Juvenile Rheumatoid Arthritis
Juvenile Rheumatoid Arthritis(JRA) may begin with a swollen knuckle, a spiking fever, or an unexplainable rash. But no matter what symptoms appear, hearing the word arthritis used as a diagnosis for your child can be unexpected and confusing.
Arthritis is an inflammation of the joints that is characterized by swelling, heat, and pain. Nearly 300,000 children in the United States have some sort of arthritis. Arthritis can be short-term - lasting for just a few weeks or months, then going away forever - or it can be chronic and last for months or years. In rare cases, it can last a lifetime.
The most prevalent form of juvenile arthritis is juvenile rheumatoid arthritis, or JRA. It affects approximately 50,000 children in the United States.
What Causes Juvenile Rheumatoid Arthritis?
The medical community doesn't know exactly what causes rheumatoid arthritis (also referred to as idiopathic arthritis) in children. Research indicates that it is an autoimmune disease. In autoimmune diseases, white blood cells lose the ability to tell the difference between the body's own healthy cells and harmful invaders like bacteria and viruses. The immune system, which is supposed to protect the body from these harmful invaders, instead releases chemicals that can damage healthy tissues and cause inflammation and pain.
To effectively manage and minimize the effects of arthritis, an early and accurate diagnosis is essential. There are several types of juvenile rheumatoid arthritis. Understanding the symptoms and characteristics of each of them can help you help your child maintain an active, productive lifestyle.
Types of Juvenile Rheumatoid Arthritis
Typically juvenile rheumatoid arthritis appears between the ages of 6 months and 16 years. The first signs are often joint pain or swelling and reddened or warm joints. Many rheumatologists (doctors specializing in joint disorders) find that the greater the number of joints affected, the more severe the disease and the less likely that the symptoms will eventually go into total remission.
There are 3 major types of juvenile rheumatoid arthritis:
- Polyarticular arthritis affects more girls than boys. Symptoms include swelling or pain in 5 or more joints. The small joints of the hands are affected as well as the weight-bearing joints such as the knees, hips, ankles, feet, and neck. In addition, a low-grade fever may appear, as well as bumps or nodules on the body on areas subjected to pressure from sitting or leaning.
- Pauciarticular JRA affects 4 or fewer joints. Symptoms include pain, stiffness, or swelling in the joints. The knee and wrist joints are the most commonly affected. An inflammation of the iris (the colored area of the eye) may occur with or without active joint symptoms. This inflammation, called iridocyclitis or iritis or uveitis, can be detected early by an ophthalmologist.
- Systemic JRA affects the whole body. Symptoms include high fevers that often increase in the evenings and then may suddenly drop to normal. During the onset of fever, the child may feel very ill, appear pale, or develop a rash. The rash may suddenly disappear and then quickly appear again. The spleen and lymph nodes may also become enlarged. Eventually many of the body's joints are affected by swelling, pain, and stiffness.
Signs and Symptoms of Juvenile Rheumatoid Arthritis
The first signs of arthritis can be subtle or obvious. Signs may include limping or a sore wrist, finger, or knee. Joints may suddenly swell and remain enlarged. Stiffness in the neck, hips, or other joints can also occur. Rashes may suddenly appear and disappear, developing in 1 area and then another. High fevers that tend to spike in the evenings and suddenly disappear are characteristic of systemic juvenile rheumatoid arthritis.
Treating Juvenile Rheumatoid Arthritis
In many cases, JRA may be treated with a combination of medication, physical therapy, and exercise. In specific situations, your child may require injection of corticosteroids into the joint or surgery. Your child's health care providers, including the primary care physician, rheumatologist, and physical therapist, should work together to develop the best method of treatment for your child.
The goals of treatment are to relieve pain and inflammation, slow down or prevent the destruction of joints, and restore use and function of the joints to promote optimal growth, physical activity, and social and emotional development in your child.
Medications
For inflammation and pain, your child's doctor or pediatric rheumatologist may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (such as Advil or Motrin). These drugs may help reduce inflammation and pain by limiting the release of harmful chemicals from white blood cells.
Higher or lower dosages may be needed, depending upon your child's response to the medication. Your child's doctor or rheumatologist should explain what the medication is meant to do and what side effects, if any, your child may experience. Although the medication may temporarily ease swelling and pain, it's important for your child to continue taking the medication until your child's doctor says to stop.
If NSAIDs do not control inflammation of the joints, your child's doctor may prescribe other medications. You can also talk with your child's doctor to find out more information about newer treatments that have become available.
Physical Therapy
An appropriate physical therapy program is essential in the management of any type of arthritis. A physical therapist will explain the importance of certain activities and recommend exercises suited to your child's specific condition. The therapist may recommend range-of-motion exercises to restore flexibility in stiff, sore joints and other exercises to help build strength and endurance.
Regular Exercise
When pain strikes, it's natural for your child to want to sit still. But it's important to maintain a regular exercise program, especially for those with arthritis. Muscles must be kept strong and healthy so they can help support and protect joints. Regular exercise also helps to maintain range of motion of joints.
At home and at school, your child should maintain regular exercise and physical fitness programs. Safe activities include walking, swimming, and bicycling (especially on indoor stationary bikes). Always be certain your child warms up the muscles through stretching before exercising. Making exercise a family activity can increase the level of fun and enthusiasm.
Informations obtained from National Institute of Health.