Juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis is a common arthritic condition that has a rare prevalence in the US but is regarded as a chronic rheumatologic disease that reduces mobility in its patients. Read and know more about this condition, including its types, causes, symptoms, diagnosis, and treatment.

Juvenile rheumatoid arthritis Definition

It is the most common form of an arthritis occurring in young children. This is normally a long-lasting disorder that slowly impairs almost all the joints of the body and can damage them permanently. It is more often described as “inflammation of the joints” that can even affect other organs of the body. It is not a separate disorder and typically covers a group of joint ailments.

The condition is also called Juvenile idiopathic arthritis. It is sometimes abbreviated as JRA or JIA.

Juvenile rheumatoid arthritis Incidence

As aforementioned, this disorder occurs in children between the ages of 7 and 12. However, adolescents as old as 15 years of age can also encounter the symptoms of the condition. It appears to be more common in young females than males. The condition is common among all Caucasians. In the UK, around 10,000 to 15,000 children are affected by JRA.

Juvenile rheumatoid arthritis Types

The disorder can be classified into several types, such as:

Picture of Juvenile rheumatoid arthritis

Picture 1 – Juvenile rheumatoid arthritis

Oligoarticular JRA

It is the most common and mildest form of JRA, which affects 4 or less number of joints. The symptoms may begin as early as 6 months after the onset of the disorder. The term oligo refers to “few”. This form constitutes about 50% of the cases of JRA. The large joints that normally involve the knees, ankles and elbows are more affected than the smaller joints. It is asymmetrical; the inflammation occurs only on one side of the body instead of both sides.

Discrepancy in length is a common feature of the disorder where one of the legs or arms of the child is longer than the other. Individuals may even suffer from muscle atrophy – partial or complete loss, or wasting away of muscle. Both these conditions result in asymmetric growth as well as shortening of the muscles, which results in deformity. This particular type may also be manifested by a few ophthalmologic disorders such as Chronic iridocyclitis or eye inflammation. The form is sometimes referred to as Persistent oligoarthritis.

Polyarticular JRA

In this case, 5 or more joints undergo acute inflammation in the first 6 months of the disorder. Here, the neck and jaw are affected other than the small joints. It is found to be more common in females than males. Joints of the fingers and hands are the most affected ones. However, severe pain and discomfort may also be experienced in the larger joints such as those of the knees, ankles and hips. It is a symmetrical type of JRA that simultaneously affects the right and the left sides of the body. Just like in the first form, individuals affected with this type also suffer from ocular disorders. The distinguishing feature of this type is the presence of an antibody called rheumatoid factor that makes the condition even more severe.

Systemic JRA

It is not a very common subtype of JRA, but can be far more serious than the other two forms. Both males and females are equally affected. Symptoms like fever, pink rash and joint pain are unique to this form. The severity of this type is attributed to the involvement of both large and small joints. The symptoms are highly unstable with fever, occurring every day or twice a day for a short span of time along with rash. This makes the diagnosis quite difficult. The rashes are actually macules of varying sizes that are salmon-pink in appearance and migrate to various regions on the skin in less than one hour.

It is also known by other names, like:

  • Systemic onset juvenile rheumatoid arthritis
  • Adolescent-onset still’s disease

Enthesitis-related

It affects males below the age of 8 and affects those regions where the tendons and ligaments are attached, to the bones. The joints are rarely affected. Back pain is a common sign of the subtype and can be linked to ankylosing spondylitis and inflammatory bowel disease.

Psoriatic

The form occurs in young females suffering from Psoriasis – an autoimmune disorder of the skin marked by the presence of scaly patches. Joint tenderness and inflammation follows after a long bout of the cutaneous condition.

