Juvenile rheumatoid arthritis (JRA) is a form of arthritis in children. It is also known as “juvenile idiopathic arthritis” and “Still’s disease.” JRA differs from adult rheumatoid arthritis. It is a chronic disease and last for months or years, but about 75% of children outgrow it. No cure exists, but earlier detection, better drugs, and good treatment greatly improve chances for a full, active life.
JRA can make it hard to do daily activities such as writing, dressing, and carrying things (hands, wrists); walking, playing, and standing (hips, knees, feet); and turning the head (neck).
JRA is an autoimmune disorder but its cause is unknown. Autoimmune means that the body’s infection-fighting (immune) system attacks its own tissues. Genetic and environmental factors may increase chances of getting JRA. JRA cannot be caught from another person.
Symptoms include joint pain and stiffness that are usually worse in the morning but get better toward the end of the day. Children may hold painful joints close to the body or bent. The three JRA types are pauciarticular, polyarticular, and systemic.
Pauciarticular JRA affects only a few joints (normally less than four: knees, elbows, and ankles) and occurs in 50% of children with JRA, more often in girls. Eye disease (inflammation, or swelling) can develop in 10% to 20% of patients.
Polyarticular JRA affects many joints and occurs in about 30% of children with JRA, more commonly in girls. Neck, knees, ankles, feet, wrists, and hands are affected. Children with this type may also have eye inflammation.
Systemic JRA occurs in about 20% of children with JRA, boys and girls equally. It often starts with fever, rash, changes in blood cells, and joint pain.
The health care provider takes a medical history and examines the joints and may order laboratory tests and x-rays. Testing for inflammation with blood tests (sedimentation rate, CRP) and the specific blood proteins rheumatoid factor (RF) and antinuclear antibody (ANA) may help diagnosis. Systemic JRA may be hard to diagnose because inflammation may not start right away.
A combination of medicines, therapies, exercise, education, and pacing activities to prevent tiredness is best. A health care provider who treats arthritis should care for your child.
Medicines for inflammation include nonsteroidal antiinflammatory drugs (NSAIDs). Disease-modifying drugs (such as methotrexate) which suppress the body’s immune system are used to stop disease progression. Biological-modifying agents can also be used and are fairly effective in children who have not responded well to other medications.
Exercise is important for joint movement and muscle strength. Splints can help rest painful, swollen joints.
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Copyright © 2016 by Saunders, an imprint of Elsevier, Inc.
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