What is JRA?
Juvenile arthritis (JA), a group of conditions related to arthritis that often causes joint pain and inflammation, occurs in children 16 or younger. JA affects about 300,000 children in the United States, most commonly in the form of juvenile rheumatoid arthritis (JRA).
What is juvenile rheumatoid arthritis?
JRA is a type of arthritis that causes joint inflammation and stiffness for more than six weeks in a child 16 or younger. The inflammation causes redness, swelling, warmth and soreness in the joints. However, many children who have JRA do not complain of joint pain. Any joint may be affected, and inflammation may limit the child's ability to move the joint.
There are three types of JRA:
- Pauciarticular (paw-see-are-TICK-you-lar): Four or fewer joints are affected. Typically, large joints (such as the knees) are involved. Eye disease affects about 20 percent to 30 percent of children with pauciarticular JRA, and regular examinations by an ophthalmologist are needed.
- Polyarticular (polly-are-TICK-you-lar): Five or more joints are affected. The small joints, such as those in the hands and feet, are most commonly involved, but the disease also may affect large joints.
- Systemic (sis-TEH-mick): Both joints and other body organs -- such as the heart, liver, spleen and lymph nodes -- are affected. Fever and rash may be present. This type of JRA is sometimes called Still's disease.
How is JRA different from adult rheumatoid arthritis?
The main difference is that many children with JRA outgrow the illness, while adults usually have lifelong symptoms. Studies estimate that by adulthood, JRA symptoms disappear in more than half of all affected children. Also, unlike rheumatoid arthritis in an adult, JRA may affect bone development as well as the child's growth.
What causes JRA?
The cause of JRA is unknown. Some research suggests it is an autoimmune disorder, which means that the body mistakenly identifies some of its own cells and tissues as foreign. The immune system, which normally helps defend the body against harmful foreign substances such as bacteria or viruses, instead attacks healthy cells and tissues in the joints. This causes joint inflammation with redness, warmth, pain and swelling. Other scientists believe that there may be a genetic link in determining who gets JRA.
What are the symptoms and signs of JRA?
The most common symptom of all types of JRA is persistent joint swelling, pain and stiffness that typically is worse in the morning or after a nap. The pain may limit movement of the affected joint, although many children, especially younger ones, will not complain of pain.
One of the earliest signs of JRA may be limping in the morning because of an affected knee. Besides joint symptoms, children with systemic JRA have a high fever and a light pink rash. The rash and fever may appear and disappear very quickly. Systemic JRA also may cause the lymph nodes in the neck and other parts of the body to swell. In less than half of cases, internal organs like the heart and (very rarely) the lungs may be involved.
Depending on the severity of the disease and the joints involved, growth in affected joints may be too fast or too slow. This can cause one leg or arm to become longer than the other. Overall growth also may be slowed.
Eye inflammation is a potentially severe complication that sometimes occurs in children with pauciarticular JRA. These diseases often are not present until some time after a child first develops JRA. A child with JRA also suffers an increased risk of bone loss and fracture.
Typically, there are periods when the symptoms of JRA are better (remissions) and times when symptoms are worse (flares). JRA is different for each child - some may have just one or two flares, then never have symptoms again, while others experience many flares or even have symptoms that never go away.
How is JRA diagnosed?
Doctors usually suspect JRA, along with several other possible conditions, when they see children with persistent joint pain or swelling, unexplained skin rashes and fever, or swelling of the lymph nodes and inflammation of internal organs. Children with an unexplained limp or who are extremely clumsy may also be suspected of having JRA.
No one test can be used to definitively identify a child as having JRA. A doctor diagnoses JRA by carefully examining the patient, considering the patient's history, and evaluating certain laboratory tests. X-rays are needed to evaluate bone damage or abnormal bone development.
Who treats JRA?
A pediatrician, family physician or other primary care doctor frequently manages the treatment of a child with JRA, often with the help of other doctors. Depending on the parents' and child's wishes and the severity of the disease, the team of doctors may include pediatric rheumatologists, ophthalmologists, orthopedic surgeons and physiatrists, as well as physical and occupational therapists.
