What is juvenile rheumatoid arthritis?

Juvenile rheumatoid arthritis is a joint condition that affects teens and children who are 15 years of age or younger. It’s sometimes called juvenile idiopathic arthritis.

Juvenile rheumatoid arthritis causes the lining of the joints to swell and release fluid inside the joint. Joints become swollen, stiff, painful and warm to the touch.

Symptoms

What are the symptoms of juvenile rheumatoid arthritis?

Symptoms can vary greatly from child to child. Your child may complain of joint pain or may limp. His or her joints may be very swollen or feel hot. Your child may have stiffness in the morning or have problems moving. You may notice that he or she avoids normal activities. Your child’s symptoms may come and go, and may be mild or intense. Symptoms can last for a short time or for years.There are three main types of juvenile rheumatoid arthritis. Your child’s symptoms will depend on what type he or she has.

In serious cases, juvenile rheumatoid arthritis can stunt growth. Eye swelling can be serious, and lead to vision problems. If your child has signs or symptoms of juvenile rheumatoid arthritis, be sure to take him or her to the doctor.

• Oligoarticular (Pauciarticular) or “few joints.”This is the most common type of rheumatoid arthritis. This type affects 4 or fewer joints, usually the knee, leg, wrist or jaw. The joints become painful, stiff and red. This type can also affect the eyes, causing the iris (the colored part of the eye) to become inflamed. This is called iritis. Sometimes, vision can be damaged, especially if the iritis is not treated properly. Girls younger than 7 years of age are most likely to have oligoarticular juvenile rheumatoid arthritis with eye problems. Boys older than 8 years of age who have this type of juvenile rheumatoid arthritis often also have spine and hip problems. In about half of cases, oligoarticular juvenile rheumatoid arthritis goes away completely over time.
• Polyarticular or “many joints.”This type of juvenile rheumatoid affects 5 or more joints. It usually affects small joints, like those in fingers and hands. Symptoms often appear in the same joints on both sides of the body. Other symptoms include low-grade fever, feeling tired, poor appetite, and tiny, rash-like bumps on the lower torso and upper arms and legs.Anemia  (low iron in the blood) is common in children who have this type of juvenile rheumatoid arthritis. In a few cases, polyarticular juvenile rheumatoid arthritis may also cause internal organs to swell. This type happens more often in girls than in boys, and is more likely than oligoarticular juvenile rheumatoid arthritis to cause long-lasting joint damage. Polyarticular juvenile rheumatoid arthritis goes away on its own in slightly fewer than half of children.
• Systemic or Still’s disease.This type of juvenile rheumatoid arthritis can affect several areas of the body, including joints and internal organs. It is the least common form of juvenile rheumatoid arthritis. The earliest symptoms are rash (flat, pink spots), chills and high fever. Fevers usually spike (often reaching 103°F) in the afternoon or evening and disappear by the next day. Joint problems may begin early or may not appear until later. Other common symptoms include anemia and swelling of the lymph nodes, spleen and liver. Systemic juvenile rheumatoid arthritis can affect the heart and lungs, causing swelling and chest pain. This type of juvenile rheumatoid arthritis is most likely to cause long-term joint damage. About half of kids who have this type recover completely, while the rest experience joint pain and stiffness for many years.

Diagnosis

What will happen at my child’s doctor appointment?

No single test can identify juvenile rheumatoid arthritis, and it can be hard to diagnose. Your child’s doctor will likely ask about your child’s symptoms and medical history. He or she will also examine your child, and may do an X-ray or blood test. Your child’s doctor may also want to get a sample of the fluid in the lining of your child’s joints. In some cases, the doctor will want to follow your child’s symptoms for a few months. The patterns of your child’s symptoms can help identify which type of juvenile rheumatoid arthritis he or she has.

Treatment

How is juvenile rheumatoid arthritis treated?

Juvenile rheumatoid arthritis and its symptoms, such as pain and long-term joint and eye damage, can be managed with treatment. Your child’s doctor may recommend a combination of treatments that may include medicine to relieve pain, along with physical therapy and exercise. Physical therapy and an exercise plan can help your child maintain range of motion and strength without causing further damage to the joints.

Can medicine help?

Your child’s doctor will probably suggest an over-the-counter nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (brand names: Advil, Motrin), to reduce joint swelling. If these medicines do not help your child’s symptoms, your child’s doctor may suggest a combination of NSAIDs with slow-acting anti-inflammatory medicines, which are more powerful and may slow down the progression of the disease. If symptoms and risk of damage are severe, your child may need steroid treatment to reduce inflammation. With all of these medicines, regular testing must be done to watch for side effects. Newer medicines allow doctors to treat the autoimmune problems that cause juvenile rheumatoid arthritis. These medicines help slow your child’s immune system so it doesn’t cause further damage to joints. These may be prescribed if anti-inflammatory drugs alone are not helping.

What about surgery?

Rarely, children need surgery to help treat juvenile rheumatoid arthritis. Soft tissue surgery to repair joints may be needed if the joints have become badly bent or deformed. Joint replacement surgery may be needed if joints are badly damaged. With proper treatment, though, many children can eventually lead full, normal and even symptom-free lives.

Will my child be able to be active?

It’s actually important for your child to be as active as possible. Regular exercise, including games and sports, can be an important part of managing juvenile rheumatoid arthritis. But be sure to check with your doctor before your child starts any new sports or activities.

Questions

• How is juvenile rheumatoid arthritis treated?
• What can my child do to relieve swelling and pain in his joints?
• How can we manage other symptoms?
• What causes juvenile rheumatoid arthritis?
• What medicines might treat this condition?
• What if symptoms come back?
• Will my child always have this condition?

Tips for Dealing with Juvenile Rheumatoid Arthritis

• Taking a hot shower, using a hot or cold pack, or sleeping in a warm bed or sleeping bag can help relieve stiffness.
• Your child’s doctor can show him or her special exercises, including stretches and range-of-motion exercises, that can also help reduce joint stiffness and improve flexibility.
• Have your child take his or her medicines at the same time as some other activity, such as eating breakfast. This might help to remind your child to take medicines at the right time.
• Doing exercises or other activities at the same time every day, as recommended by your doctor or physical therapist, can help your child remember to do these activities. For example, they can do their stretches while they watch their favorite afternoon TV show.

Other Organizations

• National Institute of Arthritis and Musculoskeletal and Skin Diseases  
• Arthritis Foundation  

Citations

• Chronic Musculoskeletal Pain in Children: Part II. Rheumatic Causes by JL Junnila, VW Cartwright( 07/15/06,http://www.aafp.org/afp/20060715/293.html  )