Juvenile Rheumatoid Arthritis (JRA) is a condition that affects children aged 16 years or younger. It causes inflamed, swollen joints, stiffness, and pain. While there are similarities among children who have JRA there are a lot of differences, too. The course of the illness, duration, and severity of symptoms are very individualized. Successful treatment strategies need to be tailored to each individual child and may change over time. Though the cause of JRA is unknown, several factors have been implicated:
~ JRA is thought to be an auto-immune disorder, whereby an over active immune response causes one's immune system to begin attacking it's own healthy joints.
~ A genetic factor is believed to be involved. Certain children may be genetically predisposed, or more susceptible, to getting the disease.
~ An infection in the body may act as a trigger which sets off the immune system response. In a child who has a genetic predisposition and an over-active immune system response, JRA may occur.
There are three main types of JRA:
~ Pauciarticular JRA is the most common form of JRA. Most children with this type of JRA have a very good long-term outlook. Pauciarticular JRA affects between 1 and 4 joints at onset. The knee is commonly the first joint affected by swelling and pain but this type of arthritis can also involve the ankles, elbows, wrists, fingers, neck, or jaw. Children, especially girls, who present with this type of JRA and who also have a positive antinuclear antibody lab test result, will often experience eye inflammation in addition to joint symptoms. Common inflammatory eye conditions, such as uveitis and iritis, often have no visible symptoms. Regular eye exams are important for the detection and treatment of developing eye problems.
~ Polyarticular JRA affects 5 or more joints and usually begins in the larger joints such as the knee or hip, though it can also start in smaller joints such as the wrists and fingers. Polyarticular JRA often affects the same joints on both sides of the body. Arthritis in the neck, spine, and jaw is more common in this type of JRA. Children with arthritis affecting their jaw may experience jaw growth problems. Children with this type of JRA who also have an RF-positive lab test result may over time develop rheumatoid nodules, small bumps under the skin, in high-pressure areas such as the elbow or the back of the heel. They are also somewhat more likely to experience problematic arthritis lasting into adulthood.
~ Systemic JRA is the least common type and is also known as Stills Disease. Fewer than 20% of children with JRA have the systemic type. It presents with whole-body symptoms such as cyclical recurring high fevers, generalized body pain, abdominal or chest pain, weakness, loss of appetite and fatigue ... in addition to the pain and inflammation of joints. Increasing numbers of joints may be affected over time. This form of arthritis sometimes affects organ systems, including inflammation involving the heart, lungs, kidneys, etc. Systemic JRA is often accompanied by irregularly shaped patterns of a salmon-pink-colored rash appearing on the child's chest, back, arms, and thighs.
Though each form of Juvenile Rheumatoid Arthritis has it's own unique characteristics, there are some symptoms that are common to all forms. These include, most notably, joint pain, swelling, and joint stiffness.
JRA is the most common form of juvenile arthritis. Other types include: the Juvenile Spondyloarthropathy Syndromes, Juvenile Psoriatic Arthritis, Juvenile Systemic Lupus Erythematosus, Juvenile Vasculitis, Juvenile Scleroderma, and Mixed Connective Tissue Disorder.
The current goal in the management of JRA is complete remission ... 'no evidence of disease.' Although achieving this goal often requires ongoing therapy, the good news is that we now have the knowledge and tools to make this a realistic goal in the treatment of most children with this disease. The prognosis for a child with JRA today is better than ever before.
What can you do to help your child? Most importantly, treat your child as you normally would. Knowing that your child has arthritis should not change your love, discipline, or expectations. During flare-ups, a child often needs to rest more than usual but when the symptoms fade ... allow the child to be as active as they'd like. Parents tend to worry about a child over-doing it but regular exercise helps keep joints strong and flexible. During flares, exercises recommended by your child's physical therapist will help to restore range of motion. Talk with your child. Even more importantly, listen to your child! And laugh with your child ... a lot : ) Things can sometimes get discouraging. Let your child know that he or she is not alone. There are many children with arthritis ... and many of them have gotten better : )
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