Juvenile Rheumatoid Arthritis


Juvenile rheumatoid arthritis is the most common form of arthritis affecting children. Arthritis can be short-term, lasting just a few weeks or months and then disappearing - or it may be chronic and last for months, years or even a lifetime. The term “Juvenile rheumatoid arthritis” (JRA) describes a heterogeneous group of chronic inflammatory arthritides, that begin in childhood and are quite distinct from adult rheumatoid arthritis.

JRA is an autoimmune disorder, which means that the body mistakenly identifies some of its own cells and tissues as foreign. The immune system, which normally helps to fight off harmful, foreign substances such as bacteria or viruses, begins to attack healthy cells and tissues. The result is inflammation - marked by redness, heat, pain, and swelling.

Juvenile rheumatoid arthritis (JRA) often referred as juvenile idiopathic arthritis (JIA) is a type of arthritis that causes joint inflammation and stiffness.

Types of Juvenile idiopathic arthritis (JIA)-

  • Pauciarticular juvenile rheumatoid arthritis: Affects four or fewer joints. It most commonly affects the knee and wrist joints. An inflammation of the iris (the colored area of the eye) may occur with or without active joint symptoms. This inflammation, called iridocyclitis, iritis or uveitis, can be detected early by an ophthalmologist.
  •  Polyarticular arthritis: Involves pain or swelling in five or more joints. This type of juvenile rheumatoid arthritis affects more girls than boys. It affects small joints such as those in the hands as well as weight-bearing joints such as the knees, hips, ankles, feet, and neck.
  • Systemic juvenile rheumatoid arthritis: Affects the whole body. This will cause a child to have the most and most severe symptoms. The spleen and lymph nodes may also become enlarged. Eventually many of the body's joints are affected by swelling, pain, and stiffness.

 Signs and symptoms: Symptoms may come and go over time. There may be times when symptoms get worse, known as flares, and times when symptoms get better, known as remission.

  • High fevers that tend to spike in the evening and then suddenly disappear
  • Fever that comes and goes
  • Less appetite
  • Weight loss
  • Anemia
  • Blotchy rash on a child's arms and legs
  • Inflammation of the eye
  • Stiffness
  • Joint pain
  • Difficulty with daily living activities such as walking, dressing, and playing

Causes of Juvenile rheumatoid arthritis: The exact cause of Juvenile rheumatoid arthritis is unknown. In Juvenile rheumatoid arthritis the immune system may not work right which causes the inflammation in the joints and other body systems.

Diagnosis: Diagnosing JIA may be difficult. There is no single test to confirm the disease. JIA is based on symptoms of inflammation that have occurred for 6 weeks or more.

  • Antinuclear antibody (ANA) and other antibody tests: These tests measure blood levels of antibodies that are often seen in people with rheumatic disease.
  • Complete blood count (CBC): This test checks for low counts of red blood cells, white blood cells, and platelets.
  • X-rays. This test uses a small amount of radiation to make images of organs, bones, and other tissues.
  • CT scan. This uses a series of X-rays and a computer to make detailed images of bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays.
  • MRI. This test uses large magnets and a computer to make detailed pictures of organs and structures in the body.
  • Bone scan. This uses a small amount of radiation to highlight the bones in a scanner.

Treatment of JIA-

  • Non-steroidal anti-inflammatory drugs (NSAIDs): including ibuprofen, naproxen and other prescription drugs.
  • Disease-modifying anti-rheumatic medicines (DMARDs): such as methotrexate, to ease inflammation and control JIA.
  • Corticosteroids: Medications such as prednisone may be used to control symptoms until another medication takes effect. They are also used to treat inflammation when it is not in the joints, such as inflammation of the sac around the heart.
  • Biologic drugs: which are genetically engineered, may be used in children if other drugs don't work. Injectables include abatacept (Orencia), adalimumab (Humira), canakinumab (Ilaris), etanercept (Enbrel), and tocilizumab (Actemra).

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