Methotrexate and prednisolone

It's been a busy few weeks with a number of medical appointments. Last Monday we had PuffyFinger's eye check up. Children with her type of JIA are meant to have 6 monthly eye check ups as they are at a significantly higher risk of some eye inflammation diseases; irisitis and uveitis (one day I'll look up what they actually are...). She got the all clear, which was good news.

Yesterday it was the dentist. PuffyFingers got the thumbs up there too. She's doing a really good job of cleaning her teeth all by herself, with us just checking occasionally. The parents got a bad mark though; LMI's teeth showed up a ghastly purple with the disclosing solution. I'm blaming the Other Half. I'm sure if I'd cleaned her teeth they'd have passed the disclosing exam.

And today it was the rheumatology check up. If I'm honest with myself, I did know that at least one finger had active arthritis again and probably two (I'd spotted the middle finger on the left hand had suspicious puffiness at the weekend). But it was a shock to find out 4 joints are active right now. 2 in right index (pointer) finger, one in her left middle finger, and her left elbow.

The doctor waded through her old notes, the finger joints are all ones that have been active before that were knocked on the head with steroid injections. The elbow is new. I don't know if the elbow counts as a big joint of little joint in the JIA naming conventions, I suspect it's a big one. If so then PuffyFinger's diagnosis remains as confused as ever.

I totally expected the doctor to say we'd go for another round of steroid injections as they've worked in the past and she typically stays arthritis free and medication free for several months afterwards. So I was surprised when the doctor recommended going with methotrexate instead.

As methotrexate takes at least 6 weeks to kick in we're going for a month of prednisolone to try and whack it on the head quickly.

More about what these medications are in the next post, when I've wrapped my head around it. I'll leave you with the thought that I'll be doing the weekly injections myself. At least it's only once a week, let's look on the bright side.

Acronyms: JIA or JRA?

JIA = Juvenile Idiopathic Arthritis
JRA = Juvenile Rheumatoid Arthritis

The name de jour is JIA. Juvenile arthritis was once thought to be like full blown rheumatoid arthritis (RA) but in children rather than adults. Hence JRA. And then some bright spark pointed out that juvenile arthritis isn't like RA in all respects and along came JIA as a moniker.

JRA is still in use by many people, but JIA is seen as being more accurate these days. If I could be bothered I'd do some research and find out just how long the term JIA has been in use. But I can't be bothered.

• Juvenile - Children (or not adults, I'm sure lots of teenagers will get worked up at being labelled a child)
• Idiopathic - (this is the good bit) Without Known Cause. Yes, indeedy, idiopathic means the doctors having got a flaming clue what causes this.
• Arthritis - Inflammation of joints (from Greek arthro-, joint + -itis, inflammation. Greek bits courtesy of wikipedia: http://en.wikipedia.org/wiki/Arthritis)

Top quote: Isaac Asimov noted a comment about the term "idiopathic" made in the 20th edition of Stedman's Medical Dictionary: "A high-flown term to conceal ignorance." (courtesy of wikipedia again).

I'm happy to relate that according to the same page that they got it slightly wrong in House. The lovely Hugh Laurie (House) says that idiopathic: "comes from the Latin, meaning 'we're idiots, because we don't know what's causing it.'" But, unfortunately, idiopathic comes from Greek, not Latin. Whoops.

So there it is, PuffyFingers and many other children like her have inflammed joints and no-one knows why.