Juvenile Rheumatoid Arthritis

Juvenile rheumatoid arthritis (JRA) is one kind of autoimmune disease that parents may have to deal with for a lifetime.  Once the destruction sets in, its effects may be hard to reverse. This is because rheumatologists (specialists of joint disorders) are still not clear about its root cause; so definitive treatment is also difficult to establish.

Despite the glum prognosis of this condition, it could be effectively managed to minimize its impact on the patient.  As with any condition, accurate diagnosis is critical so that timely intervention can be applied.  However, JRA is quite hard to pin down, because its symptoms are typical of any arthritis, or joint inflammation, which itself can be caused by a number of factors.

JRA is a cluster of joint diseases that shares common characteristics, primarily as pains in the joints that occur in a symmetrical pattern (both sides of the body).  As in any autoimmune disease, the white blood cells lose the ability to distinguish the healthy cells from harmful foreign bodies, so the immune system releases antibodies that mistakenly attack its own:  in the case of JRA, the synovium, or the lining of the joints.  As a result, the synovium becomes inflamed, and if left undiagnosed, may thicken, and grow abnormally.  In chronic cases, the expanding synovium could altogether erode joints and damage surrounding tissues, resulting to decreased range of motion.

JRA typically occurs in children between 6 months and 16 years.  The most common complaint would be pain in the joints, manifested in swelling and redness. Although joint pain is common in all types of JRA, other symptoms could arise, and may be different from one another.  It is widely experienced that the more joints are affected, the lesser the chances of JRA going into remission.

Children with JRA often grow slower than the average.  Further, the affected joint may grow faster or slower than the other, resulting to one arm or one leg growing longer (or shorter) than the other.

The following are types of JRA with their own set of symptoms:

  • Oligoarticular JRA affects four or fewer joints, particularly those of the knee and wrists.  Pain, stiffness, and swelling of joints in these areas are the common complaints, although they may not altogether manifest along with one telltale symptom – the child’s sensitivity to light.  This is due to the inflammation of the iris or the colored part of the eye (iritis) which in severe cases, may lead to blindness;
    • Polyarticular JRA affects five or more joints, particularly those of the hands, knees, hips, ankles, feet and neck.  Inflammation in these areas occurs, along with low-grade fever and appearance of bumps in areas that are subjected to pressure.  These are in fact swollen lymph nodes, that part of the immune system that helps transport dead cells out of the body.  Other susceptible areas are the armpits, the groin, above the collarbone, and under the jaw.  Girls are more prone to this kind of JRA than boys;
    • Systemic JRA compromises the whole body.  Myalgia (muscle aches) similar to that experienced in flu, is felt all throughout.  Fever spikes, especially at night, may be experienced throughout the day, as well as the appearance of rashes.  Swelling, pain and stiffness of the joints are likewise experienced.  The spleen and lymph nodes may also be compromised.

    The kind of treatment your child receives depends on how aggressive JRA progresses.  Rheumatologists typically prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and the resulting pain, as well as limit white blood cell activity.  Corticosteroids may be injected into the joint to control runaway inflammation, and in cases where the joints have stiffened as to limit motion, surgery may be in order.  To restore flexibility, physical therapy sessions may be called for.

    The collaborative effort of rheumatologists, pediatricians, physical therapists and ophthalmologists, as well as the parents’ patience and support, is important to allow the child to live as healthy and happy as possible, despite the attendant limitations.