Juvenile Rheumatoid Arthritis (JRA)

Children can develop many of the same types of arthritis that adults do. Around 300,000 minors have been diagnosed with an arthritis disease, but with appropropriate treatment children can live long and active lives. Like adult RA, Juvenile Rheumatoid Arthritis (JRA) is caused by the body’s immune system attacking its own healthy tissue. Researchers believe that children, just like adults, have the same genetic tendencies that can be triggered to develop arthritis diseases. Research has not provided any conclusive solution to preventing arthritis diseases in children because the cause of immune malfunction is still widely unknown.

In the United States, JRA is the most common term to encompass all of the types of arthritis diseases that children can get, but there are several other terms that exist. Juvenile chronic arthritis and juvenile idiopathic arthritis are terms that are interchangeable with JRA. The symptoms of JRA are similar to those of adult rheumatoid arthritis:

  • Persistent joint pain
  • Swollen, red, or warm joints
  • Limping or preference of one leg or arm
  • High fevers
  • Rashes that appear with fevers
  • Stiffness
  • Stunted growth

    In early years, many children with JRA experience slower­than­normal growth, with some joints developing faster than others. This leads to legs and arms with different lengths, and may even affect a child’s overall height. In most cases, children diagnosed with JRA at a young age grow at a slower rate than others.

    JRA may develop in any, or all, of the above methods. In some rare cases, patients will have joint problems throughout their body, and experience organ damage due to high inflammation.

    Types of JRA

    There are several types of JRA and each type affects the body differently. JRA can begin at anytime up to 16 years of age. The disease is considered chronic if the symptoms last from 6 weeks to 3 months. Some children will have persistent symptoms for the rest of their lives and some will only show signs of the disease for a few months.

    Here are three types of JRA and how they present in the body:

    Oligoarticular (sometimes known as Pauciarticular) JRA is a type of JRA that only initially affects five or fewer smaller joints usually in the wrists or knees. About 50% of children with arthritis have this form. It has the potential to follow children into adulthood depending on the age they begin showing symptoms. If children are younger than 7, there is the possibility that, over time, the disease will go into remission. Children over 7 have a much higher chance of the disease spreading to other joints and keeping it through adulthood.

    Polyarticular JRA can begin at any age and affects five or more joints of any size in the legs, arm, jaw or neck. Unlike adult RA, there are no blood tests that will positively identify JRA in children. While adults with RA will usually test positive for factors and antibodies associated with RA, children with JRA will usually test negative for these same things. In a physical examination, children might also have swollen livers, spleens and lymph nodes. To diagnose children, rheumatologists depend on physical examinations, imaging tests and monitoring the progression of symptoms.

    Systemic onset JRA is the least common type of JRA, only affecting about 10 percent of people with arthritis. It begins with spiking fevers up to 103 degrees and a persistent red rash. Joint swelling and damage may not appear for months or years after the fevers begin but once inflammation begins it can do irreversible damage to joints and internal organs. Anemia and elevated white blood cells can be an indicator of JRA and are looked for in blood tests.

    Additional Complications

    In some cases, an unfortunate accompaniment to JRA is the formation of iritis, uveitis and iridocyclitis. These are eye problems that could arise concurrently with the disease or after JRA has gone into remission. These diseases cause inflammation in the eyes resulting in blurred vision, eye pain, eye redness and sensitivity to light. It is important to take children with JRA to the optometrist regularly because they often will not show symptoms of these issues.

    Treatment

    The most important goal in JRA treatment is preventing permanent joint damage. Treatment often depends on the type of JRA that a child has.

    In Oligoarticular JRA, where the inflammation is in fewer than 5 joints, NSAIDs and Corticosteroids are usually enough manage symptoms and flare­ups.

    In Polyarticular and other types of JRA where 5 or more joints are affected, DMARDs and Biologic drugs are used to reduce inflammation. When a child is only feeling symptoms in one joint, steroids can be injected into the joint before any other medications are tried. Steroids should only be used sparingly because of their undesirable side effects such as poor growth and risk of infection.

    For more information on treatment options, view our treatment section.

    Remissions and flare-­ups

    Many children experience symptoms for months, or even years, and then go through a remission — side effects will disappear completely, only to return months later. In between these periods, symptoms will occasionally get much worse for a short period of time — this is called a flare­-up. Many children experience a few flare­-ups throughout remission while others will go months, or even years, without side effects.

    With any type of rheumatoid arthritis, each case is different. Juvenile rheumatoid arthritis is no exception. Thankfully, there are ways to improve these symptoms and fight against JRA. Proper diet and low­impact exercise are great ways to control inflammation, and doctors can prescribe some helpful medications that will fight against dangerous side effects.

    If you or your child are experiencing symptoms associated with rheumatoid arthritis, please see a doctor immediately.

    Life with JRA

    It is important to keep life as normal as possible for children with JRA. Leading an active lifestyle with exercise and independent activities will keep muscles and joints stronger. Activity and positive reinforcement will also keep children from developing depression or negative emotional problems. Support groups and summer camps are good places for children with arthritis diseases to interact with others who share their struggles. The Arthritis Foundation provides search tools for locating local groups and summer camps as well as information about annual conferences they hold.

    JRA is a difficult and often debilitating disease that makes it difficult for children to lead normal lives. Restoring normalcy and providing treatments that allow a child the fullest life possible is most important in dealing with the disease.

View Sources Last Edited: August 3, 2016

Sources and Citations

1. “Juvenile Arthritis.” Rheumatology.org. American College of Rheumatology, n.d. Web. 03 Aug. 2016. http://www.rheumatology.org/I­Am­A/Patient­Caregiver/Diseases­Conditions/Juvenile­Arthritis

2. “Juvenile Rheumatoid Arthritis: MedlinePlus Medical Encyclopedia.” U.S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 03 Aug. 2016. https://www.nlm.nih.gov/medlineplus/ency/article/000451.htm