- About 285,000 children in the United States have juvenile arthritis. 50,000 of those children have JRA, the rest have other forms of arthritis.
What is Juvenile Arthritis?
Any type of arthritis that develops before the age of 16 is considered juvenile arthritis. Within this broad category are many different types of arthritis. The most common type is juvenile rheumatoid arthritis (JRA). Other types known to affect children are: Still’s disease, lupus, dermatomyositis, vasculitis, scleroderma, and the spondyloarthropathies.
JRA is then divided into 3 types:
- Systemic JRA: occurs in 10-20% of affected children; usually characterized by a febrile onset and evanescent rash with multiple physical and laboratory abnormalities. It is strikes boys and girls equally.Polyarticular JRA: occurs in 30-40% of affected children; characterized by multiple (more than 4) joint involvement and minimal systemic features. Girls are affected by polyarticular JRA more frequently than boys. Pauciarticular JRA: occurs in 40-50% of affected children; characterized by fewer than four joints involved, usually larger joints; a risk for chronic uveitis in young girls and axial skeletal involvement in older boys.
What causes it? The cause is unknown, though abnormal immune response, genetic predisposition and environmental triggers, and infectious agents are all being considered.
What are the symptoms? Although symptoms vary between each type of juvenile arthritis and each individual child, the most common symptoms are: pain redness and swelling in the joints, fatigue, rash, fever, morning stiffness, flu like feeling, weight loss, and nausea. Nodules or lumps under the skin may form with juvenile rheumatoid arthritis.
How is it diagnosed? Juvenile arthritis is usually difficult to diagnose due to the wide range of possible symptoms and severity of symptoms. JA may be suspected when a child presents with joint pain and swelling, fever and unexplained rashes. A diagnosis of JA is also considered in children with an unexplained limp or excessive clumsiness.
No one test can definitively diagnose JA. Diagnosis is carefully based on physical exam, medical history, blood tests and x-rays. It is important to note that many blood tests that are positive in adults with rheumatic diseases may be negative in children with the same diseases. How is it treated?The treatment of JA focuses on relieving pain, reducing inflammation, slowing or stopping joint damage, and improving the child’s sense of well-being and ability to function. A combination of treatments is almost always used.
NSAIDS (Nonsteroidal anti-inflammatory drugs) are commonly the first type of drug used to treat the joint pain associated with JA. Available over the counter or by prescription, they fight inflammation or swelling and relieve pain. Aspirin is avoided if possible due to the risk of Reye’s syndrome.
DMARDS (disease modifying anti-rheumatic drugs) are also known as SAARDS (slow acting anti rheumatic drugs. As their name might suggest these medications take some time to be effective, up to several months. Most of them were originally invented to treat other diseases but were noted to have a positive effect on rheumatic diseases. Most of them do not have any common properties other than their ability to slow down the progression of the disease. They are usually given in combination with a NSAID.
In children with very severe JRA, stronger medicines may be needed to stop serious symptoms such as inflammation of the sac around the heart (pericarditis). Corticosteroids like prednisone may be added to the treatment plan to control severe symptoms. The risk of serious side effects in children is fairly high. Once the disease is brought under control the corticosteroid is likely to be reduced or discontinued. Reduction of corticosteroids should always be done under the supervision of a doctor. Never stop a steroid suddenly without a doctor’s approval.
Physical Therapy & Exercise:
Physical therapy is an important part of a child’s treatment plan. Exercise can help to maintain muscle tone and preserve and recover the range of motion of the joints. A physical therapist can design an appropriate exercise program for a child with JA.
Splints, braces and supports can protect the joints and help prevent further damage. A doctor or a physical or occupational therapist can help get a splint and ensure that it fits properly. Other ways to reduce stress on joints include self-help devices, devices to help with getting on and off chairs, toilet seats, and beds; and changes in the ways that a child carries out daily activities.
Although many children with arthritis may never need a surgical procedure, some will. Several types of surgery are available to patients with severe joint damage. These procedures can help reduce pain, improve the affected joint’s function and appearance, and improve the patient’s ability to perform daily activities. Surgical procedures include joint replacement, tendon reconstruction, and synovectomy.
What research is being done? Scientists are investigating the possible causes of JRA. Researchers suspect that both genetic and environmental factors are involved in development of the disease and they are studying these factors in detail. To help explore the role of genetics, the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) has established a research registry for families in which two or more siblings have JRA. NIAMS also funds a Multipurpose Arthritis and Musculoskeletal Diseases Center (MAMDC) that specializes in research on pediatric rheumatic diseases including JRA. Researchers are continuing to try to improve existing treatments and find new medicines that will work better with fewer side effects.
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For more information:
Dambro: Griffith’s 5-Minute Clinical Consult, 1999 ed., Copyright © 1999 Lippincott Williams & Wilkins, Inc.
American College of Rheumatology
The National Institute of Arthritis and Musculoskeletal diseases, Questions & Answers about JRA