Most eleven year old boys love physical education class, but Caleb Hestad refused to do his push-ups, and received both detention and a diagnosis of Juvenile Idiopathic Arthritis (JIA). August is Juvenile Arthritis Awareness Month and an opportunity to bring attention to the stories of children like Caleb who face the daily challenges of arthritis management and treatment.
According to the Arthritis Foundation, there are six different types of juvenile arthritis, depending on the number of joints affected. Caleb was diagnosed with polyarticular arthritis, which means it affects five or more joints (ankles, knees, wrists, and fingers) in his body. According to Mayo Clinic, there are four common signs of juvenile arthritis:
- Pain – While the child might not complain of joint pain, he or she may limp— especially first thing in the morning or after a nap.
- Swelling – Joint swelling is common and is often first noticed in larger joints such as the knee.
- Stiffness – The child may appear clumsier than usual, particularly in the morning or after naps.
- Fever, swollen lymph nodes and rash – In some cases, high fever, swollen lymph nodes or a rash on the trunk may occur and is usually worse in the evenings.
Caleb’s pain from trying to do push-ups left his mother, Lori Hestad, wondering if Caleb had somehow broken his wrist. X-rays helped diagnose Caleb and his treatment plan primarily focuses on managing pain and inflammation. Every six months Caleb has routine doctor visits with specialists at Mayo clinic to assess his treatment regimen and prognosis using MRIs and x-rays to monitor bone development and detect joint damage.
Flare ups of increased symptoms and inflammation can last a day or many months. Those diagnosed with JIA are also at higher risk of developing uveitis, an inflammation of the middle layer of the eye that, if left untreated, may result in cataracts, glaucoma and even blindness. Caleb and his parents keep watch for this condition, and he is examined regularly by an ophthalmologist.
Medications, diet, and exercise all play a key role in keeping Caleb healthy. His complex medication regiment includes weekly injections to help relieve symptoms and suppress the immune system to prevent an attack on his joints. Eventually the plan is to wean him off his one medications one at a time and then monitor for flare ups. He could possibly be off all medications in a few years.
Medications, diet, and exercise all play a key role in keeping Caleb healthy. His complex medication regiment includes weekly injections to help relieve symptoms and suppress the immune system to prevent an attack on his joints. The plan is to eventually wean him off his medications one at a time and monitor for flare ups. He could possibly be off all medications in a few years.
“The medications were probably the hardest to adjust to,” his mother stated. “Sometimes the medication makes him thrown up. At first he was annoyed with the shots, but now he takes it all in stride.”
Beyond medication, Caleb’s diet plays a significant role in avoiding flare ups. While there is no cure for arthritis, diet can have a positive or negative impact on symptoms. High fats, sugar and process foods all cause inflammation. The Arthritis Foundation is a great resource for arthritis-friendly diet tips.
Hestad explained, “We eat lots of chicken and fish and avoid red meats, as they tend to increase inflammation. We also avoid sugar and sweets, and Caleb especially likes the pineapple anti-inflammatory shakes.”
Caleb is now 15 and stays active playing hockey. Exercise is beneficial for those with a JIA diagnosis to keep the joints flexible and to maintaining a healthy weight.
“Sometimes I worry about him being in such a contact sport, but we follow his lead. We monitor flare ups and treat them as they happen. Getting him to slow down when he has a flare up can be challenging,” Hestad explained and laughed as she added, “His play station comes in handy. Don’t all kids need a break from physical activity at times?”
In the next few years as Caleb gets older, he will continue with routine doctor appointments, ophthalmology appointments, medications and eating right to help keep symptoms at bay.
Hestad is encouraged by Caleb’s progress, “They must have the right combination of treatment going as he hasn’t had any flare ups in two years.”
Like all teenagers, he does not want people to treat him any differently because of his diagnosis. Hestad used to be bothered when people would say “kids don’t get arthritis”, but now she uses it as an opportunity to educate.