What Is Juvenile Rheumatoid Arthritis?
by Peggy Deland
Juvenile rheumatoid arthritis (JRA) is a condition that causes joint pain and swelling in children and adolescents. It is also called juvenile idiopathic arthritis because the cause of the condition is unknown. Unlike adult rheumatoid arthritis, JRA is almost always temporary and doesn't usually cause damage or deformity to the joints.
There are three types of JRA: pauciarticular, polyarticular and systemic. Pauciarticular JRA affects fewer joints (up to four) and is milder than the other forms. Polyarticular JRA affects at least five joints and usually has a symmetric pattern; the same joints on each side of the body are affected. Systemic JRA, which is also called Still's disease, is the rarest and most severe form of JRA. In this form of the disease, the many different parts of the body are affected instead of just the joints. In addition to the joint symptoms present in the other two types, systemic JRA causes swollen lymph nodes, high fevers, eye inflammation and rashes.
The symptoms caused by JRA vary depending on which form of the condition the child has. However, there are some symptoms that occur in all three forms. Joints, especially those of the hands, feet and knees, become swollen, painful and stiff. The stiffness may be more pronounced in the morning and get better as the day progresses. The skin over affected joints may be red and feel hot to the touch.
Although the diagnosis of JRA may be suspected based on symptoms and a physical examination, other diseases can mimic it. A doctor, usually one that specializes in arthritis, must perform tests to determine whether the child has JRA or another condition. Blood tests that measure inflammation in the body and antibody levels can give important diagnostic clues. Testing can also be performed on joint fluid to determine the cause of swelling and pain. Although JRA cannot be diagnosed with X-rays, imaging studies can be useful to look for other causes of the symptoms and to monitor for joint damage.
JRA is treated with the same medications used to treat adult rheumatoid arthritis. However, since JRA is unlikely to cause permanent damage to the joints, arthritis medication that has a high risk of adverse reactions isn't used unless the condition is severe. Often, NSAIDs (such as ibuprofen) are the only treatment required; these drugs reduce both pain and swelling. DMARDs (such as methotrexate) and corticosteroids (such as prednisone) are sometimes used if the condition is severe. In unusually difficult-to-treat cases, TNF inhibitors (such as Remicade) can be used.
Symptoms of JRA can first occur in children as young as 6 months or in adolescents as old as 16 years. It is more common in young children than in teenagers. The disease is usually temporary in nature, and most cases resolve spontaneously within a few years of onset. In some cases, JRA may progress to a related autoimmune disorder, such as lupus or scleroderma. If this happens, the disease is likely to be permanent.