Juvenile Rheumatoid Arthritis

Juvenile Rheumatoid Arthritis (JRA) is the most common form of persistent arthritis in children. It is a chronic disease.

There are several types of JRA. The three major subtypes include:

  1. Systemic – affects the entire body or “system” before it affects the joints
  2. Polyarticular – involves 5 or more joints in the first 6 months
  3. Pauciarticular – 4 or less joints involved during the first 6 months of disease

About 1 in 1,000 children have JRA. The number of new cases per year is estimated at 9 per 100,000 population.

The exact cause of Juvenile Rheumatoid Arthritis is unknown. JRA is believed to be caused by a combination of genetic and environmental factors. It is not common for other people in the family to develop this arthritis.

Children with Juvenile Rheumatoid Arthritis (JRA) have swelling or pain ranging from very mild limited joint involvement to severe systemic disease associated with high fever, rash and lymph node enlargement. The systemic features (meaning those elsewhere in the body) usually come before the arthritis is present.

The main symptom of JRA is inflammation in the joints. In general, inflammation is necessary to protect us against germs, and it normally subsides when infection is cleared. In JRA, however, the inflammation “gets out of control” and becomes persistent in the joints. Some researchers believe that the immune system (that is supposed to react against germs), becomes confused in this disease and starts reacting against our own body.

Some children will have only one joint affected throughout the entire course of their JRA. Other children will start with one joint and it will spread to affect several additional joints or perhaps even spread to involve large and small joints. In some patients the disease remains mild and easy to control. In other patients, it is more severe and difficult to control.

Children with JRA are susceptible to developing inflammation in the eye as well as the joints. The children at highest risk are the little girls with the fewest joints involved; pauciarticular onset JRA, Type I. Most children will develop eye disease within 7 years of the onset of their arthritis if eye involvement is going to occur.

Arthritis is defined as swelling or painful loss of motion in one or more joints. In order to diagnose JRA, arthritis must be present for at least 6 weeks in a row in the same joint. The arthritis may be present in one or more joints.

The goal of medical treatment for JRA are:

  • Educate patient and family
  • Help families learn how to manage disease on a daily basis
  • Control inflammation
  • Reduce pain and stiffness
  • Prevent deformity and maintain joints in a position which gives normal function
  • Reduce any deformities that may have already developed, such as loss of motion
  • Maximize strength and function (children lose strength around the affected joints because of the inflammation)
  • Promote normal growth and development, both physical (height and weight) and psychosocial (emotional, social, intellectual)
  • Minimize side-effects of therapy

The medications used to treat JRA, are antiinflammatory drugs of different strengths. Some of them have the ability to suppress the “over-reacting” immune system. The treatment for the eyes is separate therapy from the treatment for the joints.

Drug treatment is divided into several separate groups of medications:

  • Nonsteroidal antiinflammatory drugs NSAID’s
  • Slow-acting antiinflammatory drugs
  • Corticosteroids
  • Immunosuppressive drugs
  • Biological agents

The decision to select a medication for your child will involve several factors:

  • Age of your child
  • Previous medicines that have worked or failed
  • Duration of disease (or how long they have had the disease)
  • Severity of disease
  • Potential adverse reactions (or side-effects)
  • Allergies to medications

Sometimes your doctor or nurse will ask you to keep a diary or personal record for your child. This is usually used as an aid to understanding. It is often kept to record fever, rash, pain, stiffness, limping, abdominal pain, headache, or other symptoms on a day-to-day basis. A diary may also be kept to record possible side effects of medicines or to record when other medications, such as antibiotics or pain medicine, are prescribed.

Regular school attendance and even participation in physical activities are encouraged. Impact-loading or contact sports, such as basketball or football, may be too rigorous and potentially harmful for your child’s joints. The age of your child and intensity of the sports program are also important factors. Swimming, bicycling, walking, and other strengthening exercises are all low impact activities and are strongly encouraged. Physical education is likewise important and can be modified if necessary so that your child can participate. These options will be discussed in more detail by the physical therapist and occupational therapist.

Most children do not become “crippled” from this disease. This, however, is based on early aggressive medical therapy as well as a continuous physical therapy program for the joints (usually done at home each day). Young children with JRA normally grow into productive adults. This does not necessarily mean there isn’t some residual deformity or even active arthritis; however, this does show that the children do finish high school, pursue college educations and have productive careers, marriage and parenthood.

There is some information available about the persistence or recurrence of arthritis in adulthood. Approximately half of the patients will still have active disease after 10 years. We also know that the disease may come back in adulthood or persist into adulthood, especially in those patients who have developed the disease during late school age or adolescent years.