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Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
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Juvenile Rheumatoid Arthritis

Edited by Rhadjena P. Illgen, MD,
MPH

Guyana Journal, August 2009

What is juvenile rheumatoid arthritis?

Juvenile rheumatoid arthritis (JRA) is one of the commonest childhood diseases in the United States. It is a form of arthritis that develops in childhood, usually in children aged 18 or younger. It may also be called childhood arthritis, juvenile idiopathic (that is, having no known cause) arthritis (JIA), or Still's disease. Approximately 294,000 children are affected by JRA and other rheumatologic conditions in the U.S. every year.

What are the symptoms of JRA?

JRA causes pain, swelling, tenderness and stiffness of the joints, and may sometimes cause motion in the joints to be limited. Any joint can be affected, and sometimes the internal organs can be affected as well. Symptoms may come and go, and are usually worse in the morning or after a nap. Some children may have just one or two flare-ups of the disease, while others may have symptoms that never go away. One of the earliest signs of the disease is limping in the morning, since the most commonly affected joints are the knees or the joints of the hands and feet.

Sometimes joints may become stuck in the flexed position for a long time, and this may cause damage to the bones and cartilage, resulting in joint deformity and impaired joint usage. Altered growth of bones and joints may eventually lead to short stature, and depending on disease severity and joint involvement, sometimes the bones of one arm or leg may end up shorter than those of the other arm or leg.

What causes JRA?

The exact cause of JRA is unknown, although most cases of JRA are thought to be caused by autoimmune disorders. Normally, the body produces antibodies which act to attack foreign invaders such as bacteria and viruses. However, if autoimmunity develops, the immune system, which normally helps the body to fight infection, attacks the body's own tissues instead.

There are some cases of JRA that are not caused by autoimmune reactions, but instead are caused by autoinflammatory reactions. Although the two terms sound very similar, they are different from one another. The main difference between the two types of diseases is that autoimmune reactions are caused by autoantibodies and autoinflammatory reactions are not. In autoinflammation, the body's white blood cells do not work properly, so they cause inflammation to occur for unknown reasons, instead of in response to harmful substances. Another difference between autoimmunity and autoinflammation is that autoinflammatory diseases often cause fever and rashes.

JRA is not contagious and there is no evidence that foods, toxins, allergies or vitamin deficiencies play a role. However, there may be a genetic component to the development of the disease, so if a family member has some form of arthritis or other autoimmune or autoinflammatory disease, then it is more likely that a child who presents with symptoms of JRA will have the disease.

How is JRA diagnosed?

A diagnosis of JRA is based on a complete medical history and careful medical examination. It is often necessary to be seen and evaluated by a specialist such as a pediatric rheumatologist. Different tests may also be used to determine the diagnosis, including laboratory studies such as blood and urine tests, as well as imaging studies including X-rays or magnetic resonance images (MRIs). These specialized tests are used to look for signs of joint or organ involvement in JRA.

How is JRA treated?

Treatment for JRA is similar to treatment for adult forms of arthritis. Medications and physical therapy help to ease the pain and swelling of arthritis and increase joint movement. Management varies depending on the specific form of juvenile rheumatoid arthritis, but in general:

o Care by a pediatric rheumatologist is important for most forms of JRA
o The primary goals of treatment for JRA are to control inflammation, relieve pain, prevent joint damage, and maximize functional abilities
o Treatment plans for children usually include medication, physical activity, physical and/or occupational therapy, education, eye care, dental care and proper nutrition
o One class of drugs, called nonsteroidal anti-inflammatory drugs (NSAIDs) are the first line of medication used in the treatment of JRA to help control pain and inflammation
o Corticosteroids such as prednisone may be taken by mouth or injected directly into joints to relieve inflammation
o Other classes of drugs such as biologic response modifiers (BRMs) and disease-modifying anti-rheumatic drugs (DMARDs), may be used together with NSAIDs to treat joint inflammation and reduce the risk of bone and cartilage damage

Although pain may sometimes limit activity in JRA patients, it is important that they remain physically active, as physical activity may help to maintain full joint function and range of motion. Swimming is especially helpful because it uses many muscles and joints without putting weight on the joints. However, if the child is experiencing a disease flare, then the doctor may limit the amount of physical activity at that time, depending on which joints are involved.


For a free brochure about juvenile rheumatoid arthritis or to locate the nearest Arthritis Foundation chapter, call the Arthritis Foundation toll-free at 1-800-283-7800 or visit the Arthritis Foundation website at www.arthritis.org. You can also write to: Arthritis Foundation, P.O. Box 7669, Atlanta, GA 30357-0669.

Dr. Illgen is a Senior Content Development Specialist in Horsham, PA.

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