Juvenile rheumatoid arthritis (JRA) is a chronic disease of the joints. A chronic disease develops over a long period of time. In this case it starts before the age of 16 years old.
In JRA, the immune system attacks the tissue inside joints. This causes the joints to become inflamed. The process leads to pain and/or stiffness. The inflammation can cause long term damage to cartilage and bone. Cases may range from mild to severe. In some cases it can cause changes in growth and development.
There are five major types of JRA:
Pauciarticular JRA— affects four or fewer joints
Polyarticular JRA—affects five or more joints
Systemic Onset JRA (also called Still’s disease)—affects the entire body; least common type of JRA
Enthesitis associated arthritis—occurs with inflammation of the tendon at the bone
Psoriatic arthritis—associated with a skin disease called
JRA is a potentially serious condition. It requires care from your doctor. The sooner JRA is treated, the better the outcome.
low red blood cell count. It is a common symptom experienced by both subtypes.
The first subtype is characterized by:
Presence of rheumatoid factor (RF) in the blood
A low-grade fever
Nodules (bumps on parts of body that receive a lot of pressure such as elbows)
The second subtype is less severe. It only involves joint inflammation.
Systemic onset JRA:
A high fever and chills, often accompanied by a rash on the thighs and chest. This appears off and on for weeks or months. They are the first signs of systemic onset JRA.
Joint inflammation and pain are common.
Heart, lungs, and surrounding tissues may become inflamed.
Lymph nodes, liver, and/or spleen may become enlarged.
Arthritis is in many joints.
Enthesitis associated arthritis:
Tenderness over sacroiliac joints is common. This is the joint where the pelvis and spine meet.
Children will have a positive HLA-B27 antigen test.
Children will often have anterior uveitis. It is associated with eye pain, redness, or photophobia (problem with light).
Finger or toe swelling or fingernail pitting. Pitting happens when fluids build up in the skin.
Often, there are remissions and flare-ups. During remissions the symptoms are better or disappear. During flare-ups symptoms become worse.
There is no one clear test for JRA. The doctor will work to rule out other diseases. Your doctor will ask about your child’s symptoms. Personal and family medical histories will be asked. The doctor will then perform a physical exam. Once your child's physician suspects JRA or makes this diagnosis, your child may be referred to a specialist. A pediatric rheumatologist focuses on diseases of the joints. Tests may include the following:
Ophthalmologic examinations—to detect inflammatory problems of various parts of the eye
Talk with your doctor about the best plan for your child. The goal is to preserve a high level of physical and social function and keep a good quality of life. The plan will work to control inflammation, relieve pain, prevent or control joint damage, and maximize joint function. Options include the following:
Several types of medication are available to treat JRA:
Disease-modifying antirheumatic drugs (DMARDs)—such as
to slow the progression of the disease
Corticosteroids—through IV (directly into the vein) or by mouth; for inflammation and swelling
Immune response modulators—such as TNF inhibitors, for cases that do not respond as well
Exercises are performed to keep muscle strength. It also help to preserve and recover the range of motion of the joints. Normal daily activity, such as non-contact sports and recreational activities, are encouraged. Physical therapy may be needed to keep muscles strong and joints mobile. Children are also able to develop confidence in their physical abilities through such physical pursuits.
Splints and other devices are worn to maintain normal bone and joint growth. They can also help prevent flexion contractures (permanently bent joints).
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a