JRA is the most common type of childhood arthritis. The illness commonly strikes children between the ages of two and four years. For unknown reasons, JRA is more common in girls than in boys.
Although its main manifestations are joint swelling, pain and stiffness, JRA can affect other organ systems, including the lungs and heart, and it typically produces wide-ranging symptoms such as fever, fatigue and loss of appetite. The most severe forms of the disease can cause permanent joint damage.
JRA occurs in three distinct subtypes that follow different courses over the first six months of illness. All the subtypes have the characteristic pattern in which symptoms periodically flare up and subside over several months or even years. (There are exceptions to this pattern. Some children have continuous, low-grade symptoms for a long period; others have one episode and then go into permanent remission.) By late adolescence or early childhood, 75 percent of JRA patients are in permanent remission.
WHAT CAUSES JRA?
Many experts believe that the underlying mechanism is an autoimmune reaction, which occurs when the immune system mistakenly attacks normal body tissue. In this case, the joints are the primary targets, but other tissues can be involved as well.
WHEN SHOULD I SUSPECT JRA?
Symptoms that resemble an infection usually develop first. Fever (which can climb to 103 degrees Fahrenheit or higher, especially at night), a red rash on the chest and thighs, and swollen lymph nodes are common. Signs of joint involvement, such as stiffness (especially in the morning), limping and pain, also typically develop. One or more joints may be red, swollen and warm to the touch.
IS MEDICAL ATTENTION NECESSARY?
Yes. To confirm the presence of JRA, your pediatrician will take the child's complete medical history, perform a physical examination, and draw blood for a series of tests. It is important to rule out infectious forms of arthritis such as Lyme disease), which can be cured with antibiotic therapy. If a diagnosis of JRA seems likely, the child may be referred to a pediatric rheumatologist for further testing, such as X rays and a sampling of fluid from the affected joints.
WHAT TREATMENTS ARE AVAILABLE?
Based on the type and severity of the child's illness, the doctor may prescribe one or more of the following treatments:
• Asprin reduces inflammation and controls fever and pain. High doses are given several times a day. Close monitoring is required to observe possible side effects and toxicity. No medication other than aspirin may be needed, at least on a long-term basis.
• Other drugs that are similar to asprin. If symptoms persist or aspirin toxicity develops, a switch from aspirin to such alternatives as ibuprofen or naproxen may be needed.
• Steroid injections into the joints eliminate pain without the dangers of injected or oral corticosteroids. This technique is suggested if only one or two joints are affected and aspirin or aspirinlike drugs are inadequate.
• Oral or injected steroids immunosupressive drugs (similar to drugs given to prevent rejection of transplanted organs) are reserved for the most severe cases of JRA.
• More powerful antirheumatic drugs such as gold salts are used during bad flareups or when aspirin and similar drugs are inadequate.
CAN COMPLICATIONS OCCUR?
Yes, but if the child is monitored closely, they can ususally be managed. Children with JRA are susceptible to stomach pain, inflammation of the membrane surrounding the heart (pericarditis), inflammation of the membrane covering the lungs (pleuritisuveitis). JRA can also lead to anemia.
OTHER TREATMENTS
Physical and occupational therapy may be needed to maintain or increase the mobility of arthritic joints and promote independence in eating, dressing and similar activities. In addition, rest is an important component of JRA management.
Persuading the child to stick to a reasonable schedule of exercise and rest may be a challenge. Parents can offer special rewards for younger children who comply without a fuss. Older children can be told the benefits of following the schedule—namely, more energy and better functioning.
Informal physical activity is just as important as prescribed physical therapy. Children should play as normally as possible and participate in sports such as swimming and bicycling.
Like any other chronic illness, JRA places emotional demands on both the child and the family. Ask your pediatrician for a referral to a family therapist or social worker with experience helping children who have chronic and potentially disabling conditions.
GETTING HELP
Call your doctor if your child:
• Develops a limp, especially in the morning
• Complains of pain or seems reluctant to walk
• Develops symptoms of systemic illness, including high fever, fatigue and a rash
