RE: Different Flavors of JRA - Can Someone Explain?

April 11, 2011

Just quickly - JIA and JRA are the same thing. Juvenile Rheumatoid Arthritis has

been replaced by the more accurate Juvenile Idiopathic Arthritis. People often

get confused and think that JRA is like RA when in fact they are different

diseases. Personally I just use JA as that seems even more simple . There are

three main types of JIA - pauciarticular, polyarticular, and systemic (also

known as Still's disease). Pauci is four or fewer joints, poly is five or more,

and systemic is the one with the fevers. There are types that mainly effect

tendons and some that effect organs like the skin or eyes. I have some posts

that I have saved that explain more in detail, plus I am sure others will add to

this. Michele ( 23, spondy)

From: [mailto: ] On Behalf Of

sharon.peabody

Sent: Monday, April 11, 2011 10:23 AM

Subject: Different " Flavors " of JRA - Can Someone Explain?

Hi everyone!

I hope that the weekend was good to everyone.

Since I'm still so new to this world of JRA, I've been trying to read and learn

more. I've quickly come to realize that there seems to be lots of " flavors " of

JRA (for lack of a better term) but I have yet to find a place that really

explains the differences between JRA, JIA, and the others in plain laymans

terms. If any of you have a few spare minutes, do you think you can clarify them

to me? I'm just wanting to learn and arm myself with information as we go down

's treatment path.

Thanks so much!

Cheers.

Sharon (, 17 months, systemic)

April 11, 2011

JIA is JRA. The term was recently changed. You will hear both. Here is a good

synopsis of the types. Notice that less than four joints is called oligo. This

is new, too. It used to be called pauci.

The current thinking is that systemic may be in its own class. JIA is an

autoimmune disease. It is believed that systemic is not an autoimmune disease,

but an autoinflammatory disease. There are two components of the immune system,

the innate and the specific. Autoimmune diseases have something wrong with the

specific immune system. This includes the B cells and the T cells.

Autoinflammatory diseases, such as systemic, has something wrong with the innate

immune system. This includes neutrophils, macrophages, and monocytes. What

does this mean in laymen's terms? It means sometimes the meds are different for

the two diseases. MTX isn't all that effective with systemic. The tnf

inhibitors aren't either. It doesn't mean that they don't work, they just

aren't as effective. Mtx is about 50% effective with systemic. Enbrel is about

40% effective. So other meds are sometimes used with systemic. Studies have

shown that systemics have too much of Interleukin 1 (IL-1), interleukin 6 and

interleukin 18. So there are new drugs for IL -1 and IL-6. Kineret and Ilaris

are IL-1 inhibitors. Actemra is a IL-6 inhibitor. Here is more explanation:

(n, 22, systemic)

There are several forms of JIA. Their names are derived from the number of

joints affected or associated features:

Oligoarticular JIA

This is when 4 or fewer joints are involved. These are often large joints, such

as the knee and ankle.

Oligo JIA is the commonest form of JIA and typically affects girls aged 2-6

years. Sometimes after 6 months or longer more than 4 joints become affected. In

this case the arthritis is called extended oligioarticular JIA, but behaves like

polyarticular JIA. It is not possible to predict in whom this will occur.

Eye inflammation is more common in oligoarticular arthritis and all patients

must be seen by an ophthalmologist (eye doctor) on a regular basis. This will

pick up eye inflammation (uveitis) early and prevent future problems with sight.

Patients who continue to have 4 or fewer joints affected commonly require less

treatment than those whose diagnosis changes to extended oligoarticular JIA.

From the teenage years onwards they may also have long periods of full remision.

They may even grow out of it altogether.

Extended oligoarticular JIA often continues into adulthood, but modern

treatments are good at controlling it.

Polyarticular JIA

This is when 5 or more joints are involved, including small joints of the hand

and feet, the neck etc. Polyarticular disease tends to continue into adulthood,

but treatment usually prevents long term harm.

In older girls, rheumatoid factor may be present in the blood denoting a more

aggressive form of arthritis, although with modern treatment this does not mean

a worse outcome. Far from it.

Enthesitis Related Arthritis

This typically affects boys older than 6 years of age. Girls may be affected.

Arthritis occurs in association with swelling of the tendons, especially at the

insertion point of tendons into bones (enthesitis). Sites typical for enthesitis

include:

The heel

The arch of the foot

Around the hip

Commonly there is a family history of similar types of arthritis or other

inflammation such as inflammatory bowel disease.

Enthesitis can be particularly uncomfortable and may be more difficult to treat

than arthritis. It is especially important to monitor the hips and back

although, with physiotherapy support, the outcome is usually good.

An MRI may be requested if inflammation of the back is suspected . Eye

inflammation, called uveitis, may occur suddenly causing pain sufficiently

severe to consult a GP or eye specialist urgently.

Psoriatic Arthritis

The patient or a close family member may have psoriasis or nail pitting.

Psoriasis is a flaky skin condition that commonly affects the elbows, knees,

scalp and forehead.

If there is arthritis of a finger or toe there is usually swelling of all joints

of the digit, resulting in a sausage appearance.

This arthritis may also be associated with enthesitis and eye inflammation

similar to that of enthesitis related arthritis (above).

Systemic JIA

This is where arthritis is associated with regular fevers and rash. The rash is

often a pale pink and comes and goes. The fever tends to occur just once or

twice a day with the child seemingly much improved in between times. Any number

of joints may be involved.

In some patients this form of arthritis may only last a few months and never

return. In others the inflammation may prove difficult to treat. In these

patients, growth may be affected and the outer lining of the heart may become

inflamed.

Arthritis associated with inflammatory bowel disease

This is similar to enthesitis related arthritis. It may occur many months or

years before the bowel becomes involved. Outcome of joint inflammation is

usually good once the bowel inflammation is controlled.

Examples include crohn's disease and ulcerative colitis.

On Apr 11, 2011, at 8:22 AM, sharon.peabody wrote:

> Hi everyone!

>

> I hope that the weekend was good to everyone.

>

> Since I'm still so new to this world of JRA, I've been trying to read and

learn more. I've quickly come to realize that there seems to be lots of

" flavors " of JRA (for lack of a better term) but I have yet to find a place that

really explains the differences between JRA, JIA, and the others in plain

laymans terms. If any of you have a few spare minutes, do you think you can

clarify them to me? I'm just wanting to learn and arm myself with information as

we go down 's treatment path.

>

> Thanks so much!

>

> Cheers.

> Sharon (, 17 months, systemic)

>

April 11, 2011

Good up to date info . Another one for me to save! LOL Michele

Re: Different " Flavors " of JRA - Can Someone Explain?