Juvenile Rheumatoid Arthritis

Juvenile Rheumatoid Arthritis (JRA) is the most common form of arthritis affecting young children. Learn all about the causes, symptoms, treatment and prognosis of this disorder.

What is Juvenile Rheumatoid Arthritis?

It is a common form of Arthritis that affects children aged below 16 years. It can be a long-lasting condition, causing swelling and stiffness in the joints. It is also known as Juvenile Idiopathic Arthritis or JIA.

Juvenile Rheumatoid Arthritis Prevalence

Around 50,000 children in the US are said to suffer from this condition on an annual basis. Approximately 1 out of every 1000 children in the United States is reported to have this disorder every year.

Juvenile Rheumatoid Arthritis Classification

There are three major types of this disease:

Picture 1 – Juvenile Rheumatoid Arthritis

Pauciarticular JRA or Oligoarticular JIA

It affects up to 4 joints within the first six months of its onset. Individuals with this form of JRA are often ANA positive as compared to those with other forms of JRA. Around 50% of the total JIA patients suffer from this form. Although this disease generally affects large joints, such as elbows ankles and knees, smaller joints including toes and fingers are sometimes affected as well. However, it does not affect the hip joint. Pauciarticular JRA is not a symmetrical condition, which means joints on one side of the body are affected instead of both sides.

Polyarticular JRA

Five or more joints are affected by this specific type of JRA within the first six months of the disease. The neck, jaw and the small joints (fingers, toes) are usually affected by this form. However, it may also affect weight-bearing joints such as the hips, knees and ankles. Girls are more prone to this type of JRA than boys. Polyarticular JRA is a symmetrical condition, meaning both of the similar joints on the opposite sides of body are equally affected by it. Patients of this condition have an increased risk of chronic iridocyclitis or eye inflammation.

Systemic JRA

This form of JRA is characterized by fever, arthritis and salmon pink rashes. Both boys and girls are equally affected by Systemic JRA. Diagnosing this condition can be rather difficult as the rash and fever tend to come and go continuously. The disorder affects both small and large joints. The fever generally occurs every day at a particular time, such as in the late afternoons or evenings. The rashes occur along with the fever and do not generally continue in a specific skin area for more than an hour. It often involves different internal organs. Systemic JRA is also referred to as “Systemic Onset JRA”.

Doctors often consider the presence of two other types of JRA – Psoriatic JIA And Enthesitis-Related Arthritis. Enthesitis is commonly associated with Inflammatory Bowel Disease and Ankylosing Spondylitis.

Juvenile Rheumatoid Arthritis Causes

In some cases, the immune system of human body starts attacking its own tissues and cells, thus giving rise to JRA. The reason behind this is still unknown. However, the condition is believed to occur due to various genetic and environmental causes. Some kind of gene mutation resulting from virus may cause a person to become more susceptible to various environmental factors, thus triggering the disease. The virus leaves the organism after damaging the body permanently.

Juvenile Rheumatoid Arthritis Risk Factors

Various factors are believed to be associated with JRA or likely to worsen the condition:

Heredity

The condition may occur due to genetic causes. Studies show that children from families with at least one member having a history of JRA are more likely to develop the condition.

Being female

Girls of all ages are more prone to this disease as compared to boys.

Psychological stress

Psychological stress is supposed to worsen the condition of a JRA sufferer. Although control of emotional stress does not guarantee complete prevention of all JRA symptoms, stress management helps keep the disorder in check to some extent.

Sex hormones

According to another theory, sex hormones may play an important role in causing JRA. This is due to the fact that females are more commonly affected by the condition. However, sex hormone replacements or deficiencies do not help improve the symptoms.

Juvenile Rheumatoid Arthritis Signs and Symptoms

The symptoms of JRA generally vary from patient to patient. The disease may cause mild to severe symptoms that may resolve within a few days or months. Sometimes, these symptoms last for several years. In rare cases, patients experience such symptoms all through their life.

