Q: My 16 years old cousin is suffering from rheumatoid arthritis and he has been on the bed for the last four and a half years. The doctors say that they can't perform any surgery at the moment because he is only 16 and we have to wait until he turns 18. Is there any way to do the surgery now or do we have to wait for another two year?

A:Juvenile arthritis can be an aggressive disease that can potentially damage joints and as a general rule early optimal treatment aims to cause remission of the disease activity and prevent joint damage. The two i.e. disease activity and damage go hand in hand and thus the disease must be inactive so that the correct assessment of the need for surgery can be made. As a rule we like to delay surgery till the growth is complete but not at the cost of the child being bed ridden. Your cousin should be assessed by a paediatric rheumatology team to decide the best course of action.