Juvenile rheumatoid arthritis Symptoms

The symptoms may vary from one individual to another. The condition may often fluctuate and may be either mild or severe. Affected patients may experience fatigue and weakness. The other symptoms include:

  • Muscle stiffness and warmth
  • Intense pain in the joints followed by acute swelling
  • Reduced movement and impairment of the joints
  • Lack of physical activity
  • Limp
  • Fever and chills
  • Respiratory infection
  • Joint deformity
  • Eye redness accompanied by acute pain and irritation
  • Skin rashes
  • Swelling of the lymph nodes
  • Decrease in body weight
  • Reduced growth

Juvenile rheumatoid arthritis Causes

JRA is an autoimmune condition in which the immune system of the body begins to attack and destroy its own cells and tissues for reasons unknown. An autoimmune response can be triggered by factors such as environmental changes or gene mutation caused by few viruses. Health experts believe that during an autoimmune attack there is an abnormal thickening and growth of the synovium-fluid-producing tissues that surrounds the joints. Then, this tissue expands outside of the joint and exerts pressure on the bones and cartilages of the joints as well as on the ligaments and tendons. This leads to permanent damage of the bones and muscles.

Some of the common possible factors for the development of JRA may include the following:

  • Rheumatoid arthritis is more common in females than males due to the presence of sex hormones like oestrogen and progesterone
  • Some individuals have an inherited genetic pattern that makes them more susceptible to JRA
  • Mental stress has been associated with the autoimmune condition, but it normally has no major influence on the development of the symptoms

Juvenile rheumatoid arthritis Diagnosis

A host of other disorders can also cause problems like joint pain, swelling and stiffness. Therefore, a single test may not provide any aid in the diagnosis process. Physicians initially acquire a detailed family medical history of patients and follow it up with a thorough physical examination. Unless all the required laboratory and imaging tests are done, detecting the exact cause of the continuous joint pain may remain unrecognized. Some of those tests include:

Complete blood cell count (CBC)

The amount of each type of blood cell in a sample of blood is measured for any kind of abnormality. Low levels of hemoglobin may indicate anemia that is sometimes related to JRA. The main aim of the test is to rule out the presence of bacterial or viral infections, causing similar effects.

Erythrocyte sedimentation rate (ESR)

The test is performed to measure the rate of sedimentation of the erythrocytes or RBCs. A small amount of blood is extracted from a patient and placed in a clean, dry and calibrated test tube. The time taken for the RBCs to settle down as sediments, leaving the blood serum above, is measured. Individuals with JRA show high sedimentation rate, owing to the inflammation of the joints that alters certain components on the RBCs.

Antinuclear Antibody (ANA) and Rheumatoid factor (RF) Test

ANA is often produced during an autoimmune response. It is estimated that 25% of children with JRA have been found with this antibody in the blood. Individuals with Oligoarticular form of JRA show positive ANA. RF test is normally positive in the case of polyarticular JRA and completely negative in patients with systemic JRA.

Arthrogram (Joint X-Ray)

The technique combines the use of X-rays and a contrast material to obtain a series of distinct images of the affected joints. The contrast agent in the form of water, dye or air is injected into the joint followed by an X-ray. The test also reveals detailed structure of the tendons, ligaments, cartilages and muscles.

Bone scan

It is a nuclear medicine technique where a small amount of radioactive material is infused into a vein that directly travels through the bloodstream. It later gets accumulated in the abnormal regions of the bones, which is detected by a scanner. The test helps in detecting any form of inflammation in the joints.

Magnetic Resonance Imaging (MRI)

Damaged joints can be easily monitored by using this imaging test. However, it is not a very reliable method to diagnose JRA.

Computated Tomography scan

A CT scanner is used to produce detailed images of the bones and joints in order to detect any sort of abnormality that may cause JRA.

Dual-energy X-ray absorptiometry (DEXA) scan

It is an important means of measuring bone material density (BMD) that is often less in patients with polyarticular JRA.

Synovial biopsy

In this test, a small amount of synovial tissue is removed from a joint using a probe and is further examined for any kind of damage.

Arthrocentesis

In this procedure, a sterile needle and syringe is used to collect synovial fluid from a joint. The fluid is examined to determine the exact cause of joint inflammation.

