What Is Junior Rheumatoid Arthritis?

Arthritis affects about one in every 1,000 children in the United States each year, and juvenile rheumatoid arthritis, or JRA, is the most common form. Symptoms usually appear between the ages of 6 months and 16 years and can range from mild to severe. JRA can have a significant impact on a child, but with proper medication and a good exercise plan, most children can have a fairly normal life.

Types

There are three types of juvenile rheumatoid arthritis. Oligoarticular JRA appears in only four joints and sometimes less. Inflammation of the wrist and knee joints is seen the most. Sometimes an inflammation of the eye, called iridocyclitis, appears with oligoarticular arthritis. Polyarticular JRA is seen more in girls than boys, and inflammation occurs in five or more joints. The child may have a low-grade fever and bumps on the body. Systemic JRA is the most serious form of juvenile arthritis. It affects the entire body with extensive swelling, stiffness and pain in the joints. The child may have a high fever, a rash and feel sick.

Causes

Doctors don't know exactly what causes JRA. They do know it is an autoimmune disease, where the body can't tell the difference between healthy cells and unhealthy cells. The immune system attacks all cells, including the healthy ones. JRA doesn't seem to be hereditary, but some researchers believe children with JRA have a certain gene that makes them more likely to develop the disorder.

Symptoms

JRA symptoms can come and go, and they affect each child differently. At times, the symptoms will actually disappear, but then worsen. This is called a flare. Most children with JRA experience pain in the joints in the morning, with the pain improving later in the day. Initial symptoms may also include sore joints in the hands and knees or limping. The child may have a fever that is high at night, and he may be tired and grouchy. There may be inflammation of internal organs, and a skin rash may appear. Severe JRA cases can cause damage to the joints, including joints growing unevenly.

Diagnosis

Early diagnosis is important, since most cases of JRA can be managed. A doctor will take a thorough medical history and first rule out other diseases or injuries. He will check for a decrease in range of motion in the joints, as well as look for swelling, warmth in the joints and inflammation. He may order X-rays, bone scans and blood tests. An erythrocyte sedimentation rate blood test, called a sed rate test, is common. The sed rate increases during inflammation. The doctor may also perform a blood test for rheumatoid factor. This is an antibody sometimes found in the blood of patients with arthritis.

Medications

Over-the-counter non-steroidal anti-inflammatory drugs, such as naproxen or ibuprofen, are commonly the first types of medication for JRA patients. These drugs are pain relievers that also reduce inflammation. Prescription anti-rheumatic medications are next. Methotrexate is usually the medication of choice. For severe JRA, the doctor may choose corticosteroids to reduce inflammation. They are given intravenously or orally. Corticosteroids are only given for a short time, since they have serious side effects.

Physical Therapy and Exercise

Most children with JRA need some sort of physical therapy to preserve joint function. A physical therapist can recommend a complete exercise program depending on the child's specific type of JRA. It is also important for parents to keep the child involved in sports and exercise as much as possible. Swimming, a non-weight bearing exercise, is usually a good replacement for impact sports.