Tyler McKinna
Juvenile Rheumatoid Arthritis
Alternative Names:
Juvenile chronic polyarthritis; JRA; Still disease
Definition:
A chronic, inflammatory disease that may cause joint or connective tissue damage. The onset occurs before
Age 16.
Causes, incidence, and risk factors:
JRA is thought to belong to the collagen classes of disease (those diseases that involve connective tissue).
It is a complicated disease. The primary manifestation is arthritis, but the disease may involve other body systems such as the heart and lining around the heart (pericardium), lungs and lining around the lungs (pleura), eyes, and skin. Systemic arthritis affects 20% of those with juvenile arthritis and includes fever, rash, and enlarged spleen (splenomegaly) in addition to joint inflammation. JRA is generally divided into five broad groups depending on whether a large number of joints are involved or just a few, whether the rheumatoid factor (a blood test) is positive or negative, and whether there is eye involvement or not.
The five categories of JRA may be roughly broken down as follows:
many involved joints and a positive rheumatoid factor
many involved joints and a negative rheumatoid factor
few involved joints and a positive antinuclear antibody
few involved joints and a positive HLA B27 surface antigen
systemic JRA (throughout the body)
A specialist in rheumatology generally makes the category determination.
The onset of arthritis may be slow or extremely rapid. An early sign of slow onset may be stiffness on arising in the morning. Swollen, painful joints characterize the arthritis of JRA with pain on motion and sometimes to touch. The skin over the joints is generally not red but can be. The systemic form of JRA may first appear with high fevers, chills and a rash but without joint pain. In the systemic form, arthritis may develop months after the appearance of the fever.
The two forms of JRA where there are only a few joints involved often have associated eye disease. The most severe form of eye disease, chronic iridocyclitis of JRA, may lead to lead to visual problems or blindness. The milder form of JRA-associated eye disease is acute iridocyclitis, which generally heals without permanent damage.
The cause of juvenile rheumatoid arthritis is unknown. Growth may be affected during periods of active disease. Girls are affected more often than boys are. The peak onset occurs between the ages of 2 to 5 years old and between 9 to 12 years old. Risk factors may be a family history of the disease and recent rubella infection or vaccine.
Prevention:
There is no known prevention for JRA.
Symptoms:
General symptoms:
joint stiffness on arising in the morning
limited range of motion
slow rate of growth
hot, swollen, painful joints
fever, low grade (with multiple-joint type disease)
fever, high spiking with chills (with systemic form of disease)
rheumatoid rash
rheumatoid nodules (at sites of pressure)
Symptoms of eye involvement:
red eyes
eye pain
photophobia
visual changes
Other symptoms:
chest pain
shortness of breath
abdominal pain
Signs and tests:
Physical examination may show an enlarged liver (hepatomegaly), enlarged spleen (splenomegaly), or swollen lymph nodes (lymphadenopathy). There may also be signs of:
anemia
iridocyclitis
pericarditis
pleuritis
myocarditis
Tests include:
CBC
ESR
ANA
RA factor
HLA antigens
immunoelectrophoresis - serum
synovial fluid analysis
X-ray of a joint
X-ray of the chest
ECG
slit-lamp exam of the eyes
Treatment:
Treatment is aimed at preserving mobility and joint function and supporting the patient and family through a long chronic illness.
Therapeutic medications include:
aspirin
nonsteroidal anti-inflammatory agents (NSAIDS)
corticosteroids
topical ophthalmic corticosteroids
mydriatics
gold therapy
chloroquine agents
immune suppressing agents (rarely used in children)
Note: Talk to your health care provider before giving aspirin or NSAIDS to children!
Physical therapy and exercise programs may be recommended. Surgical procedures may be indicated, including joint replacement.
Expectations (prognosis):
JRA is seldom life threatening. Long periods of spontaneous remission are typical. Often JRA improves or remits at puberty. Approximately 75% of JRA patients eventually enter remission with minimal functional loss and deformity.
The stress of illness can often be helped by joining a support group. Here, members share common experiences and problems..
Complications:
loss of vision or decreased vision
total joint destruction of the major weight-bearing joints
chronic spondyloarthropathy
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