Juvenile Rheumatoid arthritis is a chronic disease. It damages the joints of the body.Inflammation causes the damage. The inflammation occurs in joints and result in pain, stiffness, and swelling and other symptoms.The condition when five or more joints are affected is called polyarticular disease. Children may present with high fevers, skin rashes, and symptoms of inflammation of organs such as the heart, spleen, liver, and other parts of the digestive tract. It is known as Still’s disease. The medicines used in the treatment of disease especially non-steroidal anti-inflammatory drugs causes complications in children. On frequent intake of drugs irritation, pain and bleeding in the stomach and upper intestine occurs. Child must have frequent blood tests that help in screening of these problems.
Joint inflammation affects other organs.If the inflammation is not stopped, it destroys the affected joints and affects other tissues. Commonly affected joints are shoulder, elbow, hip, and knee.Young Children Are Affected
Juvenile rheumatoid arthritis is more common among children younger than 8 years of age. Affected children have 20-30% chance of acquiring inflammatory eye problems and higher risk of developing adult form of arthritis.
The death rate is higher than healthy children. Children who develop systemic symptoms have highest death rate.
Juvenile rheumatoid arthritis is an auto-immune disease. Its cause is not known.
The chronic inflammation of the synovial fluid is linked to hyperactivity of the immune system. The immune system produces antibodies that are released into the bloodstream to fight “invaders.” But in auto-immune diseases the antibodies attack body’s own tissues.
In arthritis the antibodies attack synovium which results in inflammation. The inflammation results in thick synovium and it grows abnormally; hence it expands outside the joints and puts pressure on bone, cartilage of joint , ligaments, tendons and damages them. The exact cause of auto-immune disease is not known.
• Pain, warmth, stiffness, and swelling in joint.
• Stiffness and swelling are severe in the morning.
• Loss of joint function.
• Decreased range of motion.
• Limp indicates involvement of knee.
• The joints grow in an asymmetrical way and result in deformity.
• Children with juvenile rheumatoid arthritis develop eye inflammations e.g. uveitis and iritis that causes eye irritation, pain and redness. If there is severe inflammation and it can not be reversed it can cause loss of vision.
• Recurrent fevers.
• Skin rash.
• Muscle aches.
• Lymph node swelling.
• Weight loss associated with diarrhea indicates inflammation of the digestive tract.
• Children with JRA grow slowly than average.
The physical examination may show swollen, warm, and tender joints that result in pain on moving. The child may have a rash. Other signs include swollen liver, spleen and lymph nodes.
Blood tests include:
• Anti nuclear anti-body test.
• HLA antigens for HLA B27
• Complete blood count (CBC).
Fluid is taken out from the swollen joint. This is useful in finding the cause of the disease and pain is also reduced.
Other tests include:
• X-ray of a joint and chest
• Bone scan
• Eye exam.
• Infectious Mononucleosis
• Kawasaki Disease
• Pediatric Acute Lymphoblastic Leukemia
• Viral pericarditis
• Pediatric Sarcoidosis
• Lyme Disease
• Pediatric Kawasaki Disease
• Systemic Lupus Erythematosus
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen control the symptoms if small number of joints is involved.
• Anti-rheumatic drugs (DMARDs) e.g. methotrexate, etanercept, infliximab etc. are used if children have arthritis with fever, rash and swollen glands.
• Children having pauciarticular Juvenile RA shows progressive improvement in symptoms.
• Few patients with pauciarticular Juvenile RA develop aggressive arthritis of a single joint.
• Few patients with polyarticular Juvenile RA shows rapid improvement with treatment. Most of the patients require frequent medical and non medical therapy.
• Some have significant loss of function and are relieved by physical and occupational therapy.
• Systemic JRA – Pericarditis. – Anemia. – Inflammation of the arteries in the hands or feet. – Inflammation of liver.
• Pauciarticular JRA – Knee contractures. – Uveitis. – Leg length discrepancy.
• Polyarticular JRA – Skeletal abnormalities. – Involvement of the spine in the neck. Child is unable to bend neck forward.
• Exercising and active routine helps in keeping muscles and joints strong.
• Swimming, bicycling and walking are good activities.
• Always warm up before exercise.
• Consult physical therapist if there is pain from exercise.
• Some children need surgery, including joint replacement.
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