Arthritis, Juvenile Rheumatoid (JRA)

General Illness Information

Common Name: ARTHRITIS, JUVENILE RHEUMATOID (JRA)

Medical Term: None Specified

Description:

Juvenile Rheumatoid Arthritis begins before 16 yrs of age. It is a syndrome of unknown cause causing inflammation affecting one or more joints for at least six weeks. Joint inflammation is characterized by swelling, warmth, tenderness, pain on movement, limitation of movement or redness. Starts at age 2-5 years old and often disappears by young adulthood.

JRA is four times more frequent in girls. Three distinct forms of JRA are known.

Causes:

Probably caused by an auto-immune disorder, in which the body’s immune system attacks its own normal tissues. The first symptoms maybe associated with physical or emotional stress.

Prevention:

Cannot be prevented at present.

Signs & Symptoms

  • Pain, swelling and stiffness in the toes, knees, ankles, elbows, shoulders or neck joints.
  • The pain may begin suddenly or gradually, and may involve only one or many joints.
  • The child may refuse to walk without being able to explain why.
  • Daily temperature rises to about 103 degrees F (39.4 degrees C) usually in the evening. A body rash and chills (in some forms) frequently accompany fever.
  • Poor appetite; weight loss.
  • Anemia.
  • Irritability; listlessness.
  • Swollen lymph glands.
  • Eye pain and redness.
  • Chest pains (if the disease is severe enough to affect the heart).

Risk Factors

There may be associated genetic factors.

Diagnosis & Treatment

  • Diagnosis is usually based on history and physical examination.
  • Blood studies are done which includes test for Rheumatoid factor (RF). However, RF is only positive in a small percentage of patients with JRA (mostly in adolescent girls).
  • X-rays of the involved joints must be taken. Changes may not appear on X-rays until the late stages.

General Measures:

  • Counseling to help the family cope with the child’s long-term illness.
  • Emotional support may be the most important factor in a child’s treatment.
  • Active physiotherapy, splints and other supportive measures will help prevent joint deformities.
  • Adaptive devices will help these children live as normal a life as possible.
  • Surgery to correct deformed joints (sometimes).
  • If the child doesn’t have a firm mattress, place 3/4-inch plywood between the box springs and mattress to provide better support.
  • Eye examinations at least twice a year to detect uveitis.
  • It is important for children to attend regular school on a daily basis.
  • Where necessary, the school system should provide extra services to accommodate the child’s needs.
  • Additional information available from the American Juvenile Arthritis Foundation, 1314 Spring Street N.WW, Atlanta. GA 30309. Telephone (800)283-7800. Or in Canada, the Arthritis Help-line 1-800-361-1112.

Medications:

  • Aspirin or other non-steroidal anti-inflammatory drugs (NSAIDS) to reduce pain and inflammation.
  • Disease modifying anti-rheumatic drugs, corticosteroids or gold salts may be prescribed.

Activity:

  • During an attack, keep the child in bed, except to use the bathroom, until fever and other symptoms subside.
  • Splints may be necessary to support and protect an inflamed joint.
  • After an attack passes, the child may gradually resume normal activities with rest periods during the day. The child should not become overtired and should sleep at least 10 to 12 hours each night.
  • Physical therapy exercises will be prescribed. Some the child can do alone, and some the parents will perform for the child. It is important that the child does the exercises because they help minimize pain and the crippling effects of rheumatoid arthritis.
  • Because of periodic changes in the symptoms, the physical therapy program will need revising occasionally.
  • In general, contact sports should be avoided, but the child should be encouraged to participate in other school, home, or community activities. Low impact activities such as swimming, and cycling are preferred.

Diet:

Provide a nutritious, balanced diet and encourage the child to eat.

Possible Complications:

  • Involvement of tissues other than joints, producing uveitis (eye inflammation), an enlarged spleen, pericarditis (inflammation of the lining around the heart) or inflammation of the heart muscle (myocarditis).
  • Permanent joint deformity.

Prognosis

Most patients now do well with proper treatment. Early treatment is important. Attack or relapses last a few weeks, and occur on and off throughout childhood. Symptoms can be well controlled with treatment.

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