...less medical jargon in a 'Quick Glance' format!
Juvenile Rheumatoid Arthritis, or JRA, is the most prevalent form of juvenile arthritis. It affects approximately 50,000 children in the United States.
Arthritis is an inflammation of the joints that is characterized by swelling, heat, and pain. Nearly 300,000 children in the United States have some sort of arthritis. Arthritis can be short-term — lasting for just a few weeks or months, then going away forever — or it can be chronic and last for months or years. In rare cases, it can last a lifetime.
. . . Types of Juvenile Rheumatoid Arthritis
Typically, juvenile rheumatoid arthritis appears between the ages of 6 months and 16 years. The first signs often are joint pain or swelling and reddened or warm joints. Many doctors specializing in joint disorders find that the greater the number of joints affected, the more severe the disease and the less likely that the symptoms will eventually go into total remission.
The three major types of juvenile rheumatoid arthritis are:
1. Polyarticular arthritis, which affects more girls than boys. Symptoms include swelling or pain in 5 or more joints. The small joints of the hands are affected as well as the weight-bearing joints such as the knees, hips, ankles, feet, and neck. In addition, a low-grade fever may appear, as well as bumps or nodules on the body on areas subjected to pressure from sitting or leaning. 2. Pauciarticular JRA, which affects four or fewer joints. Symptoms include pain, stiffness, or swelling in the joints. The knee and wrist joints are the most commonly affected. An inflammation of the iris may occur with or without active joint symptoms. This inflammation, called iridocyclitis or iritis or uveitis, can be detected early by an ophthalmologist. 3. Systemic JRA, which affects the whole body. Symptoms include high fevers that often increase in the evenings and then may suddenly drop to normal. During the onset of fever, the child may feel very ill, appear pale, or develop a rash. The rash may suddenly disappear and then quickly appear again. The spleen and lymph nodes may also become enlarged. Eventually many of the body's joints are affected by swelling, pain, and stiffness. Also known as Still's disease.
Joint swelling, with pain and stiffness. This may be more pronounced in the morning or after a nap. Commonly it affects the knees and the joints in the hands and feet. Children may complain of pain, or you might notice them limping.
Fever and rash
. These can be associated with many medical conditions, but if they're persistent, they may signal systemic juvenile rheumatoid arthritis. Fever and rash caused by systemic JRA may appear and disappear quickly.
Swelling of lymph nodes
. This sign may occur in children with systemic JRA.
. This problem, which occurs mostly in children with pauciarticular JRA, initially produces no signs or symptoms in most of those affected. Routine eye examinations are recommended because eye inflammation may result in blindness.
Like other forms of arthritis, JRA is characterized by times when symptoms are present and times when symptoms disappear.
It's not known exactly what causes rheumatoid arthritis in children. Research indicates that it is an autoimmune disease. In autoimmune diseases, white blood cells lose the ability to tell the difference between the body's own healthy cells and harmful invaders like bacteria and viruses. The immune system, which is supposed to protect the body from these harmful invaders, instead releases chemicals that can damage healthy tissues and cause inflammation and pain.
To effectively manage and minimize the effects of arthritis, an early and accurate diagnosis is essential. By understanding the symptoms and characteristics of each type of juvenile rheumatoid arthritis, you can help your child maintain an active, productive lifestyle.
In many cases, juvenile rheumatoid arthritis may be treated with a combination of medication, physical therapy, and exercise. In specific situations, your child may require injection of corticosteroids into the joint or surgery. Your child's health care providers, including the primary care physician, rheumatologist, and physical therapist, will work together to develop the best method of treatment.
The goals of treatment are to relieve pain and inflammation, slow down or prevent the destruction of joints, and restore use and function of the joints to promote optimal growth, physical activity, and social and emotional development in your child.
. . . Medications
For inflammation and pain, the doctor or pediatric rheumatologist may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (such as Advil or Motrin). These drugs may help reduce inflammation and pain by limiting the release of harmful chemicals from white blood cells.
Higher or lower dosages may be needed, depending upon your child's response to the medication. The doctor or rheumatologist should explain what the medication is meant to do and what side effects, if any, your child may experience. It's important for your child to continue taking the medication until the doctor says to stop.
If NSAIDs do not control inflammation of the joints, your doctor may prescribe other medications. You can also ask for information about newer treatments that might be available.
. . . Physical Therapy
An appropriate physical therapy program is essential in the management of any type of arthritis. A physical therapist will explain the importance of certain activities and recommend exercises suited to your child's specific condition. The therapist may recommend range-of-motion exercises to restore flexibility in stiff, sore joints and other exercises to help build strength and endurance.
. . . Regular Exercise
When pain strikes, it's natural for your child to want to sit still. But it's important to maintain a regular exercise program. Muscles must be kept strong and healthy so they can help support and protect joints. Regular exercise also helps to maintain range of motion.
At home and at school, your child should maintain regular exercise and physical fitness programs. Safe activities include walking, swimming, and bicycling especially on indoor stationary bikes. Always be certain your child warms up the muscles through stretching before exercising. Making exercise a family activity can increase the level of fun and enthusiasm.
Consult your child's doctor and physical therapist about sports restrictions. Some sports, especially impact sports, can be hazardous to weakened joints and bones. In addition, be certain your child eats a balanced diet that includes plenty of calcium to promote bone health.