“This whole diagnosis was nerve-racking for me and my wife,” said Arvind Pandit, Angela’s dad. “I was in a state of denial. I said, ‘This can’t happen to Angela.’ Even doctors initially were not thinking juvenile arthritis.”

If not treated early, juvenile arthritis can be aggressive and lead to deformity and disability. Medications tend to compromise the immune system and the ability to fight normal diseases, leaving children vulnerable to complications affecting eyesight and bone growth. The Centers for Disease Control and Prevention says juvenile arthritis affects children of all ages and ethnic backgrounds, and about 294,000 American kids under 18 have arthritis or other rheumatic conditions. Many take the disease into adulthood.

Angela and her parents sought specialists who could determine the best treatment. L. Nandini Moorthy, assistant professor of pediatrics and chief, division of pediatric rheumatology at Robert Wood Johnson Medical School, was at the top of the list.

“Angela came to me after she had been experiencing symptoms for about three months,” says Dr. Moorthy. ”We determined that she had polyarticular JIA. We see children coming in with joint pain, limps, and swelling in their joints. The big thing is getting these kids into treatment quickly to minimize problems.”

Angela’s treatment to get the swelling down began immediately. There were a few complications at first; Angela passed out and was hospitalized, the cause of which was later found to be dehydration. Her knee also swelled to the size of a baseball. In response, Dr. Moorthy started Angela on a more aggressive treatment—a combination of injections and oral medication.

“She responded very well to methotrexate and etanercept,” says Dr. Moorthy. “Nonsteroidal anti-inflammatory drugs like naproxen can be helpful, but with significant inflammation. Angela needed methotrexate and Enbrel.”

After initial treatment, Angela began feeling considerably better. Dr. Moorthy and her team were constantly monitoring Angela’s condition with blood tests. Angela’s inflammatory markers normalized over the first four months. Her improvement included less swelling, pain, and stiffness, and her progress continues to be favorable.

Angela is now leading a relatively normal life. Though she has dropped out of swimming, she’s back to doing other things she loves, including singing and playing piano.

Angela goes for regular checkups with Dr. Moorthy. Medications are tapered as her condition dictates and she will need to take etanercept long term. She will attend the University of Maryland this fall, and she has met with Dr. Moorthy to discuss her options as she begins life as a college student.

Thanks to Angela’s and her family’s dedication to learning about juvenile idiopathic arthritis, their fierce determination to fight it, adherence to medications and treatments—and Dr. Moorthy’s guidance—Angela Pandit will have a chance to make a life for herself.

This Rutgers Health article is an edited version of a story that first appeared in the Spring/Summer 2017 edition of Robert Wood Johnson Medical School's Robert Wood Johnson Medicine. [Read the full story]