Juvenile Rheumatoid Arthritis: Drs. Inaccurate or Delay In Diagnosis

We have too few pediatric rheumatologists in the United States, but this is not the only problem in the delay or inacurrate diagnosis of juvenile rheumatoild arthritis (JRA). Part of the problem is that there is very little emphasis on the disorder in medical school classes or in the training of pediatricians or family physicians.

Recently, a doctor friend called me about one of her friend's grandchildren. The little boy was having ankle and hip pain and his doctors had diagnosed Osgood-Schlatter's disease. The parents did not want to bother going to a specialist outside their health plan and were not listeneing to the grandmother. Both my doctor friend and I suspected the actual diagnosis was juvenile rheumatoild arthritis. With this diagnosis, it is important that aggressive medical tretment be started right away, so that the eyes can be examined and there will be no life-long pain and deformity. If inflammation of the eyes is missed, it can lead to blindness. I have seen a patient who had this occur because of a delay in the diagnosis of juvenile rheumatoild arthritis. This is tragic and should never occur.

My doctor friend and the grandmother continued to push for the child to be seen by the specialist I suggested. He was in a distant city, but was one of the best in the field. Finally, the child was seen, the diagnosis of juvenile rheumatoild arthritis was confirmed and a treatment plan worked out.

One of the problems with juvenile rheumatoild arthritis is that children do not have the same elevation of arthritis blood tests that is usually seen in adults. Many doctors do not realize this and with normal blood tests, they assume that juvenile rheumatoild arthritis is not the diagnosis.