The following describes the symptoms, diagnosis and treatment of juvenile rheumatoid arthritis. For specific information regarding your health and treatment options, please contact your Hurley physician or medical professional.

What is juvenile rheumatoid arthritis?

Juvenile rheumatoid arthritis (JRA) is a form of arthritis in children ages 16 or younger that causes inflammation and stiffness of joints for more than six weeks. Unlike adult rheumatoid arthritis, which is chronic and lasts a lifetime, children often outgrow juvenile rheumatoid arthritis. However, the disease can affect bone development in a growing child. JRA can be classified into categories based on three variables: 1) the number of and which joints are involved, 2) the symptoms present and their duration, and 3) the presence of specific antibodies produced by the immune system. These three variables often help physicians determine the progression and form of JRA:

• Pauciarticular. This form of JRA affects about 50 percent of children with this disease, involving four joints or fewer. Large joints, such as the knees, ankles or elbows are typically affected. This type of disease most often affects girls younger than age seven, and boys older than age eight.
• Polyarticular. Nearly 30 percent of children with JRA are affected by this type of the disease, which affects five or more joints. Polyarticular disease is more serious and tends to affect the small joints, such as the hands and feet, and often on both sides of the body. This type of JRA affects girls more often than boys.
• Systemic.Systemic onset JRA (also called Still's disease) is the most serious but least common form of the disease. It affects one or more joints and causes inflammation of internal organs, including the heart, liver, spleen, and lymph nodes. Boys and girls are equally likely to have systemic JRA.

What causes juvenile rheumatoid arthritis?

Like adult rheumatoid arthritis, JRA is an autoimmune disease, which means the body's immune system attacks its own healthy cells and tissues. Factors which can cause JRA often include both genetic and environmental influences, where a combination of genes from both parents, in addition to unknown environmental factors, produce the trait or condition. Often one gender (either males or females) is affected more frequently than the other in such conditions. Several family members may also be affected because they are partly caused by genes.

What are the symptoms of juvenile rheumatoid arthritis?

Symptoms of JRA may appear during episodes (flare-ups) or may be chronic and continuous, including:

• Swollen, stiff and painful joints, especially in the morning or after a nap
• High fever and rash, if systemic juvenile rheumatoid arthritis
• Swollen lymph nodes, if systemic juvenile rheumatoid arthritis
• Eye inflammation
• Warmth and redness in a joint
• Decreased use of one or more particular joints
• Fatigue
• Decreased appetite, poor weight gain and slow growth

How is juvenile rheumatoid arthritis diagnosed?

In addition to a complete medical history and physical examination, your child's physician will obtain a complete prenatal and birth history of your child and ask if your child has had any recent colds or other infections. Currently, there is no diagnostic test that can tell without a doubt that a child has JRA. Diagnosis of JRA is usually confirmed based on the presence of the following:

• Reported symptoms. Joint inflammation usually must be present for at least six weeks, continuously.
• Laboratory tests. Laboratory tests, such as certain blood tests, can help rule out other conditions and help determine the type of juvenile rheumatoid arthritis present.
• Imaging tests. These can help identify the extent of damage to the bones and may include the following:
  •  X-ray, a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs
  • Computed tomography scan (also called a CT or CAT scan), a diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays
  • Magnetic resonance imaging (MRI), a diagnostic procedure that uses a combination of large magnets, radiofrequencies and a computer to produce detailed images of organs and structures within the body
  • Bone scan, a nuclear radiology study of the bones

How is juvenile rheumatoid arthritis treated?

The goal of treatment for juvenile rheumatoid arthritis is to maintain a normal activity level for your child. Specific treatment for juvenile rheumatoid arthritis will be determined by your child's Hurley physician based on:

• Your child's overall health and medical history
• Extent of the condition
• Your child's tolerance for specific medications, procedures and therapies
• Expectations for the course of the disease
• Your opinions or preferences

Treatment may include:

• Nonsteroidal anti-inflammatory medications, NSAIDs, to relieve symptoms
• Disease-modifying anti-rheumatic medications such as methotrexate, to slow the progress of the disease
• Corticosteroids, to reduce inflammation and control severe symptoms
• Physical therapy, to improve and maintain muscle and joint function
• Occupational therapy, to improve ability to perform activities of daily living
• Assessment of nutritional status by a nutritionist and, if necessary, ongoing nutritional guidance, to ensure adequate nutritional intake for your child whose appetite may be adversely affected by the disease process itself or some medications used for treatment
• Regular eye exams, to detect early changes of eye inflammations
• Patient education, to help decrease the frequency and severity of flare-ups and prevent complications, including educational topics such as exercise, weight control, getting adequate rest, and how to use large joints rather than small joints to move or carry things

A warning about aspirin and the risk of Reye Syndrome in children

Do not give aspirin to a child without first contacting the child's physician. Aspirin when given as treatment for children has been associated with Reye syndrome, a potentially serious or deadly disorder in children. Therefore, pediatricians and other healthcare providers recommend that aspirin (or any medication that contains aspirin) not be used to treat any viral illnesses in children.

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