Juvenile Rheumatoid Arthritis (JRA) is a type of arthritis that occurs in children ranging in age from six months to 16 and causes joint swelling, stiffness and sometimes reduced motion. JRA can affect any joint and in some cases, internal organs. The cause of JRA is not known and some researchers identify it as an autoimmune disorder, meaning the child’s immune system attacks their body’s own tissues. Their white blood cells are unable to determine between their own healthy cells and harmful bacteria and viruses, and releases chemicals that can hurt healthy tissues causing inflammation and pain.
There are three types of JRA:
Oligoarticular JRA: This type of JRA affects four or less joints including the eye. An inflammation of the iris, the colored part of the eye can occur and is called iridocyclitis or unetis and can be detected by an ophthalmologist.
Polyarticular JRA: This type is more prevalent in girls and the small joints of the hands are affected as well as weight-bearing joints such as ankles, feet, hips, knees and the neck.
Systemic JRA: This type of JRA can affect the entire body which is affected by swelling, pain and stiffness.
Symptoms of JRA
JRA’s initial symptoms can be mild or severe, and may include:
- Limping
- A sore finger, knee or wrist
- Joints may unexpectedly swell and remain swollen
- Stiffness in the neck, hips or other joints
- Sudden rashes
- High fevers that spike in the evenings and suddenly disappear
Diagnosing JRA
Your doctor will conduct a detailed medical history of your child and perform a thorough physical examination, and may order additional tests to rule out conditions other than JRA that have like symptoms.
Some tests used to diagnosing JRA are:
CBC: This is a complete blood test where all blood components including red and white blood cells and platelets, the smallest of the blood cells and their role is to prevent bleeding. Any abnormalities in the cell numbers or in the cell’s appearance are helpful in diagnosing JRA.
Blood Culture: This test detects any bacteria that could cause infections in the bloodstream, and is used to rule out infections.
Bone Marrow Examination: This test allows health care providers to see where the blood is formed, in the bone marrow.
Erythrocyte Sedimentation Rate: This test checks how quickly red blood cells settle on the bottom of a test tube which is generally increased when inflammation is present.
Rheumatoid Factor: Usually found in adults, this test can find an antibody in children with some types of JRA.
Antinuclear Antibody: This is a blood test to detect autoimmunity, and is helpful when diagnosing children who may contract an eye disease with JRA.
Bone Scan: A bone scan can be done to determine any changes in bone or joints that may be responsible for a child’s bone and joint pain.
Treatment for JRA
The goals of treatment for children diagnosed with JRA are to relieve pain and inflammation, slow down or prevent further joint damage and restore joint function and use to promote growth and physical activity.
Your child’s treatment plan will vary and be specific to their needs. Some of the treatments may include:
Medications: To reduce inflammation and pain, your child’s doctor may prescribe nonsteriodal anti-inflammatory (NSAIDs) drugs such as Advil or Motrin that contain ibuprofen. Varying doses may be needed, depending upon your child’s response to the medication.
Physical Therapy: As part of your child’s treatment, their doctor may prescribe physical therapy. The physical therapist may recommend exercises suited to your child’s specific condition. Some of the types of exercises may help strengthen their range of motion, restore joint flexibility and other exercises to build strength and endurance.
Regular Exercise: Your child’s doctor along with their physical therapist may recommend regular exercise as part of their JRA treatment. Maintaining an exercise program such bicycling, swimming and walking are safe and effective ways to promote joint flexibility, strength and endurance.