Juvenile Rheumatoid Arthritis

Arthritis, or inflammation of the joint capsule (also known as synovium), is one of the main causes for joint pain, swelling, and impaired movement of the affected joint.

Parents to children suffering from arthritis may notice that the child has trouble arising in the morning, and sometimes there's an obvious limp on the same side that is hurt.

There are several main possible diagnoses leading to arthritis in young children and adolescents, among which are infections of the joint, autoimmune diseases, malignancies and rheumatic diseases.

Juvenile rheumatoid arthritis (JRA) is one of the most common rheumatic diseases of childhood. The combination of a thorough history taking and proper physical examination of the child is usually sufficient to receive enough information in order to reach a likely diagnosis.

The physician should assess the child's growth (both weight and height), general appearance, evidence of any rashes, the affected joints and their characteristics. JRA is diagnosed when several factors appear together. The child often complains of arthralgia- joint pain. Morning stiffness is also sometimes present.

In 50% of the cases JRA is characterized by involvement of only one joint (a monoarticular disease). However, there are other types of JRA where few or many joints are involved (pauciarticular or polyarticular).

In some children systemic manifestation may appear as well, including fever, inflammation of the serous tissues (serositis), eye disorders and blood count changes.

Current treatments offered to patients with JRA include Non-steroidal anti-inflammatory drugs (NSAID's), steroid injections into the joint during severe attacks, and newer biologic and immunological treatments for a severe onset.

Physiotherapy and supportive care is also very important for the child. JRA flares can result in long-term hospitalizations and missing school days. The child must be aware of his disease and receive full support from his surroundings in order to recover from these painful flares as fast as possible.

JRA affects mostly the ages of 1-16 years. Very young children with early onset JRA who have not yet learnt to walk can have severe mobility problems and long-term movement complications if not diagnosed and treated early.

As previously mentioned, other diagnoses must be taken into consideration before making the final diagnosis of juvenile rheumatoid arthritis. Severe illnesses such as leukemia or other bone tumors must be immediately ruled out in every child presenting with a new limp. Fever might suggest other causes such as bacteria infecting the joint or bone, and blood tests should be taken to find out whether or not an active infection is present.