activity they like is a good way to get them to exercise regularly. They can choose any sport they want, but highly competitive contact sports should be avoided during the periods of active disease. Kids with JIA should be taught how to recognize the signs of overuse. It would be advisable to contact your rheumatologist or physical therapist when selecting more strenuous activities.
In summary, regular exercise is one of the most important therapies for children with arthritis. Children learn by example, so help your kid by making physical activity a family affair.

Dr. Marcin Gornisiewicz graduated with an MD degree from the Medical School of Warsaw in Warsaw, Poland. He completed residency training in internal medicine at Saint Barnabas Medical Center in Livingston, New Jersey. He completed fellowship training in rheumatology at the University of Alabama at Birmingham in Birmingham, Alabama. He joined Rheumatology Consultants, PLLC (rheumatologyconsultants.org) in 2002. He is board certified in Rheumatology.