Rheumatology
Juvenile Rheumatiod Arthritis (JRA)
What Is Juvenile Rheumatoid Arthritis?
Juvenile rheumatoid arthritis (JRA) is the most common type of arthritis affecting children. Rheumatoid arthritis is a chronic (long-lasting) disease that can affect joints in any part of the body. In this disease, the immune system mistakenly targets the tissue that lines the inside of the joint, called the synovium. The synovium responds by making excess fluid (synovial fluid), which leads to swelling, pain and stiffness. The inflammation can then spread to the surrounding tissues, eventually damaging cartilage and bone. Other areas of the body—including the eyes, skin, kidneys, lungs and heart—also may be affected by the inflammation. Without treatment, JRA can interfere with a child’s normal growth and development.
There are three main subtypes of JRA, which are based on symptoms and the number of joints involved:
- Systemic JRA — Also called Still’s disease, this type occurs in about 20 percent of children with JRA. A systemic illness is one that can affect the entire person or all body systems. Systemic JRA usually causes a high fever and a rash, which most often appears on the torso, arms and legs. It also can affect internal organs, such as the heart, liver, spleen and lymph nodes. This type of JRA affects boys and girls equally.
- Pauciarticular — This type of JRA affects fewer than 5 joints, most often the knee and wrist joints. It also can cause inflammation of the iris (the colored area of the eye), called iridocyclitis or iritis. About half of all children with JRA have this type and it is more common in girls than in boys. Most children will outgrow this type of arthritis by adulthood.
- Polyarticular — This type of JRA affects 5 or more joints, usually the same ones on each side of the body (i.e. symmetrical). Polyarticular JRA most often starts by affecting small joints, such as those in the hands and feet. Later, large joints are often involved. It is more common in girls than in boys.
What Are The Symptoms Of JRA?
Symptoms may vary depending on the type of JRA and may include:
- Morning stiffness
- Pain, swelling and tenderness in the joints
- Fever
- Rash
- Weight loss
- Fatigue or irritability
- Eye inflammation
What Causes JRA?
The exact cause of JRA is not known. However, researchers are studying several factors that may be involved, alone or in combination, to trigger the inflammatory reaction seen in JRA. These factors include genetics (heredity), infection and other environmental factors that impact the immune system.
How Common Is JRA?
JRA is the most common type of arthritis in children. It affects about 100,000 children in the United States.
How Is JRA Diagnosed?
There are no tests that specifically diagnose JRA. Rather, JRA is a diagnosis of exclusion, which means the doctor works to rule out other types of arthritis and other diseases as the cause of the symptoms.
In making a diagnosis of JRA, the doctor usually begins with a complete medical history, including a description of your child’s symptoms, and a complete physical examination. Imaging techniques such as X-rays or magnetic resonance imaging (MRI) can sometimes show the condition of the joints. Laboratory tests on blood, urine and/or joint fluid may be helpful in determining the type of arthritis. These tests also can help rule out other diseases such as an infection, cancer, or an injury as the cause of your child’s symptoms.
How is JRA treated?
The goals of treatment are to relieve pain, reduce swelling, increase joint mobility and strength, and prevent complications. Treatment generally includes medication and exercise. In some cases, splints or braces also may be used to help protect the joints as the child grows.
Medications used to treat JRA include:
- Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
These medicines provide pain relief and reduce swelling. Some are available over the counter and others require a prescription. Examples include ibuprofen and naproxen. These medicines can cause nausea and stomach upset in some people.
- Corticosteroids (steroids)
These medications, given as an injection (shot) or pill, are used to reduce severe pain and swelling. These medicines are effective, but can have serious side effects—including weakened bones and cartilage—especially when used for long periods. Doctors generally try to avoid using steroids in children because they can interfere with a child’s normal growth.
- Disease-Modifying Anti-Rheumatic Drugs (DMARDs)
These medications work by targeting and changing, or modifying, the actual disease process in arthritis. The aim of DMARDs is to prevent bone and joint destruction by suppressing the immune system’s attack on the joints. Methotrexate is a DMARD often used to treat JRA.
- Biological Agents
Biological agents are a type of medication used to treat children with polyarticular JRA. These medicines block the action of a naturally occurring protein in the body that helps cause inflammation. Etanercept (Enbrel) is an example of this type of medication.
Exercise And Physical Therapy
Exercise can help reduce pain, maintain muscle tone, improve mobility (ability to move) and prevent permanent handicaps.
What Is The Outlook For People With JRA?
JRA affects each child differently. For some, the disease is mild and easy to control, with only one or two joints affected. For others, JRA may involve many joints, and the symptoms may be more severe and may last longer. In general, however, the outlook is positive for children with JRA. Fifty percent to 75 percent of children with JRA experience complete remissions, or the disappearance of symptoms. Early detection and treatment may help to control inflammation, prevent joint damage and maintain your child’s ability to function.
What Complications Are Associated With JRA?
Untreated, JRA can lead to:
- Loss of vision or decreased vision due to iridocyclitis (inflammation of the iris)
- Permanent damage to joints
- Chronic arthritis
- Interference with a child’s bones and growth
- Inflammation of the membranes surrounding the heart (pericarditis) or lungs (pleuritis)
Can JRA be prevented?
At this time, the cause of JRA is not known, and thus there is no known way to prevent JRA.
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