Juvenile Rheumatoid Arthritis

Juvenile Rheumatoid Arthritis

Alternate Names

  • JRA
  • Still's disease

Definition

Juvenile rheumatoid arthritis, or JRA, is a condition characterized by joint inflammation and stiffness in children under the age of 16.

What is going on in the body?

JRA is an autoimmune disorder. This is a condition in which the body's immune system directly attacks or produces antibodies against its own tissues. The autoimmune response can attack the joints, eyes, heart, liver, and other body organs.

Risks

What are the causes and risks of the disease?

Juvenile rheumatoid arthritis is an autoimmune disorder. Many experts believe that this autoimmune response in children has two parts. Some children may have a genetic makeup that makes them vulnerable to the condition. When these children are exposed to a factor in the environment, such as a virus, it triggers the autoimmune response of JRA.

Prevention

What can be done to prevent the disease?

There are no known ways to prevent JRA.

Diagnosed

How is the disease diagnosed?

Diagnosis of JRA begins with a medical history and physical exam. The healthcare provider may order tests, including:
  • antibody titer and other blood tests
  • joint aspiration, in which a thin needle is used to get a sample of joint fluid for study in the lab
  • joint X-rays

Long Term Effects

What are the long-term effects of the disease?

JRA may cause severe joint abnormalities and arthritis. This may make a child unable to participate in regular activities. The child's growth may be slow, and limbs may be uneven in length. Severe eye damage may cause blindness and other visual impairments.

Other Risks

What are the risks to others?

JRA is not contagious and poses no risk to others.

Treatments

What are the treatments for the disease?

The main goal of treatment is to reduce inflammation and prevent damage to the joints. Medicines used to treat JRA include:
  • corticosteroids, such as prednisone, that suppress the immune response
  • disease-modifying antirheumatic medicines, such as methotrexate and biologic agents (such as etanercept {i.e., Engrel})
  • nonsteroidal anti-inflammatory medicines, or NSAIDs, such as ibuprofen (i.e., Advil, Motrin), naproxen (i.e., Aleve, Naprosyn), diclofenac (i.e., Cataflam, Voltaren), and tolmetin
Physical therapy can be used to maintain joint function and mobility. Occupational therapy can teach the child to use adaptive equipment or methods for activities of daily living. Rarely, surgery is needed to correct severe joint deformities.

Side Effects

What are the side effects of the treatments?

The medicines used to treat JRA may cause stomach upset, allergic reactions, and increased risk for infection. Corticosteroids may cause weight gain and slow growth. During surgery, the medicines can increase the risk of abnormal bleeding and infection

After Treatment

What happens after treatment for the disease?

The course that JRA takes is hard to predict. It may go away for long periods of time or permanently. If the disease goes away, no further treatment is usually required. Some children continue to have the disease as adults and require lifelong treatment.
When the child's symptoms are under control, an exercise program tailored to fit his or her disabilities is important. Sports for children with disabilities can promote social interaction with exercise.

Monitor

How is the disease monitored?

The child will have regular visits with the healthcare provider. Blood tests, joint X-rays, and eye exams may be done regularly. Any new or worsening symptoms should be reported to the healthcare provider.

Sources

Nelson Textbook of Pediatrics, 1996, Behrman et al.

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