Eight-year-old Lukas Gunter plays in the front yard of his home, with his brothers Gabe, 3, Garrett, 5 and Eli, 7. It is a hot summer day in Scheller, a small town in Jefferson County. The boys are excited about a cat that has just had a litter of kittens under a hedge, near their front door.

"Don't be rough with the kittens, boys," warns their mother, 28-year-old Angie Gunter. She keeps a watchful eye on her kids while she talks to this writer about what it means to have a child with juvenile arthritis.

"Lukas started walking way earlier than most kids do," Angie says. "But when he was just 12 months old, he started limping. He refused to put any pressure on his right leg. I just knew deep down something was wrong."

From the age of 12 to 18 months, Lukas' right leg would suddenly swell up and be hot to touch. He would have fever, swelling and inflammation. Frantic with worry, Angie and her husband, Brian Gunter, would rush him to the ER time and again.

"None of the doctors we saw in Mount Vernon even suggested it could be arthritis," Angie says. "They all said it was growing pains. After six months of this, one of the doctors finally admitted we needed to seek help elsewhere. He said he couldn't figure out what was wrong."

The Gunters decided to take Lukas to Shriners Hospital for Children in St. Louis. Andrew White, M.D., a pediatric rheumatologist at Shriners, took a look at little red-haired, freckle-faced Lukas and gave them a diagnosis.

Lukas had juvenile arthritis.

A chronic, autoimmune disease characterized by joint inflammation which in turn causes joint pain, stiffness, swelling and decreased mobility, juvenile arthritis affects as many as 3,00,000 children in the United States.

While the cause of most forms of juvenile arthritis is unknown, current research indicates that your genes may predispose you to the disease.

The most common form of juvenile arthritis is juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis (JIA).

"JRA can be effectively managed provided it is diagnosed and treated on time," White says. "JRA is a form of non-painful arthritis. The joints get swollen and stiff, but the patients don't complain of pain."

According to White a classic case would involve the child waking up in the morning and refusing to walk. However by noon the child will be up and running.

"Other times the parent will say, I noticed my child's knee was all swollen and puffy in the bathtub; but he or she complains of no pain," White says.

In the last 10 years there has been an explosion of new therapies and treatments, most notably a class of drugs that inhibit a chemical in the bloodstream that's involved in inflammation. Currently there are 20-30 medications on trial that look promising.

"The medications are all designed to quieten down the immune system, which is trying to attack the joints and they seem to work pretty well," White explains.

"I tell parents that this not necessarily a crippling disease. It is treatable and we can prevent joint damage in most circumstances. I tell them that out of the hundreds of patients I see; only one is in a wheelchair."

Lukas' arthritis went into remission for almost three years after he received steroid shots in his knee and some physical therapy. However in February, his symptoms resurfaced, but this time his knee and both ankles have been affected.

"He couldn't play P.E. for a week, so the teacher let him stay inside and play board games with a few friends," Angie says. "It's a small community and everyone knows what's going on. They keep an eye on him."

"I don't like shots or when they draw my blood," he chirps. "But I like the Cardinals."

Getting help

"Juvenile arthritis places a heavy burden on the child," says Paula Reeves, director of the Arthritis Foundation of America, Southern Illinois branch office. "People underestimate the seriousness of the issue.

"A lot of times the child may be stigmatized by friends in school. Their may be unable to carry books or take notes in class because their hands are affected. They may have a hard time climbing stairs because their legs are affected, " Reeves says.

If you suspect something is wrong, Andrew White, M.D., a pediatric rheumatologist at Shriners Hospital for Children and an assistant professor of pediatrics at Washington University School of Medicine in St. Louis suggests you talk to your pediatrician and bring up your concerns. There are specialists you can see.

However most juvenile arthritis patients may have to travel quite a distance to get help, since there are only a handful of pediatric rheumatologists in America who are qualified to diagnose and treat the disease.

For children and their families living with arthritis or other rheumatologic conditions, the Arthritis Foundation offers educational resources, support and help. Reeves encourages parents to call (800) 283-7800 or visit www.arthritis.org for more information.

The Centers for Disease Control and Prevention (CDC) estimates that one in 250 children under the age of 18 in the United States has been diagnosed with arthritis or another rheumatologic condition

Juvenile arthritis: Warning signs

* Pain, swelling, tenderness and stiffness of joints, causing limited range of motion

* Joint contracture, which results from holding a painful joint in a flexed position for an extended period

* Damage to joint cartilage and bone leading to joint deformity and impaired use of the joint

* Altered growth of bone and joints leading to short stature

(Source: The Arthritis Foundation of America)

Management of juvenile arthritis

* The primary goals of treatment for juvenile arthritis are to control inflammation (swelling), relieve pain, prevent joint damage and maximize functional abilities.

* Treatment plans for children usually include medication, physical activity, physical and/or occupational therapy, education, eye care, dental care and proper nutrition.

* Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first line of medication used in juvenile arthritis to help control pain and inflammation (swelling).

* Corticosteroids such as prednisone can be taken orally to relieve inflammation or injected into joints that are inflamed.

* Biologic Response Modifiers (BRMs), such as anti-TNF drugs, are a class of drugs that inhibit proteins called cytokines. They must be injected under the skin or given as an infusion in the vein.

* Disease-modifying anti-rheumatic drugs such as methotrexate are often used in conjunction with NSAIDs to treat joint inflammation and reduce the risk of bone and cartilage damage.

(Source: The Arthritis Foundation of America)