Arthritis

Updated 30 November 2015

Juvenile rheumatoid arthritis (JA)

JA is chronic joint inflammation occuring before the age of 16.

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Summary

  • Juvenile rheumatoid arthritis (JA) is a chronic condition that causes inflammation in one or more joints, and begins before the age of 16.
  • The causes are unknown.
  • Common symptoms are limping, stiffness when awakening, and reluctance to use a limb or reduced activity level.

Alternative names

Childhood arthritis, JRA, Juvenile idiopathic arthritis, and Still's disease.

What is it?

Juvenile rheumatoid arthritis (JRA) is a chronic condition that causes inflammation in one or more joints and begins before the age of 16. There are several different patterns. Though all have joint inflammation in common, they behave very differently, may require different treatment approaches, and have different outcomes.

Systemic onset type begins with very high fevers, frequently is accompanied by a skin rash, and shows evidence of inflammation in many internal organ systems as well as the joints. About 10 percent of children with arthritis have this type.

Pauciarticular onset disease affects four or less joints. About half of all children with arthritis are in this category. Some are very young, from infancy to about age 5, and are at risk of developing inflammatory eye problems. Regular eye exams are essential. Others are older, and the disease may evolve into one of the adult forms of arthritis.

Polyarticular disease has more than four joints affected and can begin at any age. Some of these children have adult type rheumatoid arthritis.

What causes JRA?

The causes of JRA are unknown and there is no prevention for it. Some genetic markers are more common in certain types of childhood arthritis or in children who develop particular complications from it. Although genetic makeup may be associated with an increased chance of developing arthritis, these conditions are not regarded as hereditary and rarely affect more than one family member.

Some features of these diseases suggest that there may be infectious triggers in a genetically predisposed child, but no specific infectious cause has been identified.

Diagnosis

JRA may be difficult to diagnose because often children compensate well for loss of function, and may not complain of pain. Symptoms to look out for are limping, stiffness when awakening, reluctance to use a limb or reduced activity level.

Tests commonly positive in adult arthritis (rheumatoid factor in the blood or changes on X-rays) are usually negative in childhood types. A number of other conditions can mimic JA, such as infections (like tuberculosis of a joint or septic arthritis), rheumatic fever or childhood malignancies. Evaluation to exclude these may be necessary before a diagnosis is confirmed.

Treatment

The choices of drugs for children are similar to those for adult arthritis and include non-steroidal anti-inflammatory agents such as ibuprofen and slower acting agents such as methotrexate, sulfasalazine, and hydroxychloroquine for more severe cases.

The doses must be adjusted for the size of the child. Preference may be given to liquid preparations or less frequently dosed medications to help with compliance. Certain drugs such as steroids (cortisone) must be used with caution because of adverse effects on growth and other side effects.

Physical and occupational therapy can prevent disability. Splints, a regular home exercise programme, or outpatient treatment is often effective.

Children should participate in regular school activities, extracurricular activities and family responsibilities as much as possible.

Prognosis

JRA is seldom life threatening. The disease can improve or go into remission at puberty.

When do you call your doctor?

If the patient experiences any of the symptoms described; or if he or she is on medication and the symptoms get worse, there is no improvement, or if there are new symptoms.

Read more:

JA and diet

Hidden pain: juvenile arthritis

 

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Ask the Expert

Arthritis expert

Professor Asgar Ali Kalla completed his MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 1975 at the University of Cape Town and his FRCP in 2003 in London. Professor Ali Kalla is the Isaac Albow Chair of Rheumatology at the University of Cape Town and also the Head of Division of Rheumatology at Groote Schuur Hospital. He has participated in a number of clinical trials for rheumatology and is active in community outreach. Prof Ali Kalla is an expert in Arthritis for Health24.

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