Juvenile Rheumatoid Arthritis
Juvenile rheumatoid arthritis is the most common form of arthritis affecting children. It is a swelling of the joints that is characterized by heat and pain. Arthritis can be short-term, lasting just a few weeks or months and then disappearing - or it may be chronic and last for months, years or even a lifetime.
The first signs of juvenile rheumatoid arthritis can sometimes be mistaken for the ordinary illnesses and injuries of childhood. In other children the signs may be quite obviously those of arthritis.
Symptoms may include:
- High fevers that tend to spike in the evening and then suddenly disappear
- Limping or a sore wrist, finger or knee
- Rashes that suddenly appear and disappear in one or more areas
- Stiffness in the neck, hips or other joints
- Joint stiffness that is worse after rest
- Sudden swelling of the joints, which stay enlarged. These joints may appear reddened and feel warm.
It is important for parents and teachers to understand that the symptoms of juvenile rheumatoid arthritis vary from child to child and even from day to day in the same child.
Many rheumatologists (doctors specializing in joint disorders) find that the greater the number of joints affected, the more severe the disease and the less likely that the symptoms will eventually go away.
There are three main types of juvenile rheumatoid arthritis:
- Polyarticular arthritis, which involves pain or swelling in five or more joints. This type of juvenile rheumatoid arthritis affects more girls than boys. It affects small joints such as those in the hands as well as weight-bearing joints such as the knees, hips, ankles, feet, and neck.
- Pauciarticular juvenile rheumatoid arthritis, affects four or fewer joints. It most commonly affects the knee and wrist joints. An inflammation of the iris (the colored area of the eye) may occur with or without active joint symptoms. This inflammation, called iridocyclitis, iritis or uveitis, can be detected early by an ophthalmologist.
- Systemic juvenile rheumatoid arthritis affects the whole body. This will cause a child to have the most and most severe symptoms. The spleen and lymph nodes may also become enlarged. Eventually many of the body's joints are affected by swelling, pain, and stiffness.
Causes and Risk Factors
It is not yet known what causes rheumatoid arthritis in children. It is an autoimmune disease. In this type of disease, the white blood cells lose their ability to tell the difference between the body's own healthy cells and harmful invaders like bacteria or viruses. The immune system releases chemicals that damage healthy tissues, causing swelling and pain.
Usually the symptoms of juvenile rheumatoid arthritis appear between the ages of six months and 16 years.
The sooner juvenile rheumatoid arthritis is accurately diagnosed the better. There is no single test to diagnose JRA. A doctor will take a detailed medical history and do a thorough physical exam. In addition, he or she may also order:
- Blood tests to rule out other conditions that can produce similar symptoms or infections. A blood test can also show whether there is inflammation occurring the body and check for rheumatoid factor. Rheumatoid factor is an antibody produced in the blood that indicates whether a rheumatoid condition is present. Another blood test can be done to detect the presence of autoimmunity. This test can be helpful in predicting which children are likely to have eye disease along with juvenile rheumatoid arthritis.
- Bone scan. This test helps detect change in bone and joints to evaluate the causes of unexplained bone and joint pain.
- Examination of synovial fluid, which lines the joints. This test is usually done by an orthopedic surgeon, who removes the fluid for examination and testing.
There is no treatment that will cure juvenile rheumatoid arthritis. The goals of treatment are to relieve pain and inflammation, slow down or prevent joint damage and restore the normal use of the joints to promote the best possible growth, physical activity and social and emotional development for the child.
Usually, juvenile rheumatoid arthritis is treated with a combination of:
- Physical therapy. An appropriate physical therapy program is designed to the child's specific condition. It may include range-of-motion exercises to restore flexibility in stiff, sore joints and other exercises to build strength and endurance.