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Juvenile Arthritis
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Disclaimer: Only your physician can diagnose arthritis. Symptoms may vary from person to person. If you are not sure whether you might have arthritis or any other of the conditions listed on this Web site, please consult your doctor.
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Juvenile rheumatoid arthritis is arthritis that causes joint inflammation and stiffness for more than six weeks in children 16 years old or younger. JRA can affect any joint and mobility may become limited.
Types of Juvenile Arthritis
Symptoms
Who Gets Juvenile Arthritis?
Causes
Diagnosis
Treatment
Lifestyle
Additional information
Types of Juvenile Arthritis
There are three types of JRA:
- Pauciarticular. This is the most common form of JRA and affects about 50 percent of the children diagnosed with JRA. It is defined by the involvement of four or less joints, and typically affects the larger joints such as the knees. Eye disease is a possibility with this particular type of JRA. Many children with pauciarticular disease outgrow arthritis by adulthood, although joint inflammation may recur and eye problems can continue.
- Polyarticular. This disease affects about 30 percent of all children diagnosed with JRA. It is defined by the involvement of five or more joints, and typically affects the smaller joints of the feet and hands, although it can affect the larger joints as well. Polyarticular JRA is often symmetrical, it occurs with the same joint on both sides of the body.
- Systemic. Found in 20 percent of children with JRA, this disease is defined as affecting the multiple systems of the body. Fever, and a light pink rash typically characterize Systemic JRA. Internal organs may be involved, such as the liver, heart,lymph nodes and spleen.
Symptoms
Symptoms include redness, swelling, stiffness, warmth and soreness in the joints. Stiffness typically is worse in the morning or after a nap. The pain may limit movement of affected joints although many children, especially younger ones, do not complain of pain.
JRA commonly affects the knees and joints in the hands and feet. One of the earliest signs of JRA may be limping in the morning because of an affected knee. Besides joint symptoms, children with systemic JRA have a high fever and a light skin rash. The rash and fever may appear and disappear very quickly.
Systemic JRA also may cause the lymph nodes located in the neck and other parts of the body to swell. In less than half of the cases, internal organs including the heart and, very rarely, the lungs may be affected.
Eye inflammation is a potentially severe complication that sometimes occurs in children with pauciarticular JRA. Eye diseases such as iritis and uveitis often are not present until some time after a child first develops JRA.
Typically, there are periods when the symptoms of JRA are better or disappear (remissions) and times when symptoms are worse (flare-ups). JRA is different in each child. Some children with JRA may have growth problems. Doctors are exploring the use of growth hormones to treat this problem.
Who Gets Juvenile Arthritis?
An estimated 285,000 adolescents and children in the United States have arthritis or a related rheumatic condition. The severity and pattern of the disease varies for each child. Arthritis is a term that refers to more than 100 different conditions known as rheumatic diseases. These conditions affect the joints and muscles and tendons surrounding the joints. Some of these diseases can affect internal organs and skin, as well.
Causes
JRA is an autoimmune disorder, which means that the body mistakenly identifies some of its own cells and tissues as foreign. The immune system, which normally helps to fight off harmful, foreign substances such as bacteria or viruses, begins to attack healthy cells and tissues. The result is inflammation.
Doctors do not know why the immune system goes awry in children who develop JRA. Scientists suspect that it is a two-step process. First, something in a child's genetic makeup gives them a tendency to develop JRA; then an environmental factor, such as a virus, triggers the development of JRA.
Diagnosis
Doctors usually suspect JRA when they see children with persistent joint pain or swelling, unexplained skin rashes and fever, or swelling of lymph nodes or inflammation of internal organs. A diagnosis of JRA also is considered in children with an unexplained limp or excessive clumsiness.
No one test can be used to diagnose JRA.
Instead, the pediatric rheumatologist uses a variety of tests and pieces of information from the patient and their family to determine a diagnosis of JRA.
Along with a careful examination of the patient, results of lab tests and X-rays help rule out other conditions. Symptoms are a large determining factor in the diagnosis. Joint swelling or pain must last for at least six weeks for the doctor to consider a diagnosis of JRA. It may be useful to keep a record of the symptoms before seeing the doctor, documenting when they first appeared and when they were better or worse.
Laboratory tests by themselves cannot provide a diagnosis, but can help rule out other conditions and help to classify the type of JRA the patient may have. The doctor is typically testing for RF (Rheumatoid Factor) and ANA (Antinuclear Antibodies) and to determine the ESR (erythrocyte sedimentation rate).
ANA and RF are seldom found in the blood of JRA patients. ANA is typically found more often that RF. The RF test assists the doctor in differing among the three types of JRA the child may have.
ESR is a test that measures how quickly red blood cells fall to the bottom of the test tube. This term is also referred to as "sed rate." Some people have an elevated sed rate, meaning that there is inflammation in the body. Not all children with joint inflammation have an elevated sed rate.
X-rays are generally more useful later in the disease, when the bones may be affected. They can show cartilage damage early on in the disease. The physician may want X-rays when they suspect injury to the bone or unusual bone development.
Treatment
The main goals of treatment are to preserve a high level of physical and social functioning and maintain a good quality of life. To achieve these goals, doctors recommend treatments to reduce swelling; maintain full movement in the affected joints; relieve pain; and identify, treat, and prevent complications. Most children with JRA need medication and physical therapy to reach these goals. Pediatric rheumatologists are trained in both pediatrics and rheumatology and are best equipped to deal with the complex problems of children with arthritis and other rheumatic diseases. However, there are very few such specialists. If a specialist is inaccessible, a team approach involving the child's pediatrician and a rheumatologist with experience in both adult and pediatric rheumatic disease provides optimal care for children with arthritis. Other important members of the team include physical therapists and occupational therapists. Pediatric rheumatologists share a common goal with their patients to achieve a high level of physical and social functioning and a good quality of life. To assist in meeting these goals, the physicians recommend treatments to reduce the symptoms and complications of the disease. Most children need physical therapy and medications to reach these goals.
Lifestyle
Most children with JRA can take part fully in physical activities and sports when their symptoms are under control. During a disease flare-up, however, the doctor may advise limiting certain activities depending on the joints involved. Once the flare-up is over, a child can start regular activities again.
Swimming is particularly useful because it uses many joints and muscles without putting weight on the joints. A doctor or physical therapist can recommend exercises and activities.
How Can the Family Help a Child with JRA?
JRA not only does JRA but the family as well. This means the family, as a whole, must learn to cope with the special challenges of the disease. Here are six tips about how families can face JRA:
- Treat the child as normally as possible.
- Ensure the child is getting adequate medical care and following the doctor’s instructions.
- Work closely with the school to coordinate an appropriate lesson plan with the teachers. Make sure the teachers are educated on JRA. If you live in Missouri, a state Juvenile Arthritis Care Coordinator can help with this.
- Encourage tolerable exercise.
- Discuss the problems and concerns about JRA with your child.
- Consider joining a support group.
Additional Information
Arthritis Foundation
http://www.arthritis.org
Centers for Disease Control and Prevention (CDC)
http://www.cdc.gov
National Institute of Arthritis, Musculoskeletal, Skin Diseases
http://www.niams.nih.gov/hi/topics/juvenile_arthritis/juvarthr.htm.
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