Some of the common signs and symptoms of this disorder have been discussed below:

• Joint pain, swelling, stiffness and warmth are among the common symptoms of Juvenile Idiopathic Arthritis. In many cases, however, patients do not report or recognize the swelling and pain. Inflammation and stiffness of the joints is more severe in the morning and after naps.
• Swelling, stiffness and pain may hamper the functioning of the joints by reducing their range of motion. Some patients display little disability due to their ability to compensate the joint impairment in other ways. However, severe symptoms may lead to decreased physical function.
• JRA patients often suffer from high fever which occur and resolve without any specific cause. The fever may “spike” (shoot up) several times in a single day.
• A limp generally indicates a severe case of JRA. However, various other conditions – such as an injury, may also lead to limping. In JRA, limping may indicate knee involvement.
• Deformations of various body parts may occur due to an abnormal growth of the joints.
• Muscle ache or Myalgia is another symptom of JIA which affects the whole body.
• Patients may also develop recurrent rashes without any definite causes.
• Swelling of the lymph nodes is a comparatively rare symptom. This condition is commonly referred to as “swollen glands” although lymph nodes are not glands. Generally, inflammation of lymph nodes is seen to occur under the jaws, in the neck, in the armpits, above the collarbone and in the groin.
• Children suffering from this disease have a slower growth rate as compared to healthy children. The affected joints have an abnormal growth rate. The condition causes them to grow too fast or too slow. Due to this reason, one hand or leg may grow longer than the other one.
• JRA patients often lose weight due to their inability to eat properly. Weight loss, along with diarrhea, may indicate a digestive tract inflammation.

Juvenile Rheumatoid Arthritis Prevention

There are no known ways of preventing this condition as its causes are still unknown. Experts are still trying to find out an effective way of preventing Juvenile Idiopathic Arthritis. However, affected individuals may use some measures to lessen the severity of the symptoms and manage the condition.

Juvenile Rheumatoid Arthritis Management

Know about some of the measures to be taken to keep the symptoms of JRA in check:

• JRA patients must maintain a proper balance between activity and rest. They should not put their muscles and joints under strain as excessive activity may worsen the pain and soreness.
• Using joint supports and splints also helps keep the pain under control.
• Keeping the joints warm throughout the night helps lessen stiffness in them in the morning. Using thermal underwear, a sleeping bag or a heated water bed helps in this purpose.
• Taking a warm bath after waking up in the morning also helps lessen stiffness in the joints.

Juvenile Rheumatoid Arthritis Diagnosis

It is quite difficult to diagnose JRA due to the similarity of some of its symptoms, such as joint pain and stiffness, with that of several other diseases. JRA cannot be diagnosed correctly with a single test. However, certain medical tests can help rule out the possibility of other similar conditions. These include:

Blood Tests

The most commonly used blood tests include:

Erythrocyte Sedimentation Rate or ESR

The speed at which the red blood cells settle at the bottom of a tube containing blood is known as sedimentation rate. An elevation in the sedimentation rate may be a sign of inflammation. This test helps correctly classify the form of JRA present in the patient.

C-Reactive Protein

This blood test allows determining the extent of inflammation in the body.

Anti-Nuclear Antibody

The immune systems of individuals having autoimmune diseases, including JRA, produce proteins known as ANA or Anti-Nuclear Antibodies.

Rheumatoid Factor

It involves detecting the presence of an antibody that is commonly found in adults having JRA.

Cyclic Citrullinated Peptide or CCP

CCP is an antibody similar to the rheumatoid factor, found in adult JRA sufferers.

X-Rays

X-rays help discard the possibility of other conditions, including:

• Fractures
• Tumors
• Infection
• Congenital defects

Following the diagnosis of JRA, X-ray examinations are conducted frequently for managing development of the bones and for detecting any joint damage.

Juvenile Rheumatoid Arthritis Differential Diagnosis

The differential diagnosis of this disorder includes distinguishing it from conditions like:

• Infectious Mononucleosis
• Kawasaki Disease
• Behcet Syndrome
• Pediatric Acute Lymphoblastic Leukemia
• Pediatric Sarcoidosis
• Lyme Disease
• Viral Pericarditis
• Pediatric Kawasaki Disease
• Systemic Lupus Erythematosus
• Somatoform Disorder

Juvenile Rheumatoid Arthritis Treatment

The main objective of JRA treatment is to allow an affected child to take part in all physical and social activities. Doctors generally use a combination of medications and therapies to accomplish the goal.

