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Children get several kinds of rheumatic disease, in addition to juvenile rheumatoid arthritis (JRA), among are ankylosing spondylitis, lupus, and infectious arthritis. Because parents have an important role in maintaining these children's physical and emotional well-being, they need to know as much as possible about their children's arthritis and its care. At least three forms of JRA are recognized and they have learned that the illness in children with JRA is different from that in adults. Its signs and symptoms can change from one day to the next, and even from morning to afternoon. Joint stiffness and pain may be mild one day and then so severe on the next that the child cannot move without great difficulty. Parents often feel discouraged because the disease seems to continue endlessly. Most children with JRA can keep up with school and social activities, Some changes will have to be made when the arthritis is particularly troulesome or if the joints have been damaged. Most children can live nearly normal lives.  PHYSICAL EFFECTSEach of the three forms of JRA begins in a different way and has different signs and symptoms. Systemic JRA, which affects many body areas, including internal organs. Polyarticular JRA, which affects many joints (poly means several or many and articular refers to joint) Pauciarticular JRA. which affects only a few joints (pauci means few and articular means joint) Inflammation is the major process that occurs in every kind of juvenile arthritis. The synovium that lines the joint becomes swollen and overgrown, and produces too much fluid. This causes stiffness, swelling, pain, warmth, and sometimes redness of the skin over the affected joint. Because inflamed joints are usually painful to move, a child will often hold them still. However, lack of movement for long periods leads to stiffness of the joint and weakness of the muscles around it. Eventually, the structures around the joint may tighten up and shorten, producing the deformity known as a joint contracture. Doctors usually prescribe a physical activity program to help the child maintain a full range of motion of an inflamed joint and to keep the joint muscles strong. In some children with severe JRA, the long-lasting inflamation damages the joint surfaces. This process can result in the kinds of deformity many people have seen in adults with rheumatoid arthritis. Sometimes joint inflammation speeds up or slows down the growth centers in bones. The affected bones may become longer or shorter than normal. When long-standing arthritis affects the growth centers of many bones, a child's general physical development may be slowed. Growth usually resumes when the disease is brought under control , although a child with JRA may not grow to previously expected height. SYSTEMIC JUVENILE RHEUMATOID ARTHRITISBoys and girls are equally likely to get this kind of JRA. It affects children of any age. High fevers are a frequent symptom of systemic JRA. The fever usually starts in the evening. The temperature goes to 103 or higher, then comes back down to normal within a few hours, only to rise again the next day. Shaking chills often accompany the fever, and the child may feel very sick. Periods of fever can last for weeks or even months, but rarely go on more than six months. Children with systernic JRA also often develop a characteristic rash when they have a fever. This rash comes and goes for many days in a row. Pale red spots often appear on the child's chest and thighs and sometimes on other parts of the body. They may come on after a hot tub or shower. Often the rash is absent when the physician examines the child. The parent needs to notice this rash and tell the physician, this will help him in making a diagnogis. The arthritis of systemic JRA affects many joint problems may begin with the fever or start weeks or months later. Some children have severe pain in their joints when they have a fever and feel better when their temperature goes down. Joint problems also continue after the fever period ends, and may be a major long-term difficulty for children with systemic JRA. Other effects of systemic JRA may be inflammation of the outer lining of the heart (pericarditis) or the lungs (pleuritis) , stomach pain, severe anemia, and a high number of white cells in the blood. Regular visits to the doctor are important so that these effects can be monitored and treated from the beginning. When the disease is severe the child many be extremely ill and need to enter the hospital. POLYARTICULAR JUYENILE RHEUMATOID ARTHRITISGirls develop polyarticular arthritis more often than boys. Polyarticular JRA appears in five or more joints, usually including the small joints of the fingers and hands, and sometimes the weight-bearing joints (hips, knees, ankles, feet) The disease is often symmetrical, meaning that the same joint on both sides of the body sides of the body is involved. They are most likely to develop rheumatoid nodules on their elbows or other points of the body that receive pressure from chairs, shoes, and other sources. PAUCIARTICULAR JUVENILE RHEUMATOID ARTHRITISThis type of JRA affects only a few joints (four or less), usually large joints such as knees, ankles, or elbows. It seldom affects the same joint on both sides. There are two subtypes of pauciarticular JRA, one that develops primarily in boys and the other primarily in girls. Some boys with pauciarticular JRA are likely to have stiffness in the hips and lower back early in the disease, in addition to arthritis in the large joints. They often later develop ankylosing spondylitis, which affects the spine and hips. Some girls with pauciarticular JRA develop an eye inflammation called iridocyclitis. The symptoms of this include red eyes, eye pain, and failing vision. These symptoms may not appear until the eye inflammation has been present for a long time. Since iridocyclitis can usually be detected through a painless eye examination done by an ophthalmologist using a slit lamp, children need a regular eye examination. Treatment, if needed can be started early to prevent any loss of vision. POSSIBLE CAUSESScientists don't know what causes any of the forms of juvenile rheumatoid arthritis. They do know the JRA is not contagious and rarely occurs in more than one child in a family. Doctors do not believe that heredity is the sole cause