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Q
Rheumatoid Arthritis in Children?

My niece, age 6, has juvenile rheumatoid arthritis. One of her symptoms is uveitis. She has been on Remicade for more than two years. When they try to wean her off the drug, her symptoms return. As a result, she is currently treated every four to six weeks. What do you suggest?

A
Answer (Published 8/23/2010)

Juvenile rheumatoid arthritis is a common type of arthritis in children. The main symptoms are joint pain and swelling. We don't know exactly what causes this disorder, but it is believed to be autoimmune in nature.

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Uveitis is an inflammation of the uvea, the middle layer of the eye between the retina and the outer sclera ("white") of your eye. Kids with juvenile rheumatoid arthritis can develop autoimmune uveitis as part of the disease or in response to medications they are taking. It can begin with redness and pain in the eye or with painless blurring of vision. Other symptoms include light sensitivity and floaters (annoying spots or lines in the visual field). Unchecked inflammation of the uvea can lead to permanent loss of vision and accounts for as many as 10 percent of cases of blindness in the U.S.

I discussed your question with Sandy Newmark, M.D., a California-based pediatrician who is on the faculty of the Arizona Center for Integrative Medicine. He said that treatment of juvenile rheumatoid arthritis can be very difficult and suggested trying to support your niece in every way possible with an integrative approach to help her wean off the Remicade without a rebound of symptoms. This could include an anti-inflammatory diet, omega-3 fatty acid supplementation, probiotics, natural anti-inflammatory agents such as curcumin, and mind/body therapies like guided imagery. Dr. Newmark also said that both homeopathy and traditional Chinese medicine could be helpful. He suggests finding an integrative practitioner experienced in the treatment of chronic diseases in children to help implement these measures.

Andrew Weil, M.D.

Visit the Center for Pediatric Integrative Medicine's website for more information.

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