Juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis, is the most common type of arthritis in children. Arthritis is a long-term condition characterized by stiffness, swelling, and pain in the joints. An estimated 300,000 children in the United States have a form of arthritis. Some children have arthritis for just a few months, while others have arthritis for several years. In rare cases, the condition can last a lifetime.
The exact cause of JRA isn’t known. However, researchers believe it might be an autoimmune disease. In people with autoimmune diseases, the immune system can’t differentiate between the healthy cells in the body and harmful substances, such as viruses and bacteria. This causes the immune system to mistakenly attack harmless cells as though they are dangerous invaders. In children with JRA, the immune system releases chemicals that damage healthy tissues in the body, causing inflammation and pain in the joints.
Most cases of JRA are mild, but severe cases may result in complications, such as joint damage and chronic pain. Knowing the symptoms of JRA is important for getting treatment before the condition progresses. Treatment usually consists of controlling pain, improving function, and preventing joint damage. This can help make sure your child maintains an active, productive lifestyle.
The most common symptoms of JRA include:
- joint pain
- reduced range of motion
- warm and swollen joints
- redness in the affected area
- swollen lymph nodes
- recurrent fevers
JRA may affect one joint or multiple joints. In some cases, the condition can affect the entire body, causing a rash, fever, and swollen lymph nodes.
There are three types of JRA:
- pauciarticular JRA, which affects four or fewer joints
- polyarticular JRA, which affects five or more joints
- systemic onset JRA, which affects both the joints and internal organs
The more joints that are affected, the more severe the disease.
Your child’s doctor may be able to diagnose JRA by performing a thorough physical exam and taking a detailed medical history. They may also order various diagnostic tests, such as:
- C-reactive protein test: This test measures the amount of C-reactive protein (CRP) in the blood. CRP is a substance produced by the liver in response to inflammation.
- Rheumatoid factor: This test detects the presence of rheumatoid factor, which is a protein produced by the immune system. Rheumatoid factor can attack healthy tissues in the body, so the presence of this protein indicates an autoimmune disease, such as arthritis.
- Anti-nuclear antibody: Like rheumatoid factor, an anti-nuclear antibody is a protein created by the immune system in people with an autoimmune disease. An anti-nuclear antibody test can show whether the protein is present in the blood.
- X-rays or MRI scan: These imaging tests can be used to rule out other conditions that may be causing joint inflammation or pain, such as infections and fractures.
There are various treatments that can effectively manage and minimize the effects of JRA. Doctors usually recommend a combination of treatments to relieve pain and swelling and to maintain movement and strength.
Nonsteroidal anti-inflammatory drugs, such as ibuprofen and naproxen, are often used to reduce inflammation and swelling. Stronger painkillers may also be prescribed if over-the-counter medications aren’t effective. Aspirin might be recommended, but this is rare because the medication may cause adverse side effects in children. Never give your child aspirin without a doctor’s consent.
Other prescription medications known as biological agents might also be used to help decrease inflammation and joint damage. These include abatacept, rituximab, and anakinra. Such medications can ease symptoms by suppressing the immune system. However, they generally take several months to work and are only prescribed for a short period of time due to potentially adverse side effects. In some cases, a dug called methotrexate is used to suppress joint inflammation in children with JRA.
In severe cases of JRA, surgery may be used to replace the joints altogether. Fluids might also be extracted from your tissues to reduce inflammation.
Exercising and maintaining a healthful diet are important for everyone, but they are especially beneficial for children who have JRA. Having your child make the following lifestyle adjustments can help them cope with their symptoms more easily and reduce the risk of complications:
Weight changes are common in children with JRA. Medications may increase or decrease their appetite, causing rapid weight gain or weight loss. In such cases, a healthful diet containing the right amount of calories can help your child maintain an appropriate body weight. Speak with a doctor about a meal plan if your child is gaining or losing too much weight as a result of JRA.
Exercising at least three time per week can strengthen muscles and improve joint flexibility, making it easier to cope with JRA in the long run. Low-impact exercises, such as swimming and walking, are usually best. However, it’s a good idea to speak with a doctor before your child begins a new workout routine.
A physical therapist can teach your child the importance of sticking with an exercise routine and can even recommend exercises suited to their specific condition. The therapist may suggest certain exercises that can help build strength and restore flexibility in stiff, sore joints.
Untreated JRA can lead to further complications. These include:
- long-term recurring pain
- joint destruction
- stunted growth
- uneven limbs
- changes in vision
- swelling around the heart
The outlook for children with mild to moderate JRA can usually recover without complications. However, JRA is a long-term condition that tends to cause occasional flare-ups. Your child can expect to have stiffness and pain in the joints during these outbreaks.
Unfortunately, once JRA becomes more advanced, the chances of going into remission are much lower. This is why early diagnosis and treatment are critical. Prompt treatment can prevent arthritis from becoming more severe and spreading to other joints.