Juvenile idiopathic arthritis (patient information)

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Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
Juvenile rheumatoid arthritis (JRA) is a term used to describe a common type of arthritis in children. It is a long-term (chronic) disease resulting in joint pain and swelling.

What are the symptoms of Goodpasture's Syndrome?
Arthritis symptoms: Body-wide JRA symptoms:
 * Joint stiffness when you wake up in the morning
 * Joint pain
 * Limited range of motion
 * Joints may be warm or swollen and sometimes red
 * A child may stop using an affected limb or may limp
 * Back pain
 * Fever, usually high fevers every day
 * Rash (trunk and extremities) that comes and goes with the fever
 * Swollen lymph nodes (glands)
 * JRA can also cause eye inflammation called uveitis. This problem can occur without any eye symptoms, or someone may have:
 * Red eyes
 * Eye pain
 * Increased pain when looking at light (photophobia)
 * Vision changes

What causes Goodpasture's syndrome?
The cause of JRA is not known. It is thought to be an autoimmune illness. In this type of condition, the body's immune system mistakenly attacks and destroys healthy body tissue.

It is divided into several categories:

Systemic JRA involves joint swelling or pain, fevers, and rash. It is the least common category. Polyarticular JRA involves many joints. This form of JRA may turn into rheumatoid arthritis. It may involve large and small joints of the legs and arms, as well as the TMJ and cervical spine. Pauciarticular JRA involves only a few joints, usually the hips, knees, or ankles. Many other medical problems can cause symptoms similar to those of juvenile rheumatoid arthritis, including:


 * Lyme disease
 * rheumatic fever
 * bone infections (osteomyelitis)
 * Sarcoidosis
 * psoriatic arthritis
 * vasculitis
 * Inflammatory bowel disease

Who is at highest risk?
JRA usually occurs before age 16.

When to seek urgent medical care?
Call for an appointment with your health care provider if:
 * You notice symptoms of juvenile rheumatoid arthritis
 * Symptoms get worse or do not improve with treatment
 * New symptoms develop

Diagnosis
The physical examination may show swollen, warm, and tender joints that hurt to move. The child may have a rash. Other signs include: Blood tests may include: Any or all of these blood tests may be normal in patients with JRA.
 * Enlarged liver
 * Enlarged spleen
 * Swollen lymph nodes
 * Rheumatoid factor (may be raised, but not in all patients)
 * Erythrocyte sedimentation rate (ESR)
 * ANA (may be high)
 * Complete blood count (CBC)
 * HLA antigens for HLA B27

The doctor may need to tap a joint. This means putting a small needle into a joint that is swollen. This can help to find the cause of the arthritis. By removing fluid, the joint may feel better, too. Sometimes, the doctor will inject steroids into the joint to help decrease the swelling.

Other tests: Eye exam by an ophthalmologist (should be done on a regular basis, even if there are no eye symptoms)
 * X-ray of a joint
 * X-ray of the chest
 * ECG

Treatment options
When only a small number of joints are involved, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be enough to control symptoms.

Corticosteroids may be used for more severe flare-ups to help control symptoms.

Children who have arthritis in many joints, or who have fever, rash, and swollen glands may need other medicines. These medicines are called disease-modifying antirheumatic drugs (DMARDs). They can decrease or prevent swelling or inflammation in the body. DMARDs include:

It is important for children with JRA to stay active and keep their muscles strong. Walking, bicycling, and swimming may be good activities. Children should learn to warm up before exercising.
 * Methotrexate is often the first drug used.
 * Biologic drugs, such as such as etanercept, infliximab, and related drugs block high levels of proteins that cause inflammation.

Support and help for children who experience sadness or anger about their arthritis is also very important.

Some children with JRA may need surgery, including joint replacement.

Where to find medical care for Juvenile idiopathic arthritis?
Directions to Hospitals Treating Juvenile idiopathic arthritis

What to expect (Outlook/Prognosis)?
JRA is seldom life threatening.

Children who have many joints involved, or who have a positive rheumatoid factor are more likely to have chronic pain and poor school attendance, and to be disabled.

Long periods with no symptoms are more common in those who have only a small number of joints involved. Many patients with JRA eventually go into remission with very little loss of function and deformity.

Possible complications

 * Wearing away or destruction of joints (can occur in patients with more severe JRA)
 * Slow rate of growth
 * Uneven growth of an arm or leg
 * Loss of vision or decreased vision from chronic uveitis (this problem may be severe, even when the arthritis is not very severe)
 * Anemia
 * Swelling around the heart (pericarditis)
 * Chronic pain, poor school attendance

Prevention
There is no known prevention for JRA.