Juvenile rheumatoid arthritis Treatment

The major goal of the treatment is to relieve patients from pain and inflammation as well as to restore the function of the joints. This is done to promote physical activity and overall mental development of an affected individual. Pain management strategies, like acupuncture and massage, have also been implemented for better results. Some of the procedures followed include:

Medicine

Etanercept, Infliximab and Adalimumab are normally used to inhibit the inflammatory response triggered by Tumor necrosis factor (TNF). Antirheumatic drugs like Methotrexate, Azathioprine and Sulfasalazine are recommended in severe cases. In order to stabilize the joint inflammation and discomfort, affected patients are often administered with non-steroidal anti-inflammatory drugs like:

  • Celecoxib
  • Diclofenac (Cataflam, Voltaren)
  • Indomethacin (Indocin)
  • Tolmetin
  • Ibuprofen

Surgery

A few patients are seen to benefit greatly from steroid injections into the affected joint. The dysfunctional joint can also be replaced with an orthopedic prosthesis in a joint replacement surgery. However, the procedure is difficult in very young children and can only be performed after the bone has grown completely. The inflamed lining of a joint can be surgically removed by a technique called synovectomy.

Occupational therapy

A group of health care professionals comprising of an occupational therapist, rheumatologist, physical therapist, nurse and social care can help treat a patient by using a different approach. These professionals make an attempt to improve the quality of life of the affected patients. A host of adaptive and rehabilitative devices such as ambulatory devices or splints can help patients carry out with the routine activities.

Clothes, which come with easy openings and Velcro, may help the affected individuals in dressing up. A long handled reacher and a sock aid is recommended to patients having problem while bending. Some devices have been designed for JRA-affected patients that may assist them in maintaining cleanliness. Bath bench, electric toothbrush, long handled hairbrushes, razor handles, lightweight utensils, and tilted glasses are the other devices used by these patients. Individuals with JRA are also made to perform activities such as making crafts and participating in non-competitive sports to improve the joint movements.

Juvenile rheumatoid arthritis Home remedies

Although adopting self-care measures at home is not beneficial, certain steps can be followed to improve the condition like:

Exercises

Swimming and water aerobics are some safe form of activities that does not stress the joints. There are some routine physical activities that should be limited as it causes acute pain. Progressive muscle relaxation, deep breathing and meditation are a few techniques that can be followed by patients to handle the pain and discomfort.

Healthy diet

A balanced diet, comprising of vitamins and minerals, is highly essential for patients who are having a poor appetite.

Juvenile rheumatoid arthritis Complications

The possible health issues that a patient with JRA may suffer from include:

Image of Juvenile rheumatoid arthritis

Picture 2 – Juvenile rheumatoid arthritis Image

  • Liver inflammation
  • Inflammation of the arteries in the hands and/or feet
  • Pericarditis
  • Anemia
  • Uveitis
  • Joint contractures
  • Osteoporosis
  • Skeletal abnormalities

Juvenile rheumatoid arthritis Prognosis

JRA usually responds slowly to the various treatment procedures. However, availability of better medical facilities has been found to significantly improve the lives of sufferers. Affected patients with Pauciarticular JRA show progressive improvement and many of the symptoms actually disappear completely. The outcome of any form of treatment is highly dependent on timely diagnosis of the condition.

Juvenile rheumatoid arthritis Support Groups

Many support groups are available that are known to provide aid to the affected individuals. Patients are given motivation, inspiration and reassurance to cope with the condition. These groups also conduct counseling sessions for the family members of the affected ones. American Juvenile Arthritis Organization is a well-renowned support group that may work with patients to resolve the various challenges experienced by them.

Juvenile rheumatoid arthritis is a progressive disorder and its symptoms can get more severe with time. Regular exercise and physical fitness programs can help affected patients maintain a range of motion. Family members should also play a critical role and always encourage their affected loved ones to combat JRA.