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What is juvenile rheumatoid arthritis?
Juvenile rheumatoid arthritis (JRA) is a form of arthritis that is an autoimmune disease (that is, the body’s immune system attacks its own tissues, or in the case of children with JRA, the body’s own joints). The illness affects children between the ages of 6 months and 16 years old. Sometimes the organs are affected as well.
There are three types of JRA:
- Systemic JRA affects the whole body. Symptoms include joint swelling or pain, fevers and rash.
- Polyarticular JRA affects five or more large and small joints of the legs and arms, the jaw and neck. It may develop into rheumatoid arthritis.
- Pauciarticular JRA affects four or less joints, mainly the wrists or knees. It may also involve the eyes.
Signs and symptoms of JRA are different in each child. Common symptoms of JRA include joint stiffness and pain, limited range of motion, fever, pale skin, rash on the trunk and extremities, eye pain, red eyes, vision changes and warm, swollen, or red joints. A child may stop using the limb that has the pain or or may limp. An early sign of JRA is limping in the morning.
A doctor may diagnose a child with JRA if there has been persistent arthritis in one or more joints for at least 6 weeks after other possible conditions have been ruled out. The doctor may inject a small needle into a swollen joint to remove fluid to locate the cause of the arthritis and relieve pain. The doctor may inject steroids into the joint to relieve swelling.
Other tests the doctor may order include:
- X-rays of joints or the chest
- Bone scans
- Electrocardiogram
- Eye exam by an ophthalmologist
Upon diagnosis, the doctor may refer the child to a pediatric rheumatologist who specializes in arthritis and arthritic conditions.
Children with JRA in which only a few joints are affected can take nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen, or corticosteroids if they have more severe flare-ups. A child may be prescribed disease-modifying antirheumatic drugs (DMARDs) if he or she has JRA in many joints or if he or she also has fever, rash or swollen glands. DMARDs reduce swelling in the joints or body and include methotrexate or biologic drugs such as etanercept or infliximab. Children with JRA should exercise to keep muscles and joints strong including walking, bicycling or swimming.
A child may experience long periods with no symptoms or may go into remission with little loss of function or joint damage. However, children with more severe JRA affecting many joints have less chance of going into remission. In fact, children with JRA affecting many joints are more likely to have chronic pain, disability and poor school attendance. Those with more severe JRA may eventually experience wearing away or destruction of joints.
Other complications of JRA include:
- Slow growth rate
- Uneven growth of an arm or leg
- Loss of vision or decreased vision from chronic uveitis
- Anemia
- Swelling around the heart (pericarditis)
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