By CHRISTINE SHAW
Correspondent

There are more than 100 types of arthritis including three major categories of Juvenile Rheumatoid Arthritis (JCA), systemic, polyarticular and pauciarticular. According to Dr. David G. Stainbrook Jr. of Zanesville, it is important to classify arthritis as well as possible so the physician can tailor treatment and long-term prognosis. Juvenile Rheumatoid Arthritis (JRA) is subdivided into three types - systemic, polyarticular, and pauciarticular. Systemic JRA is characterized by fever, rash and many children have high white blood cell counts, enlargement of the liver and or spleen, swollen lymph nodes, anemia, inflammation of the heart and lungs and high platelet counts. Polyarticular JRA is characterized by involvement in five or more joints. Pauciarticular JRA is characterized by involvement in four or fewer joints and have a high risk in developing eye inflammation. "These three subtypes can be further subdivided," Stainbrook said. No matter how you divide it or what type you have, being afflicted is painful and devastating. Cory's story Imagine being a 17-year old, active in high school athletics and waking up one morning so stiff you cannot even lift the blanket. This is what happened to Cory Jones in October 2006. Initially his mother, Judy, thought he was going through a growth spurt, but when the symptoms did not subside, she took him to his pediatrician. "The doctor asked us three questions and then sent us to the Columbus Arthritic Center," Judy explained. "Cory's knuckles were twice the size as normal and his joints snapped, crackled and popped when he moved." After trying several different medications, Cory said he is 100 percent better than he was in those early months. "I still have good days and bad days, but it is much more tolerable now," he said. Cory is now using the Humira Pen, taking folic acid and a series of vitamins to help him keep his immune system in check. "He has to watch how he dresses and he has to work to stay active," Judy said. "Even though it sometimes hurts to get up and moving, he knows he feels better when he does. He just has to do everything he can to keep liquid moving to those joints to keep from getting more stiff." Aeriel's affliction Consider a 17-month-old girl who began walking with her right leg turned in and with obvious pain. "We thought she had stubbed her toe and maybe that was causing the pain," said her mother, Valerie Norman. "Then she started crying in the morning when she woke up until we would pick her up. When we put her down to walk, she would cry until we picked her up again." Imagine being too little to be able to tell anyone about the severe pain. Fortunately, for Aeriel, her parents were proactive and took her to the doctor. After verifying that the little girl did not have a broken bone and a misdiagnosis of Rickets, the Normans were referred to Akron Children's Hospital where a diagnosis of JRA was confirmed through a physical exam, followed by blood tests, to test for rheumatoid factor and antinuclear antibody (to detect autoimmunity). Aeriel was prescribed Naproxen for pain and inflammation. Her parents were told that if her symptoms did not lessen in two weeks, the specialist would consider Methotrexate, a drug often given to cancer patients receiving chemotherapy. At this, the Normans were concerned because of the side effects. This medicine may cause nausea or vomiting, hair loss, liver damage, lung damage and anemia. At Aeriel's two-week follow up appointment, she had improved tremendously. Since then the Normans agreed to have a steroid injection on her right knee to reduce the inflammation and withdrawal any fluid. The doctor has also formed a brace for her to wear at night. In addition, Aeriel receives physical therapy once a week to help build the muscle and improve her range of motion and balance. Helping hands "Upon hearing the diagnosis, we were devastated that our child was diagnosed with a medical handicap," Valerie said. "After much research of the disease and what it can do, we also found that there is a lot of help available in the community regarding this subject to educate us of what we can possibly expect in the future (once she is in school, etc.)" Cory found that same type of helping hand. Teresa Fleming, a friend of his, connected him with her grandmother, Teresa Jesse, who agreed to teach him some of the water exercises she uses to deal with the disease. "I really appreciate the support and finding out about exercises to help me stay active," Cory said. The support available from friends, others who have been afflicted and from the Arthritis Foundation has helped him cope and keep a positive attitude. Having been diagnosed with JRA just before baseball season in his senior year of high school, Cory said, "I was stunned more than anything, not knowing much about it." Since then he prides himself on not getting down and discouraged. "We're so proud of how he has handled this," Judy said. "We've always told him, you can decide I have this, but it doesn't have me," she said with conviction. Cory has that conviction and said it is important to stay positive. "It's what you choose to do with it and I choose to learn all I can, to stay active and be thankful for the opportunity to share so others can learn too," he said. Valerie said, "At this point in time, it is too soon to determine if she (Aeriel) may grow out of this disease or if she may have it her entire life. If she does not grow out of it, it may go into remission and flare up on occasion. We will just have to learn to deal with any limitations she may have, but for now, looking at her at play, you would never know there is anything wrong." "If you know someone with arthritis the important thing to understand is they will have good days and bad days like all of us, but they are dealing with a chronic disease and people with chronic disease can have depression," Stainbrook said. "So the answer is not to be hard on them, but to encourage them. Motion is life and exercise is important for everyone, therefore encourage them to move, exercise, etc." "You must understand, though, that this is not a race and although you want to encourage the patient to exercise, you must also ensure they don't over do it. That is where a physical therapist can help with a plan on what someone should and can do as everyone with arthritis is different." The positive, can-do attitude of patients like Cory and Aeriel and their families, coupled with the continuing advances in research and caring medical professionals, provides hope for the millions afflicted by this chronic disease. To learn more visit www.arthritis.org.