Juvenile rheumatoid arthritis (juvenile idiopathic arthritis, juvenile chronic arthritis)

• What is Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis)
• Statistics on Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis)
• Risk Factors for Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis)
• Progression of Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis)
• Symptoms of Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis)
• Clinical Examination of Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis)
• How is Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis) Diagnosed?
• Prognosis of Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis)
• How is Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis) Treated?
• Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis) References

What is Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis)

Juvenile rheumatoid arthritis (JRA) refers to a group of diseases causing chronic (lasting longer than 6 weeks) joint pain and swelling in children.

Statistics on Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis)

JRA is thought to affect between 10-20 children out of every 100 000. This seems to vary according to geography, with a higher number of cases reported in countries such as Sweden and Norway.

Risk Factors for Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis)

The cause of JRA is unknown. There is a higher risk of JRA when a family history of the disease exists.

Progression of Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis)

JRA is a long term disease characterised by joint disease that at times may be minimal and at other time severe. There are major types of JRA, which have different features.
1. Oligoarthritis:
The most common form of chronic arthritis in childhood, accounting for over half of all cases. 4 or less joints are involved during the first 6 months following onset of the arthritis. Children affected are usually aged between 1 and 4 years, with girls affected nearly twice as often as boys. Joint involvement may appear to be random. Most commonly affected are the knees, ankles, wrists and elbows.
2. Polyarthritis:
This type of JRA accounts for approximately one-third of cases of chronic childhood arthritis. 5 or more joints are involved in the first 6 months following onset of the arthritis. Once again, girls are affected twice as often as boys. Onset is most common in children between the ages of 2 and 4 years. Any joints in the body may be affected. Joint deformity and disability may occur in severe cases.
3. Systemic arthritis:
Affects both boys and girls equally, and may occur at any age during childhood. It accounts for about 10% of chronic childhood arthritis. Initial presentation is with a daily spiking fever, which returns to normal between spikes. The fever may be associated with a characteristic ‘salmon’ pink rash seen on the upper trunk, neck and armpits. Enlargement of the liver, spleen and lymph nodes may occur. At the beginning, joint disease may be minimal, making diagnosis difficult. Eventually joint disease may occur in both large and small joints in the body. The arthritis may be long lasting; however most children recover fully. Only a small number go on to develop severe disability.

How is Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis) Diagnosed?

The diagnosis of JRA is made on the basis of symptoms, a detailed physical examination and tests which help to confirm JRA and exclude other diseases, such as infections. These tests may include blood and urine tests, x-ray of the affected limbs, bone or MRI scans, and taking fluid from an affected joint for testing.

Prognosis of Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis)

With good treatment, most patients with JRA will be able to lead an active life. A small percentage of children will experience disability as a result of their condition. Deaths due to JRA are rare, but it may have considerable effects on quality of life due to the psychological impact of long term illness, effects on family life and side effects of medications used to treat JRA.

How is Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis) Treated?

Management of any chronic disease involves management of the disease itself, the resultant impact of the illness on child and family, as well as any associated complications or abnormalities (side effects of medications, growth problems). Many health professionals are often involved in the care of a child with JRA, including the family doctor, paediatrician, physiotherapist, occupational therapist and social worker. Assistance from school teachers, counsellors and support groups are often very helpful to families coping with the burden of JRA.
Treatment of JRA involves maintaining and improving joint function, and relieving pain and inflammation. A combination of rest, exercise and physiotherapy helps to maintion mobility and improve strength. Sometimes splinting (immobilising) of an affected joint may be needed.
Pain relief may be achieved with heat or ice packs, paracetamol and anti-inflammatory or immunosuppressive drugs depending on the severity of the disease. Some of these medications carry the risk of stomach ulcers, bleeding and liver damage so it is important to monitor carefully for side effects.

Juvenile Rheumatoid Arthritis (Juvenile Idiopathic Arthritis, Juvenile Chronic Arthritis) References

1. Kirchner J. Etanercept is Effective for Juvenile Rheumatoid Arthritis. Am F Phys 2000. [available online: http://www.aafp.org/afp/20000815/tips/10.html]
2. Merenstein, Kaplan, Rosenberg. Handbook of Paediatrics, 18th ed (1997). Appleton and Lange, USA.
3. Miller M. Juvenile rheumatoid arthritis. eMedicine 2004. [available online: http://www.emedicine.com/ped/topic1749.htm]
4. Robinson, Robertson. Practical Paediatrics (2003). Churchill Livingstone, United Kingdom.