Juvenile Rheumatoid Arthritis

By:    Published: March 8, 2012

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Although rheumatoid arthritis is most commonly associated with older adults, there also exists a version f the disease which afflicts children. This condition, called juvenile rheumatoid arthritis (JRA), can vary to temporary and relatively harmless, to permanent and potentially dangerous. As a parent, it’s important to recognize the symptoms of this disease so that treatment can begin as soon as possible.

Definition

Juvenile rheumatoid arthritis (also referred to as juvenile idiopathic arthritis) is a type of rheumatoid arthritis that affects children under the age of 16. According to KidsHealth.org, nearly 300,000 children in the U.S. suffer from some sort of arthritis. Of those cases, juvenile rheumatoid arthritis is the most common type of arthritis, accounting for about 50,000 children.

Arthritis is the inflammation of joints, which often leads to pain, stiffness and swelling. With rheumatoid arthritis, that inflammation is generally caused by the immune system attacking the body’s own tissues. However, JRA is not just a child-specific version of rheumatoid arthritis in adults (although there are many similarities). For this reason, the term juvenile idiopathic arthritis is now more commonly used to refer to this condition and encompass all of the types of juvenile arthritis it includes.

Types

There are seven major types of juvenile rheumatoid arthritis:

  1. Systemic: This type of JRA affects the entire body. It is often accompanied by fever or rash and may cause swelling of the lymph nodes.
  2. Pauciarticular: This type of JRA affects no more than 4 joints. The most commonly affected joints with this condition are located in the wrist and knee.
  3. Polyarticular (rheumatoid factor negative): This type of JRA typically affects joints in the hands, knees, hips, ankles, feet and neck. It is more common in girls than boys.
  4. Polyarticular (rheumatoid factor positive): This type of JRA is the most similar to adult rheumatoid arthritis. It has a high risk of causing joint damage.
  5. Psoriatic: This type of JRA is accompanied by psoriasis rashes, often affecting the toenails and fingernails.
  6. Enthesitis-related arthritis: This type of JRA usually affects the spine and lower extremities.
  7. Undifferentiated: This refers to any type of JRA that doesn’t fit into the other categories listed here.

In some cases, JRA is only temporary or is characterized by periods where symptoms are not present. However, the more joints are affected by a child’s JRA, the more severe the disease, meaning that periods with no symptoms will occur less often and the condition is more likely to be permanent. In cases, where very few joints are affected, the child may go for long periods with no symptoms and the condition may go into remission.

Symptoms

The signs of juvenile rheumatoid arthritis first appear between the ages of 6 months and 16 years. The earliest signs of JRA are usually limping or a sore joint (most commonly in the finger, wrist or knee). Other symptoms of the condition include:

  • Swelling, especially in larger joints like the knee
  • Stiffness, especially when waking up
  • Pain, often the worst right after waking up
  • A warm feeling in the affected joints
  • Limited range of motion
  • Vision changes or eye pain
  • High fever which spikes in the evening and may suddenly disappear (usually with systemic JRA)
  • Rashes which may suddenly appear and disappear (usually with systemic JRA)
  • Swollen lymph nodes (usually with systemic JRA)

Causes And Risk Factors

Although the exact cause of JRA is unknown, most experts believe that it is an autoimmune illness. This means that the joint inflammation occurs as a result of the immune system mistakenly attacking healthy body tissue. This may be the result of hereditary and environmental factors may have a role, such as gene mutations or exposure to viruses. However, it is not entirely clear what causes the autoimmune illness responsible for JRA, and therefore it is not preventable. The only known risk factor is that this condition affects more girls than boys.

Treatment

Medications are often recommended by doctors to help relieve the symptoms of JRA. The most common medications used to treat this condition are:

  • Non-steroidal anti-inflammatory drugs (NSAIDs): These help reduce pain and swelling. Common variations include ibuprofen (Advil, Motrin) and naproxen (Aleve).
  • Disease-modifying antirheumatic drugs (DMARDs): These also help relieve pain and swelling and may help slow the progress of JRA.
  • Tumor necrosis factor (TNF) blockers: These can help reduce pain, swelling and stiffness, but they can potentially increase the risk of infection.
  • Corticosteroids: These can help reduce the symptoms of JRA and can be taken orally or via injection. However, they may interfere with normal growth and increase the risk of infection, so they should only be used for a short period of time.
  • Immune suppressants: These medications suppress the immune system to slow its attack on healthy body tissue. These may also increase the risk of infection.

In addition to medication, some children undergo physical therapy to keep their joints healthy and flexible. Protective equipment, joint supports or splints may be used to ensure the joints are protected and proper muscle tone is maintained. In severe cases, surgery may be utilized to improve the position of an affected joint.

Home remedies can also be used to help control the symptoms of JRA. Getting regular exercises helps increase joint flexibility. Swimming is especially helpful since it minimizes pressure on the joints. It’s also important to eat healthy and maintain an appropriate body weight. Getting enough calcium minimized the chance of developing weak bones. Finally, hot or cold packs can be directly applied to joints which are swollen or stiff.

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