Arthritis, juvenile rheumatoid

It is estimated that nearly 1 in every 1000 children develops juvenile rheumatoid arthritis (JRA). In children, rheumatoid arthritis is treatable. Life with arthritis is challenging, especially in children. But, with proper care and treatment, the children with arthritis can lead an active life. Juvenile rheumatoid arthritis is also known as juvenile idiopathic arthritis (JIA).

Juvenile idiopathic arthritis is the inflammation of the one or more joints persisting for at least six weeks in the children under the age of 16 years. JIA is most commonly seen in girls. And, the researchers believe that the genetic propensity of juvenile arthritis in children is same as in adults.

Anatomy of joints

Joints or articulations are the areas where two bones connect. Joints can be mobile or immobile. But, most of your joints are movable. Joints consist of the following:

Cartilage: The cartilage is a type of tissue that covers the bone surface at the joint. It protects the joint by reducing the friction.
Synovial membrane: The synovial membrane lines your joint and secures it into a joint capsule. It helps by secreting the synovial fluid that lubricates the joint allowing the free movement.
Ligaments: The ligaments are tough, elastic bands that surround the joint. It provides support and limits the movement of the joint.
Tendons: The tendons present on each side of the joint attach to the adjoining muscles and controls the movement of the joint.

Causes of JRA

The actual cause of JRA is unclear. While, the research says that it might be an autoimmune disorder. In the autoimmune disease, the immune system is unable to differentiate between the healthy and pathogenic cells. So, the immune system attacks the healthy cells.

In juvenile rheumatoid arthritis, the immune system releases the chemicals that affect the healthy tissues in your body that leads to inflammation and pain in the joints. The incidence of JRA is increased by certain gene mutations which make you more susceptible to the environmental factors such as viruses.

Types of JRA

There are three types of JRA that include:

Pauciarticular JRA: The pauciarticular arthritis affects five or fewer smaller joints of wrists and knees. If this type of JRA occurs in the children over the age of 7, then it is most likely to spread the disease to other joints.
Polyarticular JRA: The polyarticular JRA affects five or more joints irrespective of the size of the joints.
Systemic onset JRA: The systemic onset JRA is the rare type of JRA. It affects only about 10 percent of people with arthritis. It involves sudden onset of high fever with persistent rashes.

Symptoms

The symptoms of JRA include:

Persistent and severe joint pain
High recurrent fever
Swollen, red, or warm joints
Stiffness in the joints
Rashes appear with fever
Low back pain
Limited movement of the joints
Limping

Complications

If juvenile arthritis is left untreated, it may lead to severe complications. These include the following:

Eye inflammation (Uveitis)
Anemia
Stunted growth
Joint destruction
Asymmetrical limbs
Swelling around the heart
Long-term recurring pain

Diagnosis

Your doctor diagnoses JRA in your child by taking a medical history and performing a physical examination. Your doctor may also suggest certain diagnostic tests which include:

Erythrocyte sedimentation rate (ESR): An elevated ESR indicates inflammation. This test is performed to rule out other conditions and assess the degree of inflammation.
C-reactive protein (CRP) test: In the body, the C-reactive protein is released by the liver in response to inflammation. Therefore CRP test is ordered to assess the inflammation.
Rheumatoid factor: The rheumatoid factor is the antibody which is usually present in the children with rheumatoid arthritis.
Anti-nuclear antibody: Anti-nuclear antibody is produced by the immune system in the children with the autoimmune disorder.
X-rays and Magnetic resonance imaging (MRI): The X-rays and MRI scans are suggested to rule out other conditions such as infections and fractures.

Treatment

Your doctor may recommend certain medications to relieve pain and progression of the disease. Juvenile rheumatoid arthritis treatment includes:

Nonsteroidal anti-inflammatory drugs (NSAIDs): The NSAIDs such as ibuprofen and naproxen are prescribed to reduce pain, inflammation, and swelling.
Disease-modifying antirheumatic drugs (DMARDs) : If the NSAIDs fail to relieve the symptoms, then your doctor may recommend DMARDs such as methotrexate and sulfasalazine. These drugs are used to decrease the progression of the disease.
Tumor necrosis factor (TNF) blocker: The TNF blockers such as etanercept and adalimumab are given to reduce the pain, swelling, and morning stiffness.
Corticosteroids : The corticosteroids such as prednisolone control the progression of the symptoms and prevent serious complications. But, corticosteroids may increase the risk of infections and interfere with the normal growth. So, these drugs should be used for a short duration.

Your doctor may also recommend physical therapy and occupational therapy for your child. In severe conditions, surgery may be required for the treatment of juvenile arthritis, to improve the movement at the joints.

Self-management

Performing physical activities and eating healthy foods may benefit the children with JRA. The doctor may recommend certain tips to manage JRA that include the following:

Exercising regularly:Performing physical activity thrice weekly may strengthen your muscles and improve joint flexibility. Low-impact exercises such as walking and swimming may be beneficial.
Applying cold or heat:Doing hot water bath or applying heat or cold to the affected joints may relieve morning stiffness.
Eating healthy food:In the children with Juvenile rheumatoid, weight changes are common. Therefore, a healthy diet may help to maintain normal body weight.