Medications

In many cases, pain relieving medications successfully keep symptoms under control. There are various medications that help prevent the progress of the condition. Some of these involve:

NSAIDs or Nonsteroidal Anti-Inflammatory Drugs

These are similar to Ibuprofen (Advil and Motrin) and Naproxen (Aleve) and help reduce swelling and pain. Side effects of NSAIDs include liver problems and stomach upset.

DMARDs or Disease-Modifying Antirheumatic Drugs

In severe cases of JRA, these medicines are used along with NSAIDs. DMARDs help retard the advancement of JRA. Sulfasalazine (Azulfidine) and Methotrexate (Trexall) are among the most common DMARDs used for children. These medications may cause various side effects which include liver problems and nausea.

Tumor Necrosis Factor Blockers or TNF Blockers

They effectively reduce the pain, swelling and morning stiffness. However, individuals using these medications are more likely to have various infections. Adalimumab (Humira) and Etanercept (Enbrel) are examples of Tumor Necrosis Factor Blockers. The TNF Blockers are often suspected of increasing the risk of some cancers like Lymphoma.

Immune Suppressants

Overactivity of the immune system generally leads to JRA. So, medications capable of suppressing the immune system are useful for treating the disease. Examples of Immune Suppressants include Rituximab (Rituxin), Abatacept (Orencia) and Anakinra (Kineret).

Corticosteroids

Medications like Prednisone are often used for controlling the symptoms of JIA until DMARDs take effect. Corticosteroids are administered by injecting them directly into the affected joint or by mouth. These medications are taken for a very short duration of time as they often interfere with the natural growth of the patient.

Therapies

There are various physical therapies that help a child with JRA fight the condition. These therapies keep the joints flexible helping the child carry out the everyday activities. A physical therapist may also recommend some protective equipment and suitable exercises.

Surgery

In very rare instances, a surgery may be necessary for treating severe cases of JRA. These surgeries help to improve the affected joint’s position.

Juvenile Rheumatoid Arthritis Complications

Several serious complications are associated with this ailment:

Picture 2 – Juvenile Rheumatoid Arthritis Image

Eye Problems

Uveitis and Iritis are the most common forms of eye inflammation that develop in some types of JRA. The eyes may also become very sensitive to light. In many cases, however, eye inflammation does not have any symptoms. If severe eye complications are left untreated, they may result in cataracts, glaucoma and loss of vision.

Growth Problems

JRA often interferes with the growth and bone development of a child. Some medications, such as Corticosteroids, also affect the normal growth of a patient.

Juvenile Rheumatoid Arthritis Prognosis

The outcome of proper treatment is generally positive. Exercises and protective equipments help ensure a better prognosis.

Juvenile Rheumatoid Arthritis and Pregnancy

Women diagnosed with JRA in their teens often experience an improvement of the symptoms during the early part of the second trimester. This may be due to the reason that the adrenal glands of pregnant women produce an increased amount of steroids. Another possible cause for this relieving of the symptoms is that the immune systems creates fewer inflammatory chemicals during pregnancy. However, the symptoms come back again a few weeks after childbirth.

Juvenile Rheumatoid Arthritis Life Expectancy

As per researches, individuals with JRA have a shorter lifespan than those without the condition. However, advanced medical technology helps JRA patients to lead longer and more normal lives.

Juvenile Rheumatoid Arthritis Pictures

Take a look at these images to find out how this disease affects different parts of human body.

JRA is a serious health disorder that causes severe pain, swelling and stiffness of various joints. In many cases, the disease can be completely cured by proper treatment. However, serious complications arising from the condition should receive early attention. Otherwise, these may give rise to long lasting health problems.

References:

http://www.mayoclinic.com/health/juvenile-rheumatoid-arthritis/DS00018

http://kidshealth.org/parent/medical/arthritis/jra.html#

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001487/

http://www.webmd.com/rheumatoid-arthritis/tc/juvenile-rheumatoid-arthritis-prevention