Juvenile rheumatoid arthritis

Definition

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.

Alternative Names

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

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.

JRA most often develops before age 16. Symptoms may start as early as 6 months old.

There are several types of JRA:

Symptoms

Symptoms of JRA may include:

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

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:

Blood tests that may include:

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 provider may inject steroids into the joint to help reduce swelling.

Other tests that may be done include:

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:

Children with JRA need to stay active.

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

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 with no 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, and problems 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:

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.