Juvenile Rheumatoid Arthritis (JRA)
It’s been awhile… but I figured it was time to post something educational!
Although Bubba has not been diagnosed with juvenile rheumatoid arthritis, it is one of several different autoimmune disorders than can affect children (and I said I would post about ages ago!). It is the most common cause of arthritis in children under 16 years of age.1
Juvenile rheumatoid arthritis (JRA) can cause inflammation in the joints, and eyes, and can be permanent or come and go with the child as they age. It causes joint pain, swelling, and stiffness in children.1 Over 300,000 children in the U.S. have arthritis.
Types of JRA
There are 7 main types of JRA2:
• Systemic JRA
This type affects the entire body. There is typically a high fever seen with this type, with an increase in the evening and can suddenly drop to normal. At the onset of the fever the child is very ill, appears pale, and can develop a rash.2 The spleen and lymph nodes can be enlarged, and eventually the joints can be swollen, painful and stiff.
• Oligoarthritis – affects four or fewer joints. Knee and wrist joints are most common locations affected. Inflammation of the iris, the color part of the eye, can occur with this type of JRA.
• Polyarticular arthritis, rheumatoid negative – Involves five or more joints, and usually occurs in girls. Small joints of the hands, and weight bearing joints are typically affected. Low grade fevers are also possible with nodules in the pressure point areas of the body from sitting or leaning.
• Polyarticular arthritis, rheumatoid positive – This affects 15% of kids with polyarticular arthritis, and 3% of JRA children. This is most like adult rheumatoid arthritis and this is the type that often creates the most joint damage over time.
• Psoriatic arthritis – Kids with this often have a psoriasis rash, or a family member with psoriasis. Their fingernails or toenails may be affected by this.
• Enthesitis-related arthritis – Affects mostly the lower extremities and spine. Inflammation at the tendon-bone connections is also common with this type of JRA.
• Undifferentiated JRA – Arthritis that doesn’t clearly fit the criteria of the other types.
Symptoms of JRA
Symptoms in any young child are difficult to diagnose. But a child with this may complain about joint pain, or you may notice a limp or stiffness in the child’s walk or other joints. The child may also appear clumsy, especially in the morning or after naps when stiffness is at its peak. 1
In many cases JRA affects not just joints, but the whole body. It can cause swollen lymph nodes, rashes and fever. As with other types of arthritis and other immune disorders, the disease can flare and subside over time.
Causes and Complications of JRA
As with many other autoimmune disorders, and arthritis, certain genetic predispositions exist that can lead to the condition, as well as a certain gender. Girls are more susceptible to JRA.
Joint damage, as well as eye damage can occur if the JRA is not properly treated and controlled. It’s important for a child to maintain regular check ups and treatments. A pediatrician should refer a child out to a rheumatologist to help control and maintain the child’s condition.
Testing will be done to determine if JRA could be the cause of a child’s problems. Blood work for the ESR, C-reactive protein (CRP), ANA levels (anti-nuclear antibodies), rheumatoid factor, as well as CCP (cyclic citrullinated peptide) will be examined. It is possible that a child can have JRA but not show significant changes in these levels. It’s important to keep a thorough health history, or journal to assist a physician in identifying the problems with your child’s health. A journal is a lot of work, but speaking from experience, it can make the difference between quick diagnoses, vs. un-necessary testing and poking.1
Treatments & Medications
It’s important for a child to maintain normal levels of physical and social activity. Physicians should be prescribing medications that control swelling, pain and prevent further complications.
A variation of medications such as NSAIDs, DMARDs, TNF, corticosteroids, and immune suppressants can be used. These drugs interact with each other to decrease swelling and inflammation, which should decrease pain and increase ability to physically and socially interact.
Most importantly is that children remain active, social and develop at a normal rate. Any child with symptoms like these should seek help from their pediatrician, and be referred to a specialist. Proper treatment and control of JRA is essential to a long, healthy, and active life for the child affected.
2- Kids Health – http://kidshealth.org/parent/medical/arthritis/jra.html