Dr. Harry Gewanter examines high school freshman Dymond Carle. Jay Paul photo
Pushing for Arthritis Aid
Each morning before school, Dymond Carle's mother styles her hair and helps her with her shoes. The Freeman High School freshman would like to perform those tasks herself, but her arthritis complicates things.
"My joints get really tight and so does my skin, so it's hard for me to move them," particularly when it's cold, 14-year-old Dymond says.
Arthritis is often considered an illness of the elderly. But of the 46 million people affected nationwide, nearly 300,000 are children, including 7,200 in Virginia. "There are more kids with juvenile arthritis than kids that have Type 1 diabetes," says Dr. Harry Gewanter, a Midlothian pediatric rheumatologist.
Dymond's fight with arthritis began when she was 5. She was tossing a ball with her aunt and sister when they noticed that her fingers had suddenly turned blue. She was soon diagnosed with scleroderma, one of about 100 forms of arthritis.
"Most forms of juvenile or adult arthritis are primarily focused on inflammation of the joint. In scleroderma, the primary focus is on the blood vessels, which are damaged and narrow over time, decreasing circulation," says Dr. Lenore Buckley, a rheumatologist and professor of internal medicine at VCU Medical Center. The tightening of the skin usually begins in the hands and feet and then progresses throughout the body. Eventually, the decreased circulation may cause insufficient blood flow to vital organs including the kidneys, heart and lungs.
Dymond says she experienced this several years ago, when she had seizures and then was told that her body was attacking her kidneys. After a monthlong hospital stay, the doctors were able to get her condition under control.
While the triggers of many forms of arthritis are still unknown, Gewanter says that the leading theory is that it is an autoimmune disease. "There is something there that [the immune system] needs to fight off and it does not get the ‘off' message."
A few decades ago, arthritis was treated less aggressively at the beginning, usually with a few aspirin a day until it worsened. "Our approach to treatment has changed dramatically," Gewanter says. "We have taken a cue from oncologists and gotten much more aggressive up front, early on, by using a combination of medicines and doing injections to turn off inflammation." One new treatment involves using specific proteins to block chemical messages among a person's immune cells and prevent long-term joint damage. Gewanter says arthritis does go away in an increasing number of patients, including about 70 percent of the juvenile-arthritis cases.
At 4 1/2 feet tall, Dymond's growth has been limited by her disease and some of the medications used to treat it. Nevertheless, she hopes she can put her arthritis in remission with the help of exercise. In the meantime, she is focused on her goals. "I want to be a nurse in the [Pediatric Intensive Care Unit]," she says. She also imagines herself as an occupational therapist.
This month, Dymond will help to raise money for arthritis research. As the 2010 Junior Walk Hero for the Richmond chapter of the Arthritis Foundation, Dymond will attend its April 24 walk and speak to the participants. "There are other people that have other things that are worse," she says. "I will just keep trying."