What is Juvenile Rheumatoid Arthritis (JRA)?
Juvenile rheumatoid arthritis (JRA) encompasses different forms of arthritis affecting children. This disorder is also known as juvenile idiopathic arthritis (JIA).
JRA can occur in any child under the age of 16. It is the most common arthritic condition among children.
The severity and duration of the ailment depend on the individual and type of JRA. Early diagnosis and treatment is essential for successful recovery. (1)
Juvenile rheumatoid arthritis (JRA) is the result of a child’s immune system attacking healthy joints, resulting in inflammation.
Joints are the areas connecting your bones – for example, kneecaps. They support motion and prevent bones from grinding against one another. (2)
In developing children, arthritis can also result in stunted growth or deformities. (4)
There are various different possible variations of JRA. The underlying cause of the disease in general is not fully understood, although genetics probably play a role. (5)
Symptoms can flare up (get worse) in cycles, and will typically develop before the child reaches age 16. One or more joints can be affected and symptoms vary, depending on the individual.
The disease is characterized by symptoms that last for more than a few weeks.
The telltale signs of juvenile rheumatoid arthritis (JRA) can include one or more of the following: (6)
If your child complains of persistent joint pain, it could be JRA. The pain is more likely to occur after the child has been resting, or in the morning after waking up.
JRA can provoke swelling that may be accompanied by heat. Your child’s joints may remain swollen for a period of days, or appear and then abate.
Be wary of any joint swelling which was not caused by trauma, such as a fall or an injury while at play.
Joint stiffness can cause your child to limp or hold affected joints in a certain position.
You may notice your child has trouble performing certain movements due to stiff joints.
Certain forms of JRA can cause severe eye infections. If your child complains of painful eyes or blurred vision, JRA could be the reason.
JRA sometimes triggers a distinctive type of skin rash. Rashes that are pink and appear on your child’s torso, face or limbs can be a warning symptom of the disorder.
There are multiple outcomes for a child with juvenile rheumatoid arthritis (JRA). Certain forms of the disorder will go into remission, while others may persist into adulthood.
The disease can progress differently depending on the type of JRA, when it is diagnosed and the treatment implemented.
The most common types of JRA can progress as follows: (7)
Approximately two-thirds of arthritic children have oligoarthritis. It is known as a mild form of JRA, typically manifesting in one or both of the knees.
Eye inflammation commonly accompanies this condition. Oligoarthritis is the most likely to resolve itself, with minimal or no damage to the joints.
However, extended oligoarthritis may occur in some children. This is when over five joints are affected for longer than six months at a time. (8)
Polyarthritis is another common variant of JRA, affecting five or more joints, usually around the hands or feet. Symptoms may occur suddenly or progress gradually over several months.
It can be rheumatoid factor (RF) positive or negative. The presence or absence of the rheumatoid factor in a child’s blood can determine the progress of the disease.
Polyarthritis can remain active into adulthood. RF negative polyarthritis is less severe than its positive counterpart.
This form of juvenile rheumatoid arthritis (JRA) is characterized by psoriasis (skin rash).
An estimated 30 to 40 percent of children with this condition will continue to show symptoms of psoriatic arthritis as adults. (9)
Enthesitis-related JRA impacts the entheses. These are the areas where bones and connective tissues, such as tendons, join together.
It typically manifests in the spine and leg joints, mainly in boys. Some children will develop a stiff lower back or neck as teenagers. (10)
This type of arthritis is usually associated with a high fever and can result in an enlarged spleen, liver, or lymph nodes.
Systemic JRA is a less common but more severe form of arthritis. Fever, rash and other symptoms can appear before the classic signs of arthritis (such as joint pain), making diagnosis difficult. (11)
Also known as still’s disease, it can cause severe, permanent damage to joints if not detected early.
Approximately 50 percent of affected children go into remission (meaning no active symptoms) after a few months; however, this could also take up to several years. (12)
This classification is used to describe juvenile arthritis that displays symptoms from more than one type.
It can also define a type of childhood arthritis that does not fall into any of the five distinct categories above.
Juvenile rheumatoid arthritis (JRA) is diagnosed through a series of tests.