The main goals of treatment are to preserve a high level of physical and social functioning and to maintain a good quality of life. Most children with JRA need medication and physical therapy to reach these goals.
Are there medications to treat JRA?
Treatment for JRA typically involves a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen, which should be taken with food. Your doctor may also prescribe disease modifying drugs (DMARDs) if arthritis symptoms persist after taking NSAIDs.
If only one joint is involved, your doctor may inject a steroid medication into the affected joint, too. Oral steroids are used sometimes as well in small doses and for a short time.
Medications used to treat JRA, include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs).
- Disease-modifying anti-rheumatic drugs (DMARDs).
- Methotrexate (For some children with JRA not relieved by other medications may cause liver damage and requires careful monitoring)
- Corticosteroids (For very severe JRA and can cause bone loss).
- Etanercept (Enbrel®).
Note that corticosteroids can cause weight gain and a round face. When the doctor stops giving this medication, these side effects may disappear.
 A word about NSAIDs
NSAIDs (nonsteroidal anti-inflammatory drugs) are commonly taken to reduce pain and swelling, although they are not for everyone. Ibuprofen, naproxen and aspirin are all NSAIDs. Talk to your doctor about whether taking NSAIDs is safe for you, especially if you:
What other types of treatment are available for JRA?
- Physical therapy is important in treating JRA. It can help maintain muscle tone and preserve and recover the range of motion of the joints.
- Splints and other devices may be used to keep joints growing evenly.
- Make sure your child's diet contains plenty of calcium and vitamin D. This will help your child build bone mass and reduce the risk of a fracture.
How can a family help a child with JRA?
JRA affects the entire family, presenting everyone with special challenges. JRA can strain a child's participation in social and after-school activities and make schoolwork more difficult. To help a child with JRA cope, the family should:
- Treat the child as normally as possible.
- Make sure that the child receives the right medical care and follows the doctor's instructions. Because JRA is different in each child, what works for one may not work for another. If the medication that the doctor prescribes is not effective or cause unacceptable side effects, the parents and child should discuss other choices with the doctor. A child with JRA can be more active when symptoms are controlled.
- Encourage exercise and physical therapy for the child, according to the doctor's recommendations. For many young people, exercise and physical therapy are important in treating JRA.
- Work closely with the school to make sure the child's needs are met, and to educate the teacher and other children about JRA. Some children with JRA may be absent from school for prolonged periods and need to have assignments sent home. Arrangements such as getting an extra set of books or leaving class a few minutes early to get to the next one on time can help a great deal. With proper attention, most children with JRA progress normally through school.
- Explain to the child that getting JRA is nobody's fault. Some children think that JRA is a punishment for something they did.
Do children with JRA have to limit their activities?
Although pain sometimes limits physical activity, exercise is important to reduce the symptoms of JRA and maintain joint function and range of motion. Most children with JRA can take part fully in physical activities and sports when their symptoms are under control. During a disease flare, however, the doctor may advise limiting certain activities that would put stress on affected joints. Once the flare is over, the child can start regular activities again as recommended by your doctor.
Points to remember
- Arthritis can affect children as well as adults. When arthritis is diagnosed in a child 16 or younger, the child is said to have juvenile arthritis.
- There are many different types of juvenile arthritis. The most common type is juvenile rheumatoid arthritis (JRA).
- JRA is an autoimmune disease that affects a child's overall system, as well as involved joints.
- There are three types of JRA with different characteristics: pauciarticular, polyarticular and systemic.
- Different children with JRA may have different experiences with the disease, ranging from infrequent attacks that go away and don't return to severe disease.
- Children with JRA may need specialized treatment and assistance to maximize their ability to function, and minimize pain and discomfort. A number of treatment strategies may be used to reach these goals.
This article was reviewed and updated June 2007.
|
