During a warm, clear day in Clovis, Alyssa Dalleske excitedly skipped to her neighbor’s house. “Look at that,” said Lynn Dalleske, Alyssa’s mother, as she watched her daughter proudly. “She’s doing so much better.”
Until recently, the young girl not only had trouble skipping but also running, jumping and sitting at the dinner table. That’s because Alyssa, 5, has Juvenile Idiopathic Arthritis (JIA). The most common type of arthritis in children, JIA affects about one in 1,000 children. This chronic disease characterized by persistent joint swelling, pain, and stiffness may affect any joint in the body.
Alyssa’s condition was not obvious at first. When she was about 2 ½ years old, she began limping. Unable to determine a cause, Alyssa’s pediatrician referred her to Children’s Hospital.
“She’d be stiff in her car seat, her little fingers and legs swollen, and no energy,” recalled Lynn.
Based on a physical examination, history, imaging and lab results, Dr. Dowain Wright in Children’s Immunology and Rheumatology practice determined in January 2008 that Alyssa had extensive arthritis. “There’s a misconception that arthritis is only for old people,” he said.
Specifically, Alyssa has polyarticular arthritis – a subtype of JIA that affects five or more joints and is more common in girls than boys. Drug therapy is used to treat the pain and control inflammation, while flexibility exercises increase joint movement. “We have a lot of new treatments now and avoid the older, more toxic drugs,” said Dr. Wright.
Dr. Wright prescribed Alyssa naproxen, a non-steroidal anti-inflammatory to reduce the pain and inflammation. When her condition declined over the next few months, he elevated her treatment to methotrexate, a powerful medication commonly used to decrease symptoms and slow joint damage. Alyssa’s arthritis steadily improved and by that November, she entered remission.
Following a bout with pneumonia and increased flare-ups of the disease earlier this year, Dr. Wright made some adjustments, and by June, Alyssa’s arthritis had gone back into remission.
“No more limping,” said Lynn happily. “Alyssa still has good days and bad days, but more good days now. Dr. Wright and the outpatient physical therapists are amazing. It’s not just about getting their job done and moving on – they care.”
Although the cause of JIA is unknown, viral, genetic and immune system related factors may be involved. Early detection and treatment, such as in Alyssa’s case, is critical. Affected joints grow faster in children than adults, potentially leading to deformity if untreated.
“Not every child in the U.S. has access to a pediatric rheumatologist – without that, there’s no one to treat this,” said Dr. Wright.
With Alyssa entering kindergarten this fall, Lynn said her and her husband David’s main goals are “for Alyssa to keep up with her peers” and “to keep her out of a wheelchair.”
While about half of the children with juvenile arthritis will continue to have difficulty in adulthood, the good news is most will not develop permanent disabilities. “Fifty years ago, most did have disabilities,” said Dr. Wright. “We continue to make a difference in these kids’ lives.”