Juvenile rheumatoid arthritis

Injury	Disease	Nutrition	Poison

Symptoms	Surgery	Test	Special Topic

Juvenile rheumatoid arthritis

Definition:

Juvenile Rheumatoid Arthritis is a chronic, inflammatory disease resulting in joint pain and inflammation. It may result in joint damage. It usually occurs before age 16.

Alternative Names:

Juvenile chronic polyarthritis; JRA; Still's disease

Causes, incidence, and risk factors:

Juvenile Rheumatoid Arthritis (JRA) is a chronic inflammatory arthritis in children. It occurs in between 50-100 per 100,000 children in the United States. JRA is a general term for the most common types of arthritis in children. It is divided in to several categories:

Systemic JRA: This form, which occurs in about 10% of cases, involves joint pain and swelling as well as fevers and rash. It is similar to Adult Still's Disease. The cause of this form of JRA is unknown.
Polyarticular JRA: This form occurs in about 40% of cases and involves multiple joints that are painful and swollen. The cause of this form of JRA is unknown. Some children may have a positive Rheumatoid Factor and evolve into Rheumatoid Arthritis.
Pauciarticular JRA: This form occurs in about 50% of cases and involves only a few joints. Some of these children, in particular boys, will be HLA-B27 positive. Families with HLA-B27 are at increased risk for this arthritis.

Symptoms:

Arthritis symptoms:

joint stiffness on arising in the morning
limited range of motion
slow rate of growth or uneven arm or leg growth
hot, swollen, painful joints
a child my stop using an affected limb
back pain

Systemic JRA symptoms:

Fever, usually high fevers every day
Rash that comes and goes with the fever
Swollen lymph nodes (glands)

JRA can also cause eye inflammation. These symptoms include:

red eyes
eye pain
photophobia (increased pain when looking at a light)
visual changes

Signs and tests:

The physical examination shows swollen, warm, and tender joints that hurt to move. The child may have a rash. Other signs include an enlarged liver, enlarged spleen, or swollen lymph nodes.

Blood tests may include:

CBC
ESR (sedimentation rate)
ANA
RA factor
HLA antigens for HLA B27

The doctor may need to tap a joint. This means that they will put a small needle into a joint that is swollen. This can help to find the cause of the arthritis. By removing fluid, the joint may feel better, too. Sometimes, the doctor will inject steroids into the joint to help decrease the swelling.

Other tests:

X-ray of a joint
X-ray of the chest
ECG
Eye exam by an ophthomologist

Treatment:

The goal is to preserve mobility and joint function and support the patient and family through a long chronic illness.

Therapeutic medications include:

nonsteroidal antiinflammatory agents (NSAIDS)
corticosteroids
topical ophthalmic corticosteroids
hydroxychloroquine
immune suppressing agents, including methotrexate and new biologic medications like infliximab and etanercept.

Note: Talk to your health care provider before giving aspirin or NSAIDS to children!

Physical therapy and exercise programs may be recommended. Surgical procedures may be indicated, including joint replacement.

Expectations (prognosis):

JRA is seldom life-threatening. Long periods of spontaneous remission are typical. Often, JRA improves or goes into remission at puberty. Approximately 75% of JRA patients eventually enter remission with minimal functional loss and deformity.

The stress of illness can often be helped by joining a support group where members share common experiences and problems. See arthritis support group.

Complications:

total joint destruction of the major weight-bearing joints
loss of vision or decreased vision
chronic spondyloarthropathy (back stiffness)

Calling your health care provider:

Call for an appointment with your health care provider if you notice symptoms of juvenile rheumatoid arthritis. Also call your health care provider if symptoms worsen, do not improve with treatment, or new symptoms develop.

Prevention:

There is no known prevention for JRA.

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