Juvenile Rheumatoid Arthritis
Over 50,000 children in the U.S. suffer from juvenile rheumatoid
arthritis, the most common childhood arthritis. Juvenile rheumatoid
arthritis is also referred to as “JRA”. It is also sometimes
referred to as “idiopathic juvenile arthritis” which means that the
cause is unknown.
JRA has several subtypes and each has a different presentation and may need different treatments. Some children have the adult form of RA (rheumatoid arthritis) but with a very early onset. Some children will even seem to outgrow the arthritis and symptoms will diminish when they get older, but others have progressive disease.
Unlike adult RA, JRA has no blood tests that guarantee the diagnosis. Diagnosis is made by symptoms and signs as well as by ruling out other causes. By definition, joint symptoms occur before the age of 16 to have a diagnosis of JRA. Some of the problems associated with JRA such as iritis may have no symptoms while still causing damage so excellent medical care and surveillance is critical. Common symptoms may include feel stiff when waking from sleep or a nap, hesitation in using a limb, decreased activity, a limp, continued and unexplained fevers, and joint swelling.
About 10% of children with JRA have what is called systemic onset JRA. It is characterized with a high fever, rashes, low red blood count and elevated white count. Arthritis or inflamed joints may not appear for several months after the other symptoms and signs appear. However, the arthritis may go on after the other symptoms have diminished or disappeared.
About half of children with arthritis have pauciarticular juvenile rheumatoid arthritis. “Pauci” means “few” and fewer than five joints are affected. Many children have only one joint involved, often the knee, and girls are more likely than boys to have this form. If the diagnosis of pauciarticular JRA is made before the child is seven years old, the chances are good that the disease will eventually resolve completely. However, eye problems are more common in these young onset patients so rigorous eye care and exams are needed to prevent damage. Older children may have disease that lasts into adulthood.
Polyarticular JRA affects five or more joints, with “poly” meaning “many.” This form can occur at any age and it is this group who may have the adult form in childhood and they will have the disease persist throughout their lives. Some of these children do test positive for the rheumatoid factor and have the highest risk of joint damage and will need the most aggressive treatment.
Treatment of JRA is directed at controlling the symptoms. Decreasing the inflammation reduces pain and lessens damage to joints and initial treatment is often an NSAID or non-steroidal anti-inflammatory drug. Common examples are aspirin, ibuprofen and naproxen, although there are many prescription NSAIDs used as well. Most of these can upset the stomach and need to be taken with food.
When only one or two joints are involved, treatment may be injections of steroids directly into the joint, and oral steroids are also sometimes used. Children with more aggressive disease are treated with many of the same DMARDs (disease-modifying anti-rheumatic drugs) and biologic modifiers as used with adults. With children, there are issues with growth and development with some drugs that aren’t concerns with adults. Both doses and kinds of medications are individualized to each child with JRA. With good care, the prognosis is very hopeful for children with JRA.
Resources
Arthritis Foundation disease center for JRA:
www.arthritis.org/
General JRA information:
http://kidshealth.org/
JRA causes, treatments and symptoms:
www.emedicinehealth.com/
Diagnosis and treatment of JRA:
www.medicinenet.com/juvenile_arthritis/article.htm Cincinnati
Children’s Hospital JRA information:
www.cincinnatichildrens.org/
National Institutes for Health site, information about JRA research
www.nlm.nih.gov/