Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
Self-treatment is not encouraged in JRA. Without appropriate inflammation-stopping medical treatment, the inflammation in JRA progresses and becomes worse, increasing the risk of permanent damage to joints, eyes, and other body systems. You can take steps at home, however, to improve your child's comfort and decrease his or her chance of becoming disabled with JRA.
Encourage your child to be as active as possible. Bed rest is not part of the treatment of JRA except for children with severe systemic disease. Indeed, the more active the child, the better the long-term outlook. Swimming and water aerobics are ideal activities because they place no stress on the joints. Children may experience pain during routine physical activities and thus must be allowed to limit their own activities, particularly during physical education classes. A consistent physical therapy program, with attention to stretching exercises, pain avoidance, joint protection, and home exercises, can help ensure that a child with JRA is as active as possible.
Make sure your child is eating enough to maintain a healthy weight. Some children with JRA have little appetite. They need to be encouraged to eat enough calories to maintain a healthy weight and a proper energy level. A balanced diet that provides all required vitamins and minerals is essential. Give your child at least
three servings of calcium-rich foods each day. While there is no evidence that this actually improves JRA, it does help keep bones strong and flexible. Make sure your child also gets enough magnesium and vitamin D
to help keep bones healthy. Ask your child's health care professional for information about diet and nutrition for your child. He or she can refer you to a dietitian if necessary.
Help your child learn techniques for dealing with the discomfort and pain of JRA. In many cases, combining pain-relieving medication (analgesics) with other techniques gives the best balance of pain relief with fewest unwanted side effects. Techniques such as biofeedback, progressive muscle relaxation, meditation, deep breathing, and guided imagery can help children overcome pain. Hot baths or showers, a warm bed, range-of-motion exercises, and hot packs can relieve morning stiffness. Some children respond better to cold packs than to warmth. A plastic bag of frozen vegetables makes a great ice pack.