Juvenile Rheumatoid Arthritis
(JRA, Juvenile Chronic Polyarthritis, Still’s Disease)
Juvenile rheumatoid arthritis (JRA) is a chronic (long-lasting), disease of the joints, which starts before the age of 16 years old. The joints become inflamed, which leads to pain and/or stiffness. The inflammation can damage cartilage and bone. In some cases, a systemic disease is present along with the arthritis. Without treatment, JRA can interfere with a child’s normal growth and development.
This is a potentially serious condition that requires care from your doctor. The sooner JRA is treated, the more favorable the outcome.
JRA is an autoimmune disease. For unknown reasons, the immune system attacks the tissue that lines the inside of one or more joints, limiting the use of the joint and potentially damaging it.
There are no clear risk factors for JRA. Girls are affected more often than boys.
If your child experiences any of these symptoms, do not assume it is due to JRA. These symptoms may be caused by other, less serious health conditions. If your child experiences any one of them, see your physician.
- Joint stiffness, especially in the morning or after periods of rest
- Pain, swelling, tenderness, or weakness in the joints
- Weight loss
- Fatigue or irritability
- Eye inflammation
- Swollen lymph nodes
- Growth problems, such as:
- Growth in affected joints may be too fast or too slow, causing one leg or arm to be longer than the other
- Joints grow unevenly, off to one side
- Overall growth may be slowed
Often, there are remissions (symptoms are better or disappear) and flare-ups (symptoms become worse).
Your doctor will ask about your child’s symptoms and medical history, and perform a physical exam. Once your child's physician suspects or makes this diagnosis, your child may be referred to a pediatric rheumatologist. There is no one clear diagnostic test for JRA. Rather, the doctor/specialist works to rule out other diseases as the cause of the symptoms. Tests may include the following:
- Imaging techniques (such as X-rays)
- Laboratory tests on blood, urine, and/or joint fluid, to:
- Rule out physical injury; bacterial or viral infection; other inflammatory diseases such as Lyme disease, inflammatory bowel disease, psoriasis, lupus, dermatomyositis; and some forms of cancer.
- Determine what subtype of JRA is present:
- Pauciarticular, which affects four or fewer joints
- Polyarticular, which affects five or more joints
- Systemic Onset JRA (Still’s Disease), which affects at least one joint and causes inflammation of internal organs
- Ophthalmologic examinations are performed to detect inflammatory problems of various parts of the eye itself.
Talk with your doctor about the best treatment plan for your child. Treatment aims to preserve a high level of physical and social functioning and maintain a good quality of life. Treatment options include the following:
Several types of medication are available to treat JRA:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, diclofenac, or tolmetin.
- Disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate. DMARDs slow the progression of JRA.
- Corticosteroids, given either intravenously (directly into the vein) or by mouth.
- Immune Response Modulators, such as TNF inhibitors are considered in refractory cases.
Exercises are performed to maintain muscle tone and preserve and recover the range of motion of the joints.
Splints and other devices are worn to help maintain normal bone and joint growth, and prevent flexion contractures (permanently bent joints).
There is no known way to prevent JRA.