The first step involves reviewing your child’s medical history. This is to rule out any injury, infection or illness that could be responsible for symptoms.
If no other underlying cause is found, JRA is suspected. A diagnosis of this disorder generally requires arthritis to be present in at least one joint for a minimum of six weeks.
A physical examination allows the doctor to inspect your child’s joints. Stiffness, pain and range of motion will be checked and recorded.
Blood tests will be performed to check for certain markers which can indicate JRA. These markers include specific proteins, chemicals and more.
Finally, your child may undergo imaging tests, such as an MRI scan, to assess the condition of the affected joints. (13)
Treatment for JRA aims to control symptoms to reduce joint damage and improve your child’s quality of life.
One or more of the following options may be recommended: (14)
Non-Steroidal Anti Inflammatory Drugs (NSAIDs)
NSAIDs are drugs which help to relieve inflammation and pain in the joints. These medications do not stop the disease from damaging your child’s joints.
They are typically used as a form of pain management, alongside other treatment options.
Corticosteroids are powerful steroids that work to combat inflammation rapidly. They are prescribed to treat particularly bothersome, painful joints.
As with NSAIDs, corticosteroids are often implemented alongside other treatment.
For example, your child may take them while waiting for disease modifying antirheumatic drugs (DMARDs) to take effect.
These drugs can have unpleasant side effects. For this reason, treatment is usually short term at a low dosage.
Disease Modifying Antirheumatic Drugs (DMARDs)
Disease modifying antirheumatic drugs (DMARDs) prevent joint damage by lowering inflammation within your child’s body. Methoxatrate is the staple DMARD prescribed for JRA.
However, these medications do not work instantly. Your child may have to take them for a minimum of one month before beneficial effects are seen.
While being treated with DMARDs, your child will undergo regular testing. This is to monitor for possible side effects, such as increased risk of infection or gastric distress. (15)
Biologics are similar to disease modifying antirheumatic drugs. As with DMARDs, they suppress dysfunctional immune systems to reduce inflammation.
In turn, this decreases the symptoms of juvenile rheumatoid arthritis (JRA). Biologics
can also increase your child’s vulnerability to infections.
What is juvenile rheumatoid arthritis (JRA)? Juvenile rheumatoid arthritis (JRA) is a term used to describe arthritic conditions affecting children.
How do you develop juvenile rheumatoid arthritis (JRA)? This condition develops when a child’s immune system malfunctions and attacks the joints. The exact cause is not known, although genetics may play a role.
How are you diagnosed for juvenile rheumatoid arthritis (JRA)? JRA is diagnosed by: excluding other possible reasons, medical history review, physical examination and blood tests. Imaging tests may also be performed.
What is the best treatment for juvenile rheumatoid arthritis (JRA)? To manage your child’s pain, a doctor will suggest non-steroidal anti inflammatory drugs (NSAIDs), or corticosteroids. Disease modifying anti rheumatic drugs (DMARDs) and biologics can also be prescribed to suppress the immune system and lower inflammation.
What are the long term complications of juvenile rheumatoid arthritis (JRA)? JRA can cause irreversible joint damage, stunted growth, anemia and disproportionate limbs in affected children. (16)
Is juvenile rheumatoid arthritis (JRA) considered a disability? If you have a child with juvenile rheumatoid arthritis (JRA), you may be eligible to receive benefits for the child. From age 16 onwards, a child with JRA may also receive disability benefits, depending on the severity of the condition. (17)
Is there any cure for juvenile rheumatoid arthritis (JRA)? No, there is no cure for this disorder. However, some children with the disease can enter permanent remission, meaning the symptoms are no longer active. (18)
Is juvenile rheumatoid arthritis (JRA) life threatening? Systemic juvenile rheumatoid arthritis can result in a type of whole-body inflammation known as macrophage activation syndrome (MAS), which can be fatal. (19)
If you suspect your child may have juvenile rheumatoid arthritis (JRA), consult your
The earlier JRA is detected, the greater the likelihood of reducing the potential joint damage and other complications in your child.
It is important to support your child emotionally as well as medically. Counseling services may be available to both parents and children, to help them deal with a diagnosis of JRA. (20)