Juvenile Rheumatoid Arthritis
- Also Known As:
- Juvenile Idiopathic Arthritis
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What is juvenile rheumatoid arthritis?
Juvenile rheumatoid arthritis (JRA), also called juvenile idiopathic arthritis (JIA), is the most common type of arthritis that occurs in children, affecting 50,000 youth in the U.S. It is defined as at least 6 weeks of persistent arthritis in a child younger than 16 years of age and is characterized by joint inflammation, pain, swelling, redness, and stiffness. It can also damage joints, affect growth, and cause eye problems such…
Juvenile rheumatoid arthritis (JRA), also called juvenile idiopathic arthritis (JIA), is the most common type of arthritis that occurs in children, affecting 50,000 youth in the U.S. It is defined as at least 6 weeks of persistent arthritis in a child younger than 16 years of age and is characterized by joint inflammation, pain, swelling, redness, and stiffness. It can also damage joints, affect growth, and cause eye problems such as uveitis as well as inflammation of internal organs.
JRA is believed to be an autoimmune disorder. The tendency to develop JRA may be inherited, but it is believed that a triggering event is required for it to emerge, although little is known about what triggers JRA. It is for this reason it is often called “idiopathic” (no known cause).
Classification systems for JRA vary but may include the following major types:
- Pauciarticular (Oligoarthritis) – about 50% of the cases of JRA are of this type; it affects 4 or fewer joints, usually large joints such as the knees or wrists, and is associated with eye inflammation.
- Polyarticular – affects 5 or more joints, especially those in the fingers and hands; subdivided into two types: rheumatoid factor (RF)-negative and RF-positive; RF-negative is seen more frequently in girls than boys; RF-positive behaves the most like adult rheumatoid arthritis.
- Systemic – least common form of JRA; it affects many parts of the body, including joints and internal organs. Children with this type may have frequent fevers and rashes that can come and go rapidly.
- Psoriatic arthritis – associated with the skin condition psoriasis, either in the child, a sibling, or a parent. Some consider this a separate disease from juvenile chronic arthritis.
- Enthesitis-related arthritis – affects the lower extremities and the spine
- Undifferentiated arthritis – arthritis that does not fit into the above classifications, or fits into more than one
Symptoms may vary from child to child and will frequently change over time, with flare-ups and remissions. In some children, the symptoms may persist; in others, they may permanently disappear. These symptoms may include morning stiffness, limping, reluctance to move an affected joint, joint pain and swelling. Children with systemic JRA may have intermittent fever, rash, swollen lymph nodes and, in some cases, liver, spleen, and (very rarely) lung involvement.
Complications of JRA may include eye inflammation such as uveitis and problems related to joint growth. The disease may cause the affected joints to grow either too quickly or too slowly, causing one arm or leg to be shorter or longer than the other. It may also cause uneven growth in the joint itself. General growth may also be affected by JRA.
The goals of testing are to help diagnose juvenile rheumatoid arthritis (JRA), to distinguish it from other forms of arthritis and conditions with similar symptoms, and to evaluate its severity. Testing can be used to monitor the condition, its potential complications, response to treatment, and to monitor for potential side effects associated with some treatments.
Diagnosis of JRA is based on medical exam, including review of clinical signs and symptoms, such as persistent arthritis in one or more joints for at least six weeks that cannot be attributed to another cause. Those affected may also have an enlarged liver or spleen, swollen lymph nodes, anemia, heart problems, and eye inflammation.
Laboratory tests that can aid in the diagnosis of JRA include the following, although many children with JRA will not have any abnormal findings on these:
- Antinuclear antibody (ANA) – to detect the presence of autoantibodies; most common test to be positive in children with JRA; about 80% of those with eye involvement will test positive for ANA.
- Rheumatoid factor (RF) – may be positive or negative depending on the type of juvenile arthritis a child has; more commonly found in adults with rheumatoid arthritis
- Erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) – to detect inflammation in the body
- Complete blood count (CBC) – to evaluate a child’s red and white blood cells and hemoglobin to help evaluate and monitor the condition and complications, such as anemia and/or a decreased white blood cell count
- Comprehensive metabolic panel (CMP) – to help evaluate and monitor a child’s kidney and liver function
Other lab tests that may be performed to rule out other conditions with similar symptoms include:
- HLA-B27 – a genetic test that can help to distinguish the type of arthritis affecting a child, such as a type that affects the spine (ankylosing spondylitis)
- Synovial fluid analysis – sometimes ordered to detect crystals that may be present in the joint and to look for signs of joint infection
- Blood culture – to rule out infection
- Other laboratory tests, such as a test for Lyme disease, as appropriate
- X-rays of the joints and chest – to identify the presence of joint inflammation or fluid build-up around the heart or lungs and to rule out other conditions, such as fractures, tumors, infection, or congenital defects
- Eye exam – to detect the development of eye inflammation
- EKG – to detect inflammation of the heart
There is no cure for juvenile rheumatoid arthritis (JRA). The goals of treatment are to decrease pain and inflammation, maintain mobility and joint function, and minimize joint damage and complications. Treatment will vary from child to child and frequently varies over time.
