Julie-Ann Amos Juvenile rheumatoid arthritis (JRA) may sometimes be called juvenile idiopathic arthritis. While it is possible for children under the age of 16 to develop other types of arthritis, this is by far the most common. Finding an authority on the disease is important because it is possible for juvenile rheumatoid arthritis to cause significant complications.
Symptoms
Children are not always able to put into words the pain they are experiencing. Sometimes it is necessary for caregivers to learn to ascertain how a child is feeling based on his or her actions. The most common symptoms are:
• Pain – Not all children will complain of pain. However, caregivers may notice the child has a tendency to limp early in the morning or after waking up from a nap.
• Stiffness – Children may appear to be clumsier upon waking from naps and in the mornings.
• Swelling – Joint swelling can occur in any joint of the body and is quite common. However, it may be more noticeable in larger joints such as the knees.
Other symptoms may include:
- Fever
- Rash
- Swollen lymph nodes
As with other forms of arthritis, patients may experience active periods of the disease during which symptoms will be more prevalent. After a flare-up patients may experience weeks or months where symptoms seem to disappear. Some patients will only experience symptoms for a few months while others will have the condition their entire life.
Causes
Juvenile rheumatoid arthritis is an autoimmune disease. Autoimmune diseases occur when the body’s immune system begins to see its own cells as a threat and begins to release antibodies to attack them. Researchers still do not fully understand what triggers this reaction but it is believed to be a combination of genetics and environment. It is possible that some gene mutations may make an individual more susceptible to environmental factors, such as bacterium or viruses, which may then allow the disease to form.
Tests
Diagnosing juvenile rheumatoid arthritis can be difficult because joint pain in children can be caused by a variety of factors. There is not a single test that can be performed to identify the disease; however, multiple tests can be utilized to rule out other possible causes. Blood tests and imaging scans are the two types of tests most frequently used to diagnose juvenile rheumatoid arthritis.
• Blood Tests – There are many tests that can be used to help eliminate other medical diagnoses.
- ESR – An erythrocyte sedimentation rate is the speed at which red blood cells settle to the bottom of a vial of blood. Elevated rates may indicate inflammation, a key component in JRA.
- C-reactive protein – This test measures the general inflammation.
- Anti-nuclear antibody – This test looks for proteins that are often found in individuals with a variety of autoimmune diseases such as arthritis.
- Rheumatoid factor – This test looks for an antibody commonly found in individuals with rheumatoid arthritis.
- CCP – This test looks for cyclic citrullinated peptides. These antibodies are frequently found in adults with rheumatoid arthritis.
• Imaging Scans – The x-ray is the most frequently used imaging scan used to detect juvenile rheumatoid arthritis. These scans can be used to detect other conditions and to look at bone development and joint damage.
Treatments
When treating juvenile rheumatoid arthritis, the goal is to allow children to live lives that are as normal as possible. Medications may be used to limit pain and physical therapy may be recommended to maintain strength and movement. In extreme cases surgery may be required.
• Medications – Pain medications may be the only treatment necessary for some children while others may benefit from medications which attempt to limit disease progression.
- NSAIDs – Nonsteroidal anti-inflammatory drugs are used to reduce swelling and pain.
- DMARDs – Disease-modifying antirheumatic drugs may be taken with NSAIDs to relieve pain and slow or halt progression of the disease.
- TNF blockers – Tumor necrosis factor blockers are designed to reduce stiffness, joint swelling and pain. However, serious side effects such as an increased risk of infection and cancer are possible.
- Immune suppressants – Medications designed to suppress the immune system can help manage the disease as it is caused by an overactive immune system. Again, side effects may include an increased risk of infection and cancer.
- Corticosteroids – These may be used to control symptoms until a DMARD has had time to effect change. They may also be used to prevent complications from the disease. However, they may also increase the risk of infection and may also interfere with growth.
• Therapy – Physical therapy can help maintain joint flexibility, muscle tone, and range of motion. The therapist may also recommend therapeutic devices to protect joints.
• Surgery – In rare cases surgery may be required to improve joint position.
Juvenile rheumatoid arthritis is a serious condition that is usually manageable with medical intervention. Because of the possibility of serious complications it is best to seek medical assistance at the first sign of symptoms.