Lots of teens think that arthritis is something only their
grandparents get, but it's actually a condition that affects
people of all ages. Read on to find out about juvenile rheumatoid
arthritis, a specific kind of arthritis that usually occurs in
people under age 17.
What Is Juvenile Rheumatoid Arthritis?
-mah-toid) refers to diseases that affect the muscles, tendons,
joints, bones, or nerves.
is an inflammation (which means that it's characterized by
heat, swelling, and pain) of the
(the lining of the joints, such as the knees or knuckles). When the
synovium becomes inflamed, fluid is produced, and the joints can
become stiff, swollen, painful, and warm to the touch.
About 285,000 kids and teens in the United States have some form
Juvenile rheumatoid arthritis
is the most common kind of arthritis among kids and teens. Usually
diagnosed between the ages of 2 and 16, it's also called
juvenile idiopathic arthritis (JIA)
because it is different from adult rheumatoid arthritis.
Symptoms of JRA can come and go many times over the course of
the condition. Although JRA mostly affects the joints and
surrounding tissues, it can also affect other organs, like the
eyes, liver, heart, and lungs. JRA sometimes causes only minor
symptoms and problems, but in some cases it can cause serious joint
damage or limit
Kids and teens with JRA may have pain and stiffness that can
change from day to day or from morning to afternoon. Flares are
periods of time when the condition becomes more active and symptoms
JRA is a chronic condition, meaning it usually lasts for a
relatively long period of time (at least 6 weeks or more) and can
last for months and years. Sometimes the signs and symptoms just go
away on their own, which is called remission. Remission may last
for months, years, or for a person's lifetime. In fact, many
teens with JRA eventually enter full remission with little or no
permanent joint damage.
The three major types of JRA are:
The prefix oligo means "few" and articular means
"associated with a joint or joints." This kind of JRA
involves four or fewer joints and usually affects larger joints
such as the knee. About half the kids and teens with JRA have the
oligoarticular type. It generally begins in young children
between infancy and age 5. Sometimes
-tis), an inflammation in front of the eye near the iris (the
colored part of the eye) also occurs. For this reason, eye exams
are important, even when the arthritis is not active.
means "many." Polyarticular JRA affects five or more
joints, usually the small ones in the hand and fingers. It also
can affect the knees, hips, ankles, feet, and neck. Polyarticular
JRA may have symmetric involvement of joints, meaning it affects
the same joint on each side of the body. Involved joints are
usually swollen. Symptoms may include a low-grade fever,
tiredness, poor appetite, and rheumatoid nodules (bumps) on the
affected joints. This form of JRA can lead to long-term joint
problems and frequently requires treatment with strong
Systemic JRA can affect several parts of the body, including
internal organs and joints. This is the least common form of JRA.
The first signs of systemic JRA are usually high fevers, chills,
and a rash. Arthritis may begin with the fevers or not until
weeks or months later. Fever usually occurs late in the afternoon
or evening and can go up to 103Âº Fahrenheit (39.4Âº Celsius) or
higher and return to normal within a few hours. The person may
feel very sick when his or her temperature is high but fine
during the rest of the day. About half of the kids and teens with
systemic JRA recover completely, whereas the other half
experience joint symptoms, such as pain and stiffness, which may
persist for many years. In some cases the effects of the disease,
such as decreased movement, stiffness, and pain in the joints,
may last into adulthood.
What Causes JRA?
Although scientists don't know the exact causes of JRA yet,
much research is being done on JRA and other forms of arthritis.
They do know that JRA involves abnormalities of the immune system,
which defends our bodies against
, such as bacteria and viruses.
When the immune system isn't working properly - as in a
condition like JRA, for example - it has difficulty telling the
difference between germs and the body's own tissues. This
confusion causes the immune system to mount an attack and release
chemicals that actually damage the body's own healthy tissues.
This results in the type of inflammation that causes the symptoms
It is also known that JRA is not contagious. You can't catch
it from someone else or pass it along to another person the way you
might a cold or other infection.
What Do Doctors Do?
JRA can be difficult to diagnose. All forms of this type of
arthritis involve inflammation, but they also cause a variety of
symptoms and require different kinds of treatment. No single test
can diagnose all the forms of JRA and other types of arthritis. The
doctor will do a complete physical examination to detect joint
swelling, eye problems, and rashes. He or she may do blood tests,
X-rays, and, in some cases, may use a needle to take a sample of
synovial (joint) fluid for examination.
The doctor may need to follow the course and symptoms of a
person with JRA for several months to determine the particular type
the person has. The doctor will also take your
by asking you about any concerns and symptoms you have, your past
health, your family's health, any medications you're
taking, any allergies you may have, and other issues.
Certain infections, such as parvovirus infection and
, have similar symptoms and may be mistaken for JRA. These
possibilities must be ruled out before a diagnosis of JRA can be
How Is JRA Treated?
When JRA is diagnosed early and treated appropriately, it can
usually be managed effectively and damage to joints can be limited
or prevented. Medical care is aimed at easing the symptoms of JRA
and may include medications to reduce inflammation (like
ibuprofen). Newer medications, such as methotrexate and etanercept,
can keep the immune system in check and control the disease far
better than was possible 10 or 15 years ago. Range-of-motion
physical therapy (exercises that improve flexibility), and the use
of heat can also help control symptoms. Surgery is very rarely
needed to repair damaged joints.
Living With JRA
If you have JRA, some mornings it may be hard to get out of bed.
Maybe you reach for your sock on the floor, and you can't
straighten your elbow or bend your knees. Or you touch your
shoulder, and it feels tender, warm, and painful. Periods of
inactivity, like sleeping for 8 hours, can be followed by
It may be tempting to roll back into bed and sleep the day away.
But this can make things worse. Even though you may feel lousy
sometimes, you can help yourself feel better. Just as runners,
bodybuilders, and other athletes do
exercises to warm up, you can use gentle massaging and stretching
to help soothe the muscles and ligaments around your sore joints.
Once you're up and moving, the discomfort usually lessens.
can help keep full motion in your joints and strengthen your
muscles and bones. A physical therapist can help you plan an
effective exercise program to do at home.
Proper nutrition can improve your overall health, and a
registered dietitian can help you to understand the basics of a
healthy diet. For example, you might feel sick and unable to eat as
much when you experience a flare. A dietitian can assist you in
selecting foods that have a higher nutritional value to compensate
for a poor appetite.
A positive mental outlook is just as important as exercise and a
healthy diet. If you feel
or angry sometimes, talk to someone who can support you. Tell your
parents, your doctor, or a friend about how you feel. Some teens
with JRA become more comfortable with the condition by asking
questions and learning as much as possible. It may also help to do
simple things that we often take for granted. For example, each day
try to schedule something to do that you enjoy and that makes you
Most teens with JRA do the same stuff as other teens - they go
to regular schools, help around the house, hang out with their
friends, and are active physically, academically, and socially.
Remember, your doctor and other medical professionals are there to
support you and can help you manage the condition so that it has
the least possible impact on your life.
AnneMarie C. Brescia, MD
Date reviewed: June 2008
Note: All information is for educational purposes only. For specific medical advice,
diagnoses, and treatment, consult your doctor.
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