Juvenile Rheumatoid Arthritis: Joint Pain in Children

Juvenile rheumatoid arthritis (JRA) is very similar to adult rheumatoid arthritis: Both are chronic conditions that cause joint inflammation and joint pain. Juvenile rheumatoid arthritis affects children 16 years of age or younger.

Juvenile rheumatoid arthritis causes symptoms in the joints such as:

• redness
• soreness
• swelling
• warmth.

Statistics on Children and Arthritis

Here are some statistics for JRA in America:

• In the United States, over 300,000 children have some form of arthritis.
• Approximately 75,000 children have some form of juvenile rheumatoid arthritis.
• Juvenile rheumatoid arthritis is more common in Caucasian children than in African-American and Asian-American children.

JRA vs. Adult Rheumatoid Arthritis

Children suffering from juvenile rheumatoid arthritis often outgrow the condition. The joint inflammation and pain is normally not permanent and symptoms gradually disappear as the child gets older. For adults with rheumatoid arthritis, this isn't the case; the condition is almost always permanent.

The other major difference between juvenile rheumatoid arthritis and adult rheumatoid arthritis is the presence of rheumatoid factor in the blood. Rheumatoid factor is an antibody that attaches to a substance in the body to trigger inflammation. Most children with juvenile rheumatoid arthritis don't have rheumatoid factor in the blood, while 70 percent to 80 percent of adults with rheumatoid arthritis have rheumatoid factor present in the blood.

Causes of Juvenile Rheumatoid Arthritis

The exact cause of juvenile rheumatoid arthritis is unknown, but researchers have discovered that it is an autoimmune disease, a condition in which the immune system is no longer able to correctly identify self from non-self.

Unable to distinguish healthy cells in the body from harmful viruses and bacteria, the immune system begins to indiscriminately attack various cells in the body, leading to inflammation of joints and other parts of the body. The exact reason for this malfunction in the immune system has not yet been discovered, but scientists suspect that something such as a viral infection may trigger the misdirected immune response.

The Types of Juvenile Rheumatoid Arthritis

Juvenile rheumatoid arthritis is divided into three different groups based on the number of joints involved, the symptoms and the presence of certain blood proteins. The three main categories of JRA are:

• Pauciarticular JRA: Pauciarticular JRA is the most common type of juvenile rheumatoid arthritis and affects fewer than five joints. Pauciarticular JRA most often affects the larger joints. Girls under the age of eight and boys over the age of eight are at greatest risk of developing this condition.Some 20 percent to 30 percent of children with pauciarticular JRA develop eye inflammation and have antinuclear antibodies in their blood. Other children with pauciarticular JRA, in particular boys over the age of eight, may have the genetic factor HLA-B27, an inherited gene marker that is associated with a number of rheumatic diseases.

• Polyarticular JRA: Polyarticular JRA affects five or more joints. The smaller joints are most often affected, though larger joints may also be affected. Polyarticular JRA is also symmetrical, meaning that it affects the same joints on both sides of the body, such as both knees, both wrists or both elbows. Some children with polyarticular JRA may have rheumatoid factor in their blood.

• Systemic JRA: Also known as Still's disease, systemic JRA is the least common form of juvenile rheumatoid arthritis. Systemic JRA affects various joints and internal organs in the body.

Symptoms of Juvenile Rheumatoid Arthritis

The most common symptom of juvenile rheumatoid arthritis is swelling and pain in the joints. The knees, hands and feet are the most commonly affected joints.

Your child may be reluctant to complain of joint pain, so you should observe her closely if you suspect she may have juvenile rheumatoid arthritis. Look for any swelling and observe the child's movements, especially in the morning immediately after she gets out of bed. Many children with juvenile rheumatoid arthritis have a limp as a result of an inflamed knee.

Some children with juvenile rheumatoid arthritis develop a skin rash and fever. These symptoms may be more difficult to observe, as they have a tendency to appear and disappear very quickly.

Other symptoms of juvenile rheumatoid arthritis include joint deformation, swollen lymph nodes and eye irritation.

Treating Juvenile Rheumatoid Arthritis

Juvenile rheumatoid arthritis is treated with a combination of:

• Exercise: Movement may result in pain, but exercise is an important part of the treatment process. Exercise strengthens muscles, bones and joints and may help fight the arthritis. Regular exercise or a customized exercise program is particularly important.

• Medications: Medication is often given to relieve joint inflammation and pain. Many different medications are available for juvenile rheumatoid arthritis. Some of the more commonly used medications include:
  • biologic agents
  • corticosteroids
  • disease-modifying anti-rheumatic drugs (DMARDs)
  • non-steroidal anti-inflammatory drugs (NSAIDs).

  Medication alone is almost never enough to treat juvenile rheumatoid arthritis. While some medications have been shown to slow the progression of the disease, many serve simply to relieve pain.

• Physical Therapy: Physical therapy is often recommended to restore range of motion and flexibility. Physical therapy is often combined with medications in order to manage the condition. In more serious cases, or in cases where deformities or joint damage has occurred, surgery may be necessary to relieve pain and other symptoms.

Living with Juvenile Rheumatoid Arthritis

Children are already under a lot of stress: They're learning the basics of life and adapting to the social structure of school. The pain of juvenile rheumatoid arthritis may add to the stress.

Treat your child as normally as possible. Let her know that having juvenile rheumatoid arthritis isn't her fault. Encourage your child to play, have fun, exercise, go to school, make friends and learn.

Work closely with your child's doctor, and join a support group if you feel it will help, but, most importantly, let your child participate in normal childhood activities, within reason. Treating your child like an invalid won't help and may delay her progress in the long run.

Resources

eMedicine.com, Inc. (updated 2005). Juvenile rheumatoid arthritis. Retrieved August 31, 2007, from the eMedicine.com Web site: http://www.emedicinehealth.com/juvenile_rheumatoid_arthritis/article_em.htm.

MedicineNet (2007). Juvenile Rheumatoid Arthritis. Retrieved August 31, 2007, from the MedicineNet Web site: http://www.medicinenet.com/juvenile_arthritis/article.htm.

Nemours Foundation (2005). Juvenile rheumatoid arthritis. Retrieved August 31, 2007, from the Nemours Foundation Web site: http://www.kidshealth.org/parent/medical/arthritis/jra.html.