Medical Encyclopedia: Juvenile rheumatoid arthritis

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Medical Encyclopedia: Juvenile rheumatoid arthritis

URL of this page: http://www.nlm.nih.gov/medlineplus/ency/article/000451.htm

Alternative names

Juvenile chronic polyarthritis; JRA; Still's disease; Juvenile idiopathic

arthritis

Definition

Juvenile rheumatoid arthritis (JRA) is a general term for the most common

types of arthritis in children. It is a long-term (chronic) disease

resulting in joint pain and inflammation, which may lead to joint damage.

Causes, incidence, and risk factors

JRA occurs in 50-100 per 100,000 children in the United States. It usually

occurs before age 16.

JRA is divided into several categories:

Systemic JRA occurs in about 10% of cases. It involves joint pain, swelling,

fevers, and rash. It is similar to adult Still's disease. The cause of this

form of JRA is unknown.

Polyarticular JRA occurs in about 40% of cases and involves multiple

painful, swollen joints. The cause of this form of JRA is also unknown. Some

children may have a positive rheumatoid factor and the condition may turn

into rheumatoid arthritis.

Pauciarticular JRA occurs in about 50% of cases and involves only a few

joints. Some of these children, in particular boys, will be HLA-B27

positive. HLA-B27 is a substance called a gene marker that is associated

with several autoimmune disorders.

Symptoms

Arthritis symptoms:

Joint stiffness on arising in the morning

Limited range of motion

Slow rate of growth or uneven arm or leg growth

Hot, swollen, painful joints

A child may stop using an affected limb

Back pain

Systemic JRA symptoms:

Fever, usually high fevers every day

Rash that comes and goes with the fever

Swollen lymph nodes (glands)

JRA can also cause eye inflammation. These symptoms include:

Red eyes

Eye pain

Photophobia (increased pain when looking at a light)

Visual changes

Signs and tests

The physical examination shows swollen, warm, and tender joints that hurt to

move. The child may have a rash. Other signs include an enlarged liver,

enlarged spleen, or swollen lymph nodes.

Blood tests may include:

CBC

ESR (sedimentation rate)

ANA

RA factor

HLA antigens for HLA B27

The doctor may need to tap a joint. This means that they will put a small

needle into a joint that is swollen. This can help to find the cause of the

arthritis. By removing fluid, the joint may feel better, too. Sometimes, the

doctor will inject steroids into the joint to help decrease the swelling.

Other tests:

X-ray of a joint

X-ray of the chest

ECG

Eye exam by an ophthalmologist

Treatment

Medicines used to treat this condition may include:

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Corticosteroids

An antimalaria medicine called hydroxychloroquine, which helps reduce

inflammation related to JRA

Disease-modifying anti-rheumatic drugs (DMARDs), including methotrexate

Biologic drugs, such as such as etanercept and infliximab, which block high

levels of inflammatory proteins

Note: Talk to your health care provider before giving aspirin or NSAIDs to

children.

Physical therapy and exercise programs may be recommended. Surgery may be

needed in some cases, including joint replacement.

Expectations (prognosis)

JRA is seldom life threatening. Long periods of spontaneous remission are

typical. Often, JRA improves or goes into remission at puberty.

Approximately 75% of JRA patients eventually enter remission with minimal

functional loss and deformity.

For additional information and resources, see arthritis support group.

Complications

Total joint destruction of the major weight-bearing joints

Loss of vision or decreased vision

Chronic spondyloarthropathy (back stiffness)

Calling your health care provider

Call for an appointment with your health care provider if you notice

symptoms of juvenile rheumatoid arthritis. Also call your health care

provider if your symptoms get worse, do not improve with treatment, or if

new symptoms develop.

Prevention

There is no known prevention for JRA.

Update Date: 5/27/2007

Updated by: Steve Lee, DO, Rheumatology Fellow, Loma University

Medical Center, Loma , CA.

Review provided by VeriMed Healthcare Network.