of any type. DIAGNOSISBecause the signs and symptoms of JRA can very so much from one child to another, diagnosis can be difficult. The major steps are the medical history, physical examination, laboratory tests, and x-rays. Sometimes joint fluid or tissue will be examined. Many infections caused by viruses can lead to arthritis in children. To make a diagnosis of chronic JRA, the arthritis must have been present for six or more weeks. The parent may notice that the child has a slight limp or is reluctant to be as physically active in games or other activities. The doctor will do a physical examination, paying special attention to the child's joints. The doctor must find evidence of joint inflammation to be sure that JRA is the problem. However joint involvement may not be detectable early in the disease. The doctor will also look for other signs of JRA, like a rash that goes with systemic JRA or nodules that can be present in polyarticular JRA. Several laboratory tests can help the doctor decide if the child has JRA, and which type of JRA it is. Diagnostic blood tests may include the erythrocyte sedimentation rate, rheumatoid factor test, antinuclear antibody test, HLA-B27 typing. Many of the children with JRA are anemic, a hemoglobin test is often done. X-ray examinations of the joints are sometimes helpful to find out if some other condition such as a bone infection, tumor, or fracture is causing the joint pain and swelling. X-rays may be used to assess joint damage. A sample of fluid from one or more joints may be aspirated by a needle and examined to find out if there is an infection in the joint. Other diseases, such as psoriasis (chronic skin condition) and colitis (inflammation of the large intestine), can also cause arthritis. TREATMENTGetting a correct diagnosis is really the first step in treating JRA. The treatment will be based on the kind of arthritis a child has, and the symptoms causing it. Usually this included medications, rest, exercise, eye care, balanced diet. Other types of treatment, such as surgery, may be necessary for special long-term problems. The treatment is likely to go on for a long period of time. and the progress may seem slow. The symptoms of child with JRA can change with time, expect to make changes periodically in the treatment program. MEDICATIONSAspirin is the first medication the doctor is likely to prescribe to reduce any pain, inflammation or fever. A sufficient blood level of aspirin must be maintained to work against swelling, pain, and stiffness in the joints, therefore children with arthritis must take large doses of aspirin at least four times a day. Because of these high doses the child needs to be watched for side effects. The affected child and its parents should be aware of the side effects. If the child is in school, its teacher must know the possible effects of too much aspirin. Some of these include rapid or deep breathing, ringing in the ears, decrease in hearing, drowsiness, nausea, vomiting, irritability, unusual behavior. Nonsteroidal anti-inflammatory drugs are used regularly in treating arthritis. Only a few have been approved for children. Some children with severe arthritis who aren't helped by aspirin respond to gold treatment. Gold treatment is given by injection, usually once a week at first. Four to six months may pass before a child responds to the treatment. Gradually, thr injections are given less often. Corticosteroid drugs are used in severe cases, if used for long periods of time, as may be necessary in JRA, their side effects can build up and cause severe problems such as reduced resistance to infection and high blood pressure, These medications also slow down a child's normal growth, and cause softening of the bones. Penicillamine is an antiarthritic drug that has recently been tested in some children. Used for sever cases of JRA. EXERCISEChildren with JRA should be encouraged to be reasonably active within the limitations of their disease. They should be allowed to participate in whatever enjoyable play and games their physical condition will allow. If the child is experiencing a flare-up of the disease, the amount of activity allowed should be restricted. A certain amount of specially planned exercise to maintain or restore alignment and function of specific joints needs to be started. A doctor, nurse, or physical therapist will teach parents how the child's joints are suppose to move through their range of motion. In school the child needs to be allowed to walk around the classroom from time to time. Otherwise, the child may become stiff. A child who has lost motion in a joint, or whose joint has become fixed in a bent position, or whose muscles have become weak may need other exercises. A special therapy program should be worked out by the doctor or physical therapist with the parents and the child. Exercise is important for keeping diseased joints from becoming stiff, and for maintaining muscle strength, too much exercise can be harmful. Excessive or over use of a joint can cause the inflammation in a joint to become worse. Children with JRA can usually tell if they have done too much by the way they feel the next day. Sometimes the children with JRA push themselves too hard in trying to keep up with their playmates. Splints may be needed to keep certain joints in proper position. These need adjusted as the child grows and the degree of inflammation changes. Orthopedic surgery can play and important role in treating children who have suffered severe joint damage from JRA. Totally replacing an affected joint with an artificial one can reduce pain and improve a child's function. Total joint replacement surgery is not generally done until a child has stopped growing. The child must usually be sixteen years old or older. Another operation, called soft-tissue release, may sometimes be used to improve the position of a joint pulled out of line by a contracture. Family members may feel overwhelmed by the difficulties of living with a chronic disease in the family. Sometimes all that is needed is a talk with a sympathetic Person or someone who is professionally trained. juvenile rheumatoid arthritis is a cronic disease. Parents and the child must learn to live with the disease. There is no cure for the child's problem. Even though no cure is presently available, the disease can usually be controlled. HLA-B27: Blood test Corticosteroid: Steroid |