OVERVIEW
We usually associate arthritis with adults. But children can be affected by almost all of the types of arthritis that adults can have. Juvenile Rheumatoid Arthritis (JRA), as it is called, is a chronic condition causing joint inflammation for at least six weeks in a child 16 years of age or younger. It’s the most common form of arthritis in children. In most cases, it is not a lifelong disorder, and signs and symptoms may fade after several months or years.
The term “juvenile rheumatoid arthritis” is an umbrella term for a group of conditions, which are classified according to the number of joints affected, signs and symptoms, and the results of blood tests.
Treatment of JRA focuses on preserving physical activity to maintain full joint movement and strength.
SIGNS AND SYMPTOMS
A parent or caretaker should look out for signs of JRA, especially in young children.
The main categories of JRA are:
• Pauciarticular JRA. Four or fewer joints are affected, typically larger joints such as the knees. This is the most common form of JRA.
• Polyarticular JRA. This affects five or more joints, typically small joints such as those in the hands and feet. This form often affects the same joint on both sides of a child’s body.
• Systemic JRA. Also known as Still’s disease, this type affects many areas of the body, including joints and internal organs. This is the least common form of JRA.
Signs and symptoms of JRA may include:
• Joint swelling, with pain and stiffness. This may be more evident after a nap or in the morning. Commonly, it affects the knees and the joints in the hands and feet. Kids may complain, or you may just notice them limping.
• Fever and rash. Of course, these occur in many medical conditions, but if they are persistent, they signal systemic JRA. These symptoms may appear and disappear quickly.
• Swelling of lymph nodes (glands). This may occur in children with systemic JRA.
• Eye inflammation. This mostly occurs in kids with pauciarticular JRA, but the problem produces no signs or symptoms in most of those affected. Routine eye examinations are recommended; eye inflammation may result in blindness.
Like other forms of arthritis, JRA is characterized by flares and remissions.
CAUSES
We believe that JRA is an autoimmune disorder. This means that the body attacks it own cells and tissues. Why? We’re not sure, but both the environment and heredity (genetics) seem to play roles.
It may be that a virus or bacterium triggers the development of JRA in kids with certain genetic profiles. These profiles are detected in some children with JRA and are considered genetic markers for JRA. But not all children with the markers develop JRA, and conversely, children without the markers can develop the condition.
WHEN TO CHECK THE DOCTOR
If your child shows signs of joint swelling, stiffness or pain, or just limps for no good reason, take him to the doctor. If your child has a fever of 102 F that persists for more than two or three days, find a doctor. The fever of JRA may come and go once or twice during a day and last a few hours each time.
If your child gets a diagnosis of JRA, take him or her to your doctor regularly to monitor the disease’s development and its treatment.
Kids with pauciarticular JRA should be screened for eye inflammation regularly. A child who is diagnosed before age 7 with the pauciarticular variety should have his eyes checked every three months if a blood test is positive for anti-nuclear antibody (ANA). These are proteins that are generally found in people with auto- immune disorders, like arthritis.
If your child is ANA negative, doctor will recommend an eye screening schedule based on your child’s risk of developing eye problems.
SCREENING AND DIAGNOSIS.
A history (story) and physical examination, as always, will be done by the doctor. Then there are:
*Blood tests. These may include:
• An erythrocyte sedimentation rate (ESR) to detect signs of inflammation.
• Anti-nuclear antibodies (ANA), discussed earlier, may also be looked for.
• Rheumatoid factor (RF) is an antibody commonly, but not always, found in persons with JRA.
*Imaging. X-Rays may be taken to exclude other conditions such as fractures, tumors, infections and congenital defects. X-Rays may also be used sometimes to monitor bone development and to detect joint damage.
*Joint fluid removal. Fluid removed from a child’s swollen joint can relieve pain and help doc determine the cause of the arthritis.
Complications
• Eye inflammation. These are common with pauciarticular arthritis. Symptoms may not occur, so it’s important for kids with JRA to check with the eye doctor (Optometrist, Ophthalmologist) regularly. Untreated eye inflammation can result in cataracts, deposition of calcium in the cornea, glaucoma, and ultimately blindness.
• Growth interference. JRA can interfere with your child’s bones and growth. Some medications used to treat JRA, mainly steroids, also can inhibit growth.
TREATMENT
Treatment aims at relieving pain and swelling, and maintaining full movement and strength and preventing complications. All of this will help your child maintain normal physical and social activity.
Medications include:
• Non-steroidal anti-inflammatory drugs (NSAIDS). These are Aspirin, Ibuprofen, Naproxen, and others. These have side-effects, as do the medications below, so a doctor’s supervision is necessary.
• Disease-modifying antirheumatic drugs (DMARDs). This group includes Methotrexate and Sulfasalazine, which must be monitored by a physician.
• Tumor necrosis factor (TNF) blockers. These block an immune system protein called TNF, which acts as an inflammatory agent in some types of arthritis.
• Corticosteroids. Those are for more severe cases. They are useful to prevent, for example, inflammation of the sac surrounding the heart (pericarditis). One should not stop these suddenly after long-term use; this can be dangerous. Always follow doctor’s instructions.
THERAPIES
The help of a physiotherapist or occupational therapist can be invaluable.
SELF-CARE
• Getting regular exercise to promote muscle strength and joint flexibility.
• Applying cold or heat. Stiffness is a feature of JRA, especially in the morning. Some kids respond well to cold packs, but most prefer a hot pack, bath or shower.
• Eating well. How can anyone go wrong with this?
See you next week.
thanks doc!!