Does your child have a rash and a listless body? Let's learn about Juvenile Dermatomyositis (JDM).

Does your child feel more tired than usual, even when running around or climbing stairs? Or, does he have red/purple spots on his face or hands? If you have these symptoms, don't dismiss them as normal. This could be a common condition among children, but many people don't know about it. Don't worry, we'll talk about it clearly.

What is Juvenile Dermatomyositis (JDM)?

Simply put, Juvenile Dermatomyositis (JDM) is a condition in which our own skin, muscles, and blood vessels are attacked by a defect in our immune system. We call such diseases autoimmune diseases. In this, there is inflammation in the body. This mainly causes a skin rash and muscle weakness . "Juvenile" means this because it starts at a young age, that is, during childhood.

This disease can make it difficult for a child to get up, run, climb stairs, and even perform everyday tasks like lifting their arms and combing their hair. As a parent, it can be very distressing to see a child struggling like this. But the most important thing is that with proper treatment, these symptoms can be well controlled and the child can have a good quality of life .

Who is most likely to get this disease?

JDM usually begins in children between the ages of 5 and 10. It is more common in girls than boys. Although it can affect any child, it is more common in white children.

Adults can also experience these symptoms. But it usually appears in the 40s and 50s. It is called Dermatomyositis. Both are in the same group of conditions.

What are the main symptoms of JDM?

The child may show some early signs of this disease even before it is diagnosed. The main symptoms of the disease include skin changes and muscle weakness. Let's look at these separately.

Symptoms that may occur in severe cases

These are usually rare. However, if JDM becomes severe, it can also affect the child's breathing and swallowing muscles . These symptoms may include:

• Food always gets stuck when swallowing.
• Voice changes, weakening.
• Difficulty breathing (Dyspnea).

What are the complications if left untreated?

Don't be alarmed by this. This is about what can happen if you don't get treatment. With today's advanced treatments, many of these things can be prevented.

• Calcium deposits: Hard, stone-like lumps can form under the skin. These make it difficult to move muscles.
• Muscle contractures: Muscles become tight and can be present even when the joints are bent.
• Ulcers: Ulcers may occur on the skin or in the intestines.
• Severe weakness: You may become so weak that you cannot breathe or swallow.

Why is this JDM happening? What is the reason?

Think of it this way: our body is like a fortress. Inside it is an army called the immune system. Their job is to protect us by attacking foreign enemies like viruses and bacteria. In an autoimmune disease like JDM, this army mistakenly starts attacking our own good cells (skin, muscle).

The exact cause of this immune system malfunction is not yet known, but doctors believe it may be caused by a combination of both a genetic component and environmental factors (for example, a viral infection).

How does a doctor accurately diagnose this disease?

When you take your child to a doctor, he or she will first examine the child carefully, checking for things like skin rashes and muscle strength. In addition, several tests may be done to confirm the diagnosis.

• Blood tests: These can check the level of inflammation in the blood and the level of muscle enzymes produced when muscles are damaged. They can also look for special proteins (autoantibodies) that are seen in JDM.
• Electromyography (EMG): This involves inserting very fine needle-like electrodes into the muscles and measuring their electrical activity.
• MRI (Magnetic Resonance Imaging): This test uses a large magnet to get a clear picture of inflammation and swelling inside the body, especially in the muscles.
• Muscle biopsy: This involves a minor surgical procedure to remove a very small piece of muscle tissue and examine it under a microscope. This is very important to confirm whether it is JDM or another muscle disease (e.g. muscular dystrophy).
• Nailfold capillaroscopy: A special instrument is used to examine the tiny blood vessels (capillaries) under the child's nails for swelling. These blood vessels can be seen to have specific changes in children with JDM.

What are the treatments for JDM?

The main goal of JDM treatment is to reduce inflammation in the body, control symptoms, and help the child live a good life. Treatment can induce periods of remission when symptoms disappear.

Medications

• Corticosteroids: These are the main type of medication given first. They reduce inflammation quickly. They are given in high doses at first, and then the dose is gradually reduced as symptoms subside.
• Methotrexate: Another important drug given with or after corticosteroids. It controls the activity of the immune system.
• Hydroxychloroquine: This medicine is very helpful in controlling the skin rash.
• Intravenous immunoglobulin (IVIG): This involves giving purified antibodies into the body through a vein. This can block antibodies that are damaging our bodies.
• Other medications: If the condition is severe or does not respond to other medications, the doctor may prescribe other medications such as cyclosporine and rituximab.

Lifestyle changes and other treatments

In addition to medication, these things are also very important.

• Physical therapy: A physical therapist teaches exercises to strengthen muscles, reduce joint stiffness, and increase flexibility.
• Sun protection: This is very important. Sun exposure can worsen skin rashes. Therefore, you should always use a sunscreen with an SPF of 30 or higher. Wear a hat and sunglasses. Avoid exposure to strong sunlight between 10 am and 4 pm.
• Good nutrition: Eating a nutritious diet rich in vegetables, fruits, lean proteins, and whole grains can help reduce inflammation in the body.
• Speech therapy: A speech therapist teaches children with swallowing difficulties safe eating techniques and exercises.

What should we think about the future?

There is no cure for JDM. But don't be alarmed. The good news is that with treatment, many children can live very successful, active lives.

Most children will go into remission within two years of starting treatment. You may be able to stop taking the medication at that time. However, you should continue to maintain a good diet, exercise, and sun protection to prevent symptoms from returning.

Some children may have the disease for a long time, or symptoms may disappear and then reappear. However, JDM is not a life-threatening disease. With proper medical care, the condition can be managed well and children can live a normal life like other children.

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