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Juvenile Rheumatoid Arthritis

written by: bevs lim • edited by: Donna Cosmato • updated: 5/24/2011

Arthritis in children? This can be confusing and unexpected. Normally, arthritis is associated with old age or athletes who have injured their joints. However, rheumatoid arthritis in children does exist. If you suspect your child to be suffering from this condition, see your doctor immediately.

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    Juvenile Rheumatoid Arthritis affects kids 6 month to 16 years of age. Arthritis translates literally to joint inflammation in Greek. It is characterized by heat, pain and swelling. There are around 300,000 kids suffering from some sort of arthritis; JRA or juvenile rheumatoid arthritis in children being the most prevalent with over 50,000 diagnosed cases of children with arthritis. (1) This type of arthritis happens to children 16 years of age or younger. In most cases, it causes stiffness and reduced motion to joints, in worst cases, can affect internal organs and cause growth problems.

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    Causes of JRA

    The definite cause of JRA is unknown. However, it is an autoimmune disease – which means that white blood cells lose their ability to identify the healthy cells from harmful invaders, like viruses and bacteria, and attack the body's healthy tissues instead of fighting off infection. The damage of healthy tissues can cause pain and inflammation. Immune systems can be affected by errors in the gene or changes in the environment. Some of these factors have been linked to JRA, although none has been medically proven to cause it:

    • Genetic predisposition. The chances are highly possible that when one family member is diagnosed with rheumatoid arthritis, other members may also develop this condition.
    • Caucasian girls are more likely to suffer from this disease (2).
    • Psychological stress is believed to worsen the symptoms of JRA, however, when the stress is controlled, the symptoms do not always vanish, suggesting that this finding is not straightforward.
    • Experts believe that some certain viruses can trigger JRA.
    • Because JRA is more common in girls, it is supposed that sex hormones modulate or cause arthritis. Then again, neither sex hormone replacement nor deficiency has been established to worsen or improve arthritis.
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    Types of JRA

    JRA affects kids from six months to 16 years of age. The initial signs are often joint swelling and pain. Many rheumatologists find that the more joints that are affected, the more likely the symptoms will remain for years, or in rare cases, even for a lifetime. Here are the major types of JRA depending on the number of joints affected in the first six months of disease:

    • Oligoarticular affects four or lesser joints. Oligo means few. This type is more common to girls than to boys. The wrist and knee joints are the most common affected area. Symptoms include stiffness, swelling, and pain in the joints. Redness of the iris, called iridocyclitis, uveitis or iritis, may occur without the symptoms; an ophthalmologist can detect this at an early stage.
    • Polyarticular affects five or more areas. Poly means five. This type is more common to girls than to boys. Weight-bearing joints are commonly affected; knees, ankles, feet, hips, and neck. The small joints found in the hands can be involved as well. Additionally, a low-grade fever, nodules, or bumps on the body may appear on areas subjected to strain from leaning or sitting.
    • Systemic affects the child’s whole body. Affects girls and boys equally. It is often characterized by high fevers in the evenings that may suddenly normalize in the morning. During the fever, the child may appear pale, develop a pink rash and feel very ill, but all these symptoms may unexpectedly disappear, and then reappear. The lymph nodes and spleen may become enlarged. This type of JRA may involve the internal organs and can lead to serositis.

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    Signs and Symptoms of JRA

    The first signs of rheumatoid arthritis in children can be as subtle as lethargy or as obvious as swelling and redness. Here are some of the common signs and symptoms of JRA:

    • Lethargy
    • Loss of appetite
    • Reduced physical activity
    • Limping
    • Flu-like symptoms that suddenly appear then disappear.
    • Swelling of joints (commonly the knee, wrist, ankle, small joints of the feet and hands).
    • MRI or ultrasound can detect swelling on the less obvious areas such as the sacroiliac joints, hip, jaw, shoulder and spine.
    • Morning stiffness that aggravate as the day and activity progress.
    • Late effects include joint damage and joint contracture (bent joint).

    * Children may have a hard time describing how they feel. JRA manifests differently on each child depending on the degree that the joints are affected. If you suspect your child suffers from JRA, please see your family doctor for consultation and physical examination and tests (to eliminate other diseases), if needed. Tests may include Complete Blood Count, Blood Culture and Bone Marrow Examination, Erythrocyte Sedimentation Rate, Rheumatoid Factor, Antinuclear Antibody and Bone Scan.

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    Treatments of JRA

    In most case, JRA can be remedied with a combination of physical therapy and exercise. Some children may need corticosteroid injections or surgery. Work together with your doctor, physical therapist, and rheumatologist to figure out the best treatment for your child. The primary goals are to relieve inflammation and pain, prevent or slow down joint destruction, and to restore your child’s physical ability.

    Medications

    NSAIDs (Nonsteroidal anti-inflammatory drugs), such as Motrin or Advil, may be prescribed by the physician to help manage the inflammation and pain by limiting the discharge of the chemicals emitted by the white blood cells to fight off the body’s healthy tissues. Depending on the child’s response, the dosage may need adjusting. Have your physician to explain the indications and side effects of the medicine to your child, so they may involved in their treatment. You can also inquire about newer treatments for JRA that may be available.

    Physical Therapy and Exercise

    Experts like those at the Mayo Clinic recommend physical therapy as the cornerstone of treatment for rheumatoid arthritis in children. (2) This is especially true for those who want to strengthen their muscles and gain back their full range of motion. This can also help one to lose weight, which helps alleviate pain in weight-bearing joints. Safe activities include swimming, biking, and walking. Make sure that you talk with your child’s pediatrician or physical therapist first before allowing such activities to avoid further damage to the joints.

    To learn more about arthritis and other treatments, please read Arthritis and Light Therapy: Does it Work? and Benefits of Physical Therapy For Arthritis.

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    Image Credits

    • Charlotte.Morrall - http://farm3.static.flickr.com/2436/3850109985_ec24eef5f3_z.jpg
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    References

    1. Kids Health - http://kidshealth.org/parent/medical/arthritis/jra.html
    2. MayoClinic.com - http://www.mayoclinic.com/health/juvenile-rheumatoid-arthritis/DS00018/DSECTION=risk-factors, lifestyle and home remedies
    3. American Academy of Orthopaedic Surgeons - http://orthoinfo.aaos.org/topic.cfm?topic=a00075
    4. MedicineNet.com - http://www.medicinenet.com/juvenile_arthritis/article.htm

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