by Cindy Abbate

Created on: May 07, 2008

Juvenile rheumatoid arthritis (JRA) affects approximately 300,000 children in the United States. It varies in form and degree. It may last a short while - weeks or months - before going away entirely. It can be considered chronic lasting years or in some cases a lifetime.
It is believed to be an autoimmune disease where the immune system attacks the body because it mistakes the body's healthy cells for invaders. It releases chemicals which then cause inflammation and pain.

There are three types of JRA. It makes itself known between the ages of six months and sixteen years. It is believed by many rheumatologists that the more joints that are affected the less likely the condition will go into remission.

Polyarticular arthritis affects more girls than boys. Five or more joints are affected and have pain and/or swelling. The small joints in the hands and weight bearing joints are the most commonly affected. Nodules may develop on body areas that have pressure put on them when the child sits or leans.

Pauciarticular JRA affects four or fewer joints. The knee and wrist joint are the most commonly affected. The iris (the colored area of the eye) may become inflamed without any joint involvement. It can be detected by an ophthalmologist.

Systemic JRA affects the entire body. The child may have high fevers which increase towards the end of the day and then disappear only to return. He or she may look pale and ill. A rash may develop only to disappear just as quickly. The spleen and lymph nodes may become enlarged and as the condition progresses many of the body's joints will become stiff, sore and swollen.

The symptoms of JRA can vary in their intensity. Fevers that spike in the evening, rashes that come and go and joint pain are frequent symptoms. If your doctor suspects JRA he or she will get a detailed medical history and perform an in depth physical exam.

Be prepared for the following tests:

Complete blood count (CBC) which checks for abnormalities in the cellular components of the blood

Blood Culture which will rule out infections.

Bone Marrow Examination which will help rule out other conditions like leukemia.

Erythrocyte sedimentation rate this checks to see how fast red blood cells settle to the bottom of a test tube. It often accelerates when inflammation is present.

Your doctor may want to do a test for a rheumatoid factor - this is an antibody which is found in the blood of children with certain forms of JRA.

Antinuclear antibody (ANA) which will detect autoimmunity. The blood test is helpful in predicting eye disease.

Bone scan to look for changes and causes of bone and joint pain.

Depending on the circumstances your doctor may ask an orthopedic surgeon to examine your child's joints and possibly take samples of joint fluid or the joint lining itself for examination.

They may also test for other causes like Lyme disease which may produce the same symptoms as JRA.

Treatment of JRA is a combination of medication, physical therapy and exercise. Your family doctor, a rheumatologist and a physical therapist will work as team to tailor a treatment program to your child. It is important that the youngster stay active so that muscles are kept strong and healthy. Activity will also help maintain range of motion in affected joints.
A physical therapy routine will be developed to suit your child's needs so that he or she will protect joints and regain mobility.

Many children with arthritis live normal lives and for many it is an unpleasant period they have to live through before it goes into remission.

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