Juvenile Rheumatoid Arthritis
What is juvenile rheumatoid arthritis?
Juvenile rheumatoid arthritis (JRA) is a form of arthritis in children ages 16 or younger. It causes inflammation and stiffness of joints. Unlike adult rheumatoid arthritis, which is chronic and lasts a lifetime, children often outgrow JRA. But the disease can affect bone development in a growing child.
The disease has 3 types:
- Pauciarticular (Oligoarthritis). This type affects 4 or fewer joints. Large joints, such as the knees, ankles, or elbows are most often affected. About 50 percent of children with JRA have this type.
- Polyarticular (Polyarthritis). This type affects 5 or more joints. Polyarticular disease is more serious and tends to affect the small joints, such as the hands and feet, and often on both sides of the body. Nearly 30 to 40 percent of children with JRA have this type of the disease.
- Systemic. Systemic onset JRA (also called Still's disease) is the most serious. It affects one or more joints and causes inflammation of internal organs, including the heart, liver, spleen, and lymph nodes. It is the least common type of JRA. It affects 10 to 15 percent of children with JRA.
What causes juvenile rheumatoid arthritis?
Like adult rheumatoid arthritis, JRA is an autoimmune disease. This means the body's immune system attacks its own healthy cells and tissues. JRA is caused by several factors. These include genes and environmental factors. This means the disease can run in families, but can also be triggered by exposure to certain things. JRA is associated with part of a gene called HLA antigen DR4. This means a person with this antigen may be more likely to have the disease.
What are the symptoms of juvenile rheumatoid arthritis?
Symptoms of JRA may appear during episodes (flare-ups) or may be ongoing (chronic). Symptoms can occur a bit differently in each child, and may include:
- Swollen, stiff, and painful joints in the knees, hands, feet, ankles, shoulders, elbows, or other joints, often in the morning or after a nap
- Eye inflammation
- Warmth and redness in a joint
- Less ability to use one or more joints
- Decreased appetite, poor weight gain, and slow growth
- High fever and rash (in systemic JRA)
- Swollen lymph nodes (in systemic JRA)
The symptoms of JRA can be like other health conditions. Make sure to see your health care provider for a diagnosis.
How is juvenile rheumatoid arthritis diagnosed?
Diagnosing JRA may be difficult. There is no one test to confirm JRA. Diagnosis starts with a medical history and a physical exam. Your child's healthcare provider will ask about your child's symptoms, and any recent illness. JRA is based on symptoms of inflammation that have occurred for 6 weeks or more.
Tests may also be done. These include blood tests such as:
- Antinuclear antibody (ANA) and other antibody tests. These tests measure blood levels of antibodies that are often present in people with rheumatic disease.
- Complete blood count (CBC). This test checks for low counts of red blood cells, white blood cells, and platelets.
- Complement test. This test is done to measure the level of complement. This is a group of proteins in the blood that help destroy foreign substances. Low levels of complement in the blood are associated with immune disorders.
- Erythrocyte sedimentation rate (ESR or sed rate). This test looks at how quickly red blood cells fall to the bottom of a test tube. When swelling and inflammation are present, the blood's proteins clump together and become heavier than normal. They fall and settle faster at the bottom of the test tube. The faster the blood cells fall, the more severe the inflammation.
- C-reactive protein (CRP). This is protein that is shows up when inflammation is found in the body. ESR and CRP show similar amounts of inflammation. But in some case, one will be high when the other is not. This test may be repeated to check your response to medication.
- Creatinine. This is a blood test to check for kidney disease.
- Hematocrit. This measures the number of red blood cells present in a sample of blood. Low levels of red blood cells (anemia) are common in people with inflammatory arthritis and rheumatic diseases.
- Rheumatoid factor (RF). This detects whether rheumatoid factor is present in the blood. This is an antibody found in the blood of most, but not all, people who have RA and other rheumatic diseases.
- White blood cell count (WBC). This measures the number of white blood cells in the blood. Increased levels of white blood cells may indicate an infection. Decreased levels may indicate certain rheumatic diseases or reaction to medication.
Your child may also have imaging tests. This can show the extent of damage to the bones. The tests may include:
- X-rays. This test that uses a small amount of radiation to create images of organs, bones, and other tissues.
- Computed tomography scan (CT scan). This uses a series of x-rays and a computer to create detailed images of bones, muscles, fat, and organs. CT scans are more detailed than regular x-rays.
- Magnetic resonance imaging (MRI). This test uses a large magnets and a computer to make detailed images of organs and structures in the body.
- Bone scan. This uses a small amount of radiation to highlight the bones in a scanner.
And your child may have other tests such as:
- Urine tests. These are to look for blood or protein in the urine. This can mean the kidneys are not working normally.
- Joint aspiration (arthrocentesis). A small sample of the synovial fluid is taken from a joint. It's tested to see if crystals, bacteria, or viruses are present.
How is juvenile rheumatoid arthritis treated?
Treatment will depend on your child's symptoms, age, and general health. It will also depend on how severe the condition is. The goal of treatment is to reduce pain and stiffness, and help your child keep as normal a lifestyle as possible. Treatment may include:
- Nonsteroidal anti-inflammatory medications (NSAIDs), to reduce pain and inflammation
- Disease-modifying antirheumatic drugs (DMARDs), such as methotrexate, to decrease inflammation and control JRA
- Corticosteroids, to reduce inflammation and severe symptoms
- Drugs that interfere with your body's inflammatory response (biologics), such as etanercept, infliximab, adalimumab, abatacept, and anakinra. These are used if there is no response to other treatment.
- Physical therapy , to improve and maintain muscle and joint function
- Occupational therapy , to improve ability to perform activities of daily living
- Nutrition counseling
- Regular eye exams to find early eye changes from inflammation
- Regular exercise and weight control
- Getting enough rest
- Learning to use large joints instead of small joints to move or carry things
Talk with your healthcare providers about the risks, benefits, and possible side effects of all medications.
What are the complications of juvenile rheumatoid arthritis?
Nearly half of all children with JRA recover fully. Others may have symptoms for years. Some will have rashes and fever, while others may have arthritis that gets worse. Complications may include slow growth and thinning bones (osteoporosis). In rare cases, there may be problems with the kidneys, heart, or endocrine system.
Helping your child live with juvenile rheumatoid arthritis
Help your child manage his or her symptoms by sticking to the treatment plan. This includes getting enough sleep. Encourage exercise and physical therapy and find ways to make it fun. Work with your child's school to make sure your child has help as needed. Work with other caregivers to help your child take part as much possible in school, social, and physical activities. Your child may also qualify for special help under Section 504 of the Rehabilitation Act of 1973. You can also help your child find a support group to be around with other children with JRA.
When should I call my child’s health care provider?
If your child's symptoms get worse or he or she has new symptoms, let the healthcare provider know.
Key points about juvenile rheumatoid arthritis
- JRA is a form of arthritis in children ages 16 or younger. It causes inflammation and stiffness of joints for more than 6 weeks.
- The disease may affect a few or many joints, and may cause symptoms around the body.
- The most common symptoms include swollen, stiff, warm, red, and painful joints.
- Treatment options include medications, physical therapy, healthy eating and exercise, eye exams, and rest.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Before your visit, write down questions you want answered.
- At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you for your child.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.