| What is juvenile rheumatoid arthritis? |
Arthritis is usually associated with adults. But approximately one in every thousand children in the United States has some type of arthritis. Juvenile rheumatoid arthritis (JRA) is defined as a chronic condition causing joint inflammation for at least 6 weeks in a child 16 years of age or younger. In most cases it’s not a lifelong disorder, and the symptoms fade after several months or years.
Still, JRA can be a complicated condition. The main reason is that it’s actually an umbrella term for a group of conditions. The conditions are classified according to the number of joints affected, the symptoms, and the presence or absence of certain antibodies in the blood. The main categories of JRA are:
- Pauciarticular JRA. This affects four or fewer joints. Typically, it affects larger joints,
such as the knees. Children with pauciarticular JRA sometimes develop eye inflammation.
- Polyarticular JRA. This affects many joints. Small joints, such as those in the hands and
feet, are most commonly affected.
- Systemic JRA. Also known as Still’s disease, systemic JRA affects many areas of the body, including joints and internal organs. In addition to joint swelling, symptoms of systemic JRA include fever and a rash.
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| Signs and symptoms |
It’s important for parents and other caretakers to watch for signs of JRA, particularly in young children. These signs may include:
- Joint swelling, with pain and stiffness. This may be more pronounced in the morning or
after a nap. Commonly it affects the knees and the joints in the hands and feet. Children may complain
of pain, or you might notice them limping.
- Fever and rash. These are characteristic signs of systemic JRA. They may appear and
disappear quickly.
- Swelling of lymph nodes. This sign tends to occur mainly in children with systemic and polyarticular JRA. Like other forms of arthritis, JRA is characterized by times when symptoms are present (flares) and times when symptoms disappear (remissions).
| Causes |
JRA is thought to be an autoimmune disorder. This means that the body attacks its own cells and tissues. It’s unknown why this happens, but both heredity and environment seem to play a role. It may be that a virus or bacterium triggers the development of JRA in children with certain genetic profiles. These genetic profiles are detected in many children with JRA and are considered genetic markers for juvenile rheumatoid arthritis. However, not all children with the markers develop JRA, and children without the markers can develop the disease. It’s rare for more than one member of a family to develop JRA.
| When to seek medical advice |
If your child displays signs of joint swelling, stiffness or pain or just limps for no obvious reason, take him or her to your family doctor. Also, if your child has a fever of 102 F that persists for longer than 2 or 3 days, take him or her to the doctor. A fever that signals JRA may come and go one or two times during a day and last a few hours each time.
If your child has received a diagnosis of JRA, take him or her to your family doctor regularly to monitor the development of the disease and its treatment. Children with polyarticular and systemic JRA should be screened for eye inflammation every 6 months. For children with pauciarticular arthritis, screenings should occur every 3 months.
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| Screening and diagnosis |
If your child’s pediatrician or family doctor suspects that your child has JRA, he or she will refer you to a rheumatologist for a confirmed diagnosis and treatment.
A diagnosis of JRA usually begins with a medical history and a physical examination. Blood tests, including an erythrocyte sedimentation (sed) rate test, also may be used to rule out other conditions, to help classify the type of JRA and to measure the degree of inflammation.
X-rays may be taken to exclude other conditions, such as fractures. X-rays may also be used from time to time after the diagnosis to monitor bone development and possible joint damage.
| Complications |
Several serious complications can result from JRA. But keeping a careful watch on a child’s condition and seeking appropriate medical attention can greatly reduce the risk of these complications:
- Eye inflammation. Eye diseases such as iritis, inflammation of the iris, and uveitis,
inflammation of the uvea, sometimes occur in children with JRA especially those with pauciarticular
arthritis. They may occur without symptoms, so it is important for children with JRA to be examined
regularly by an ophthalmologist. Children with pauciarticular arthritis should have eye screenings
every 3 months. Others should be screened every 6 months. Untreated inflammation can result in
cataracts, calcium in the cornea, glaucoma and, ultimately, blindness.
- Growth interference. JRA can interfere with the development of your child’s bones and growth. Some medications used to treat JRA, mainly corticosteroids, can also inhibit growth.
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| Treatment |
Treatment for JRA focuses on maintaining a normal level of physical and social activity. To accomplish this, a combination of strategies may be necessary to relieve pain and swelling, maintain full movement and strength, and prevent complications.
Medications
For some children pain relievers may be the only medication they need. Others may need help from medications designed to limit the progression of the disease. Typical medications include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as aspirin,
ibuprofen (Advil, Motrin, others) and naproxen (Aleve), are used to reduce pain and swelling. Because
children can develop side effects such as bleeding, liver and stomach problems, these medications
should be used under a doctor’s supervision.
- Disease-modifying antirheumatic drugs (DMARDs). These are used when NSAIDs alone fail to
relieve symptoms of joint pain and swelling. They may be taken in combination with NSAIDs and are used
to slow the progress of JRA. The most commonly used DMARD for children is methotrexate (Rheumatrex).
Other DMARDs include gold compounds such as auranofin (Ridaura) and aurothioglucose (Solganal),
hydroxychloroquine (Plaquenil, Quineprox), sulfasalazine (Azulfidine, Azaline) and etanercept
(Enbrel).
- Corticosteroids. These medications may be prescribed to children with more severe JRA to control symptoms until a DMARD takes effect or to prevent complications such as inflammation of the sac around the heart (pericarditis). Corticosteroids, such as prednisone (Deltasone, Orasone) , may be administered by mouth or by injection. But they can interfere with normal growth and increase susceptibility to infection. Stopping long-term use of corticosteroids suddenly also can be dangerous, so it’s important to follow a doctor’s instructions on usage.
Your doctor may recommend that your child work with a physical therapist to help keep joints flexible and maintain range of motion. A physical therapist or an occupational therapist may make additional recommendations regarding the best exercise and protective sports equipment for your child. A therapist may also recommend that your child make use of special supports or splints to help protect joints and keep them in a good functional position.
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| Self-care |
Caregivers can help children learn self-care techniques that help limit the effects of JRA. Exercise is important because it promotes both muscle strength and joint flexibility. Swimming is an excellent choice because it places minimal stress on joints.
Stiffness affects many children with JRA, particularly in the morning. Although some respond well to cold packs, most children prefer a hot pack or a hot bath or shower.
Some children with arthritis have poor appetites. Others may gain excess weight due to medications or physical inactivity. A well-balanced diet can help maintain an appropriate body weight.
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| Coping skills |
Family members can play critical roles in helping a child cope with JRA. Parents may want to try the following:
- Treat your child, as much as possible, like other children in the family.
- Allow your child to express anger about having JRA. Explain that JRA is not caused by anything he
or she did.
- Encourage your child to participate in physical activities, keeping in mind the recommendations of
your child’s doctor and physical therapist.
- Work with your child’s teachers and school administrators to make any necessary modifications in his or her schedule or responsibilities. These modifications may include giving your child extra time to move from class to class, providing him or her with an extra set of textbooks so that these books won’t need to be carried home, and making arrangements for assignments to be sent home when your child misses school because of his or her condition.
— March 4, 2002 —