Juvenile Rheumatoid Arthritis

Juvenile rheumatoid [roo-MUH-toid] arthritis, or JRA, is a type of autoimmune disorder, or autoinflammatory disease.

The immune system is supposed to protect the body from illness, infection, and disease. Sometimes the immune system makes a mistake and attacks the healthy cells of your child’s body instead of protecting them. When this happens, it is called an autoimmune disease (also called an autoimmune disorder). There are many types of autoimmune disorders, and certain types of JRA are considered to be one.

An autoinflammatory disease is a disease that causes inflammation to happen in the body for no reason. Usually inflammation happens in response opt an injury or trauma, but sometimes it can happen without any reason. When this happens, it is called an autoinflammatory disease. Some types of JRA are considered an autoinflammatory disease.

JRA is also known as juvenile idiopathic [id-ee-oh-PATH-ick] arthritis, and is the most common type of arthritis in children. JRA causes your child’s joints to swell, become stiff, and feel painful. Sometimes these symptoms can last for a short while, or they can last through the rest of your child’s life. Sometimes your child’s JRA can go into remission for a while, and then have symptoms return after some time.

Doctors don’t know what causes JRA. While there is no cure for it at this time, JIA is treatable with a plan that focuses on reducing the pain through therapy, orthotics, and medicine.

Sometimes, JIA can cause other complications with your child’s growth, or your child’s eyes. If your child’s doctor finds that your child has JIA, they will work with you to create a plan that helps watch for other problems that often happen with JIA.

There are six different types of JRA:

• Systemic [sis-TEM-ick] onset JRA, considered an auto-inflammatory disease, causes unexplained inflammation in one or more joints, as well a high fever and (often salmon-colored) rash. These symptoms may appear at the same time, or the fever may come first, with the rash and joint swelling following up to several months or years later. These symptoms usually last for at least two weeks. About 10% of children with JRA have this form.
• Oligoarticular [oh-li-go-ar-TICK-u-lar] JRA, considered an auto-immune disorder, causes arthritis in four or fewer joints. Usually the joints that get arthritis are the larger ones, such as the ankles, elbows, and knees. Children with this kind of JRA may also be at risk for chronic eye inflammation, and will need to have their eyes regularly checked. About half of the children that have arthritis have this type of arthritis. Girls are also more likely to get this type of arthritis than boys.
• Polyarticular [paul-EE-ar-tick-u-lar] JRA, considered an auto-immune disorder, causes arthritis and inflammation in five or more joints. Usually this type of arthritis affects the smaller joints, like those found in the jaw, hands, or fingers. Sometimes that larger joints can also be affected, but it is less common with this type of JRA. This type of JRA affects about 25% of the children that have arthritis.
• Juvenile psoriatic [sore-ee-AT-ick] arthritis, considered an autoimmune disease, causes some sort of skin condition as well as arthritis symptoms. The psoriasis will often look like a scaly red rash, and usually affects the elbows, knees, eyelids, scalp line, belly button, or behind the ears. Along with the rash, there will also be the symptoms of arthritis, which are joint pain and swelling. The rash may or may not happen at the same time as the arthritis symptoms.
• Enthesitis-related [en-the-SIE-tis] JRA, considered an autoimmune disorder, causes pain or tenderness where the bone meets the connective tissues, such as ligaments or tendons. This type of JRA may also cause pain in the spine. It still has the regular symptoms of arthritis, which include joint pain and swelling. This type of JRA may also cause swelling in other parts of the body besides the joints.
• Undifferentiated arthritis, which can be either an autoimmune disorder and/or an auto-inflammatory disease, is a type of JRA that does not fall into one of the main arthritis categories, and may show characteristics of several different types of JRA.

Symptoms must last for longer than six weeks, and must start before your child turns 16 in order for your child’s condition to be considered JIA.

Signs and symptoms of an autoimmune disease vary, but usually include:

• Muscle aches
• Fatigue (feeling very tired)
• A fever
• Stiffness
• Inflammation / swelling
• Joints that are warm to the touch
• Tenderness
• Rash
• Swollen lymph nodes
• Pain (usually after periods of little to no movement, like sleep)
• Difficulty bending or straightening the joints
• Sleep problems
• Reduced appetite or weight loss

Once your child is diagnosed with JIA, you can treat the symptoms, but the disease doesn’t ever go away. There may be times it flares up and gets worse, and other times when it goes into remission (re-MISH-uhn), a period when the symptoms seem to get better or disappear.

You should take your child to see the doctor if they have any of the symptoms of JIA that have lasted for longer than a few weeks, or show up without any reason. If your doctor can diagnose JIA early, there is more time to develop a treatment plan that will help your child feel better.

Doctors don’t know what causes JIA. There is no evidence that certain foods or activities cause JIA. Some studies have shown possible genetic (inherited) causes for JIA, but these genetic markers cannot determine who will or will not get arthritis.

Autoimmune diseases like JIA can be difficult to diagnose because the symptoms are different from person to person and can be caused by many other conditions.

The sooner you and your child’s doctor diagnose your child’s condition, the better. It is important to catch and diagnose JRA as early as possible so that you and your child’s doctor can work together to prevent damage to your child’s joints.

Your doctor may use the following things to help diagnose JRA:

• Your child’s medical history, including when the symptoms started and how serious they have been
• Your family history
• Physical exam, where your doctor will check your child’s joints for range of motion and swelling
• Lab tests, such as blood work, or other fluid tests
• Imaging tests, such as x-rays or CT scans

If your doctor thinks your child may have JIA, they might refer your child to a doctor that specializes in JIA, called a pediatric rheumatologist [roo-muh-TOL-oh-jist], for a final diagnosis and follow-up.

Although there is no way to cure JRA, you can treat the symptoms, and your child’s condition may go into remission, meaning that their symptoms get better or disappear. Once your child’s disorder is diagnosed, your child’s doctor can help you manage any pain or inflammation that your child may have. Treatments vary depending on the disease, but doctors usually try to reduce inflammation and pain.

Some of the treatments for JRA include:

• Medication
• Surgery
• Physical therapy
• Splints, braces, or orthotics

Your child may also need to regularly see an eye doctor and/or dentist to make sure that their eyes and teeth are not damaged by JRA. Talk to your doctor about how likely other complications may be, and ask how often you may need to see other doctors. Make sure to ask any questions you may have.

Because doctors don’t know what causes JIA, there is no known way of preventing it. However, the right treatment plan can reduce your child’s symptoms and improve their quality of life.

Juvenile rheumatoid arthritis, or JRA, is the most common type of arthritis in children. It is also called juvenile idiopathic arthritis (JIA). JRA causes your child’s joints to swell, become stiff, and feel painful. Sometimes these symptoms can last for a short while, or they can last through the rest of your child’s life.