Juvenile Rheumatoid Arthritis

What is juvenile rheumatoid arthritis and what causes it? How is juvenile rheumatoid arthritis diagnosed and how is it treated? Will it "go away" or is it a lifetime disease?

Juvenile rheumatoid arthritis is an immune system disease. It is very much like rheumatoid arthritis but is classified as juvenile when it occurs in children under the age of 16. It is an immune system disease because for some unknown reason the body begins attacking itself as the immune system goes awry.

Why the body starts attacking itself is unknown, but it is generally thought that when a virus or other foreign agent enters the body of someone with a genetic predisposition the result is arthritis. In the case of children it is called juvenile rheumatoid arthritis or JRA.

There are 3 classes of JRA based on the number of joints being affected, the symptoms, and the presence or absence of certain antibodies in blood tests.

Polyarticular JRA is a disease of many joints usually affecting more than five joints and usually symmetrically. Most children with polyarticular JRA test negative for rheumatoid factor.

Pauciarticular JRA affects four or fewer joints and usually involves the elbows, wrists, ankles, or knees asymmetrically. Most children with pauciarticular JRA test positively for ANA (anti-nuclear antibodies).

The third and least common form of JRA is called systemic disease. It begins more like an illness with fever or a rash and can affect other organs besides the joints. These children will tend to be anemic and have a high white blood cell count.

Diagnosing juvenile rheumatoid arthritis is not a simple matter of blood tests although blood tests help to rule out other possible causes of the symptoms. Before JRA is considered the symptoms must have been present for at least six weeks. X-rays are also used to evaluate the condition of the affected joints and the doctor considers all the evidence together to determine a diagnosis.

For treatment of juvenile rheumatoid arthritis the best care can be found with pediatric rheumatologists. However, there are very few of these doctors and some areas of the country have none. In that case a good team including both a pediatrician and a rheumatologist working together will also provide excellent treatment for a child with JRA.

Treatment usually consists of training the child to maintain a relatively normal childhood while protecting the affected joint(s) from stress or further injury. In addition, medication to handle the pain and inflammation is often prescribed. Depending on the severity of the pain and how the child responds the same types of medications given to adults will be given to the child. These include analgesics, NSAIDS (non-steroidal anti-inflammatory drugs), and DMARDS (disease-modifying anti-rheumatic drugs). Due to the risks involved with side effects the least offensive drug that works will be prescribed.

For some children the diagnosis of JRA means a lifetime of dealing with arthritis. For many long periods of remission occur and often JRA improves or goes into remission at puberty.

Research continues to search for ways to help children with juvenile rheumatoid arthritis. Especially important for children is the research to find new medicines with fewer side effects. Researchers continue to look for the cause of JRA with hope that someday it can be prevented.