In addition to getting appropriate rest and exercise and avoiding stress on the affected joints, children with JRA may take some medications. These can include pain relievers, anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation, corticosteroids to reduce inflammation, disease-modifying antirheumatic drugs (DMARDs) to help slow the course of the disease, and biologic response modifiers to help reduce inflammation and damage to the joints. Immune suppressants may also be prescribed.
Physical therapy and regular exercise are very important. They can help maintain flexibility, range-of-motion, muscle strength, and joint mobility. Splints may be used in some cases to help keep a joint in the proper position. Hot and/or cold treatments may help relieve morning stiffness.
Some accommodations may need to be made at school and at home for children with JRA but, in most cases, they can lead and should be encouraged to lead relatively normal lives.
Sources Used in Current Review
American College of Rheumatology. 2017. Juvenile Arthritis. Available online at https://www.rheumatology.org/I-Am-A/Patient-Caregiver/Diseases-Conditions/Juvenile-Arthritis. Accessed 6/20/2017.
MedlinePlus. 2016. Juvenile Arthritis. Available online at https://medlineplus.gov/juvenilearthritis.html. Accessed 6/20/2017.
National Institute of Arthritis and Musculoskeletal and Skin Disease. 2015. Juvenile Arthritis. Available online at https://www.niams.nih.gov/Health_Info/Juv_Arthritis/default.asp. Accessed 6/20/2017.
Rheumatoid Arthritis Support Network. 2016. Juvenile Rheumatoid Arthritis. Available online at https://www.rheumatoidarthritis.org/ra/juvenile/diagnosis/. Accessed 6/20/2017.
Sources Used in Previous Reviews
MedlinePlus Medical Encyclopedia. Juvenile rheumatoid arthritis. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/000451.htm. Accessed Nov 2013.
Arthritis Foundation. Juvenile Arthritis. Available online at http://www.arthritis.org/conditions-treatments/disease-center/juvenile–arthritis/. Accessed Nov 2013.
Centers for Disease Control and Prevention. Childhood Arthritis. Available online at http://www.cdc.gov/arthritis/basics/childhood.htm. Accessed Nov 2013.
KidsHealth. A to Z: Juvenile Idiopathic Arthritis (JIA). Available online at http://kidshealth.org/parent/dictionary/j/az-jia.html. Accessed Nov 2013.
KidsHealth. Juvenile Idiopathic Arthritis. Available online at http://kidshealth.org/parent/medical/arthritis/jra.html. Accessed Nov 2013.
MayoClinic. Juveile rheumatoid arthritis. Available online at http://www.mayoclinic.com/health/juvenile-rheumatoid-arthritis/DS00018. Accessed Nov 2013.
American College of Rheumatology. Arthritis in Children. Available online at http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/juvenilearthritis.asp. Accessed Nov 2013.
WebMD. Juvenile Rheumatoid Arthritis-Exams and Tests. Available online at http://www.webmd.com/rheumatoid-arthritis/tc/juvenile-rheumatoid-arthritis-exams-and-tests. Accessed Nov 2013.
Christine L. Snozek, PhD. Lab Tests Online adjunct board member.
Brescia, A. (2005 April, Updated) Juvenile Rheumatoid Arthritis. Nemours Foundation, KidsHealth for Parents [On-line information]. Available online at http://kidshealth.org/parent/medical/arthritis/jra.html.
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(2001 July, Currently being updated). Questions and Answers about Juvenile Rheumatoid Arthritis. NIAMS [On-line information]. Available online at http://www.niams.nih.gov/hi/topics/juvenile_arthritis/juvarthr.htm.
Arthritis Foundation. Juvenile Rheumatoid Arthritis. Available online at http://www.arthritis.org/disease-center.php?disease_id=38&df=definition. Accessed October 2010.
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