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    Juvenile rheumatoid arthritis

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

    Juvenile rheumatoid arthritis (JRA) is a term used to describe a common type of arthritis in children. It is a long-term (chronic) disease resulting in joint pain and swelling.

    Causes

    The cause of JRA is not known. It is thought to be an autoimmune illness. This means the body attacks and destroys healthy body tissue by mistake.

    JRAmost often developsbefore age 16. Symptoms may start as early as 6 months old.

    There are several types of JRA:

    • Systemic (bodywide) JRA involves joint swelling or pain, fevers, and rash. It is the least common type.
    • Polyarticular JRA involves many joints. This form of JRA may turn into rheumatoid arthritis. It may involve five or more large and small joints of the legs and arms, as well as the jaw and neck.
    • Pauciarticular JRA involves four or less joints, most often the wrists, or knees. It also affects the eyes.

    Symptoms

    Symptoms of JRA may include:

    • Swollen, red, or warmjoint
    • Limping or problems using a limb
    • Sudden high fever
    • Rash (on trunk and extremities) that comes and goes with fever
    • Stiffness, pain, andlimited movement in a joint
    • Bodywide symptoms such as pale skin, swollen lymph gland, and “sick” appearance

    JRA can also cause eye problems called uveitis, iridocyclitis, or iritis. There may be no symptoms. When eye symptoms occur they can include:

    • Red eyes
    • Eye pain, which may get worse when looking at light (photophobia)
    • Vision changes

    Exams and Tests

    The physical exam may show swollen, warm, and tender joints that hurt to move. The child may have a rash. Other signs include:

    • Swollen liver
    • Swollen spleen
    • Swollen lymph nodes

    Blood tests that may include:

    • Rheumatoid factor
    • Erythrocyte sedimentation rate (ESR)
    • ANA
    • Complete blood count (CBC)
    • HLA antigens for HLA B27

    Any or all of these blood tests may be normal in children with JRA.

    The health care provider may place a small needle into a swollen joint to remove fluid. This can help to find the cause of the arthritis. It can also help relieve pain, too. The health care providermay inject steroids into the joint to help reduce swelling.

    Other tests that may be done include:

    • X-ray of a joint
    • Bone scan
    • X-ray of the chest
    • ECG
    • Regular eye exam by an ophthalmologist. This should be done even if there are no eye symptoms.

    Treatment

    Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be enough to control symptoms when only a small number of joints are involved.

    Corticosteroids may be used for more severe flare-ups to help control symptoms.

    Children who have arthritis in many joints, or who have fever, rash, and swollen glands may need other medicines. These are called disease-modifying antirheumatic drugs (DMARDs). They can help reduce swelling in the joints or body. DMARDs include:

    • Methotrexate
    • Biologic drugs, such as such as etanercept, infliximab, and related drugs

    Children with JRA need to stay active.

    Exercise will help keep their muscles and joints strong and mobile.

    • Walking, bicycling, and swimming may be good activities.
    • Children should learn to warm up before exercising.
    • Talk to the doctor or physical therapist about exercises to do when your child is having pain.

    Children who have sadness or anger about their arthritis may need extra support.

    Some children with JRA may need surgery, including joint replacement.

    Outlook (Prognosis)

    Children with only a few affected joints may have long periods withno symptoms.

    In many children, the disease will become inactive and cause very little joint damage.

    The more joints that are affected, the more severe the disease will be. It is less likely that symptoms will go away in these cases. These children more often have chronic pain, disability,andproblems at school.

    • Wearing away or destruction of joints (can occur in patients with more severe JRA)
    • Slow rate of growth
    • Uneven growth of an arm or leg
    • Loss of vision or decreased vision from chronic uveitis (this problem may be severe, even when the arthritis is not very severe)
    • Anemia
    • Swelling around the heart (pericarditis)
    • Chronic pain, poor school attendance

    When to Contact a Medical Professional

    Call your health care provider if:

    • You, or your child, notice symptoms of juvenile rheumatoid arthritis
    • Symptoms get worse or do not improve with treatment
    • New symptoms develop

    Prevention

    There is no known prevention for JRA.

    References

    Rabinovich CE. Evaluation of suspected rheumatic disease. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics.19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 147.

    Long AR, Rouster-Stevens KA. The role of exercise therapy in the management of juvenile idiopathic arthritis. Curr Opin Rheumatol. 2010 Mar;22(2):213-7.

    Prince FH, Otten MH, van Suijlekom-Smit LW. Diagnosis and management of juvenile idiopathic arthritis. BMJ. 2010 Dec 3;341:c6434.

    Ruperto N, Lovell DJ, Quartier P, et al; Paediatric Rheumatology International Trials Organization and the Pediatric Rheumatology Collaborative Study Group. Long-term safety and efficacy of abatacept in children with juvenile idiopathic arthritis. Arthritis Rheum. 2010 Jun;62(6):1792-802.

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                Review Date: 4/20/2013

                Reviewed By: Gordon A. Starkebaum, MD, Professor of Medicine, Division of Rheumatology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

                The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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