Is Your Child Facing
Juvenile Rheumatoid Arthritis?

Juvenile Rheumatoid Arthritis can be a scary diagnosis. If your child is facing this disease, you want to arm yourself with knowledge. What kind of arthritis symptoms are typical? What are the treatment options? Learn more about this disease and how you can help your child manage it.

What is Juvenile Rheumatoid Arthritis?

Although it may sound as if Juvenile Rheumatoid Arthritis (JRA) is similar to adult Rheumatoid Arthritis (RA) the diseases are quite different. Because most often rheumatic tests are negative with JRA, this disease is also referred to as Juvenile Idiopathic Arthritis, (JIA). JRA is the most common form of arthritis in children under the age of 16. There is no known cause of JRA although early research suggests genetic susceptibility with an environmental trigger may be involved. JRA is autoimmune in nature with arthritis symptoms potentially being both short lived or chronic.

doctor and child

Types of Juvenile Rheumatoid Arthritis

There are three main types of JRA: Oligoarticular, Polyarticular, and Systemic.

Oligoarticular (also called pauciarticular) affects 4 or fewer joints of the body within the first 6 months of onset of symptoms. This type generally accounts for 50% of all JRA symptoms and more often involves the large joints of the body including such as the shoulder, hips and knees. In addition to joint pain, redness, and swelling; inflammation of the iris of the eye can also occur.

Polyarticular arthritis is classified by affecting more then 5 joints of the body. This form affects girls more then boys. This type more commonly affects smaller joints including joints of the fingers, toes, jaw and spine. In addition, joint involvement generally occurs in a symetrical pattern, affecting both sides of the body. In this form, rheumatoid factor tests are positive. This form of JRA accounts for approximately 30% of JRA cases.

JRA fingers and toes

Systemic JRA (also referred to as Still's disease)is characterized by fever, rash, and arthritis symptoms, with symptoms affecting the whole body. Rash symptoms can appear and disappear rather quickly. This form of JRA affects girls and boy equally and may include internal organ involvement including the spleen and lymph nodes. This form of the disease is the least common with it accounting for only 20% of JRA cases.

JRA Symptoms

Typical of other arthritis symptoms, JRA symptoms include

• joint pain

• joint heat, swelling, and stiffness

• limited joint range of motion

• morning stiffness

• reluctance to use the painful joint

Because JRA is a systemic disease, other symptoms can occur including

• high fever

• light pink rash

• eye inflammation or redness

• swollen glands

As JRA symptoms can come and go, often these symptoms are not always obvious as being connected to an underlying disease process. Children may act tired or be unwilling to participate in physical activities. Joint stiffness in the morning can also cause a child to limp. Occasionally, with pauciarticular JRA, growth rates of bones in the legs can cause a leg length discrepancy.

As with many autoimmune diseases, JRA symptoms can go into remission. During these times no symptoms are experienced. However, flare ups can occur with symptoms becoming significant.

Treatment of JRA

As with many arthritic conditions, the use of anti-inflammatory medications is generally the first treatment choice for Juvenile Rheumatoid Arthritis (consult your doctor regarding medications). The goal with all forms of JRA is to quickly minimize inflammation with as little side effects as possible. Both non-steroidal anti-inflammatory (NSAIDS) and corticosteroids can be used based on the severity of the symptoms and disease. Disease modifying anti-rheumatic drugs such as Methotrexate may be prescribed to slow or stop the progression of JRA.

When joints are inflamed and painful, the use of ice therapy can be helpful in reducing pain and inflammation. Apply ice to painful joints for 10 to 15 minutes a few times a day to help reduce joint inflammation.

In significant cases of joint inflammation and pain, injections of steroids may be recommended.

Physical Therapy

Physical therapy is also recommended to help maintain joint mobility and function. Muscles work to help absorb force and protect joints making muscle strengthening exercises a must in the overall treatment plan.

To help maintain joint mobility, activities such as stationary biking and swimming are encouraged. Swimming minimizes joint stress while allowing for muscle activity. Stationary biking helps promote joint range of motion without joint stress.

If joint stiffness and swelling has impacted the mobility of the finger and hand joints, include exercises to promote joint motion. A great hand and finger exercise is to use play dough to promote gripping and pinching of the fingers.

It is important to encourage your child to be active. Seek recommendations from a physical therapist regarding the best specific strengthening and general exercise program for your child. Participate in exercises as a family and structure activities to be fun and interactive.

Having a diagnosis of Juvenile Rheumatoid Arthritis can be daunting. Work with your rheumatologist and physical therapist to help construct the most effective plan for your child.

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