Juvenile Rheumatoid Arthritis

"Juvenile" or "childhood" arthritis is a disease occurring in children below the age of sixteen. The affected children experience pain, stiffness, and swelling in one or more joints. This trio is called inflammation. This inflammation is present for more than six weeks. The prevalent form of this type is called juvenile rheumatoid arthritis (JRA). Almost 50,000 children in the United States are suffering from this disease.

Types

Polyarticular JRA: It affects more girls than boys. The small joints of the hand and the weight-bearing joints are affected. There is swelling or pain in minimum 5 joints.
Pauciarticular JRA: The knee and wrist joints are generally affected. Inflammation of maximum four joints is observed. Additionally, the iris may be inflamed with or without active joint symptoms.
Systemic JRA: There is initial fever that increases in the evening and abruptly comes back to normal. During fever, the child may develop a rash. This rash may all of a sudden disappear and reappear. The spleen and lymph nodes increase in size. Finally, many joints of the body are inflamed.

Symptoms

Limping or a sore wrist, knee, or finger
Joints may swell and appear enlarged
Stiffness in the neck, hips, and other joints
Appearance and disappearance of rashes
High fevers that rise during the evening and suddenly disappear

Causes

This is an autoimmune disease. The white blood cells in the body cannot differentiate between the body's own healthy cells and harmful invaders, like viruses and bacteria. The immune system, instead of attacking the invaders, releases chemicals that may damage healthy tissues. This causes inflammation and pain.

Diagnosis

The doctor demands a detailed medical history and conducts a thorough physical examination. X-rays and blood tests are done to exclude other conditions that have similar symptoms. Other tests are as follows:
Complete blood count to evaluate basic cellular components of blood, like red blood cells, white blood cells, and platelets
Blood culture to determine the presence of bacteria in the bloodstream
Bone marrow examination to test blood in the bone marrow for deciding about leukemia
Test to check the erythrocyte sedimentation rate, which increases with inflammation
Test to check the rheumatoid factor, which is an antibody produced in the blood of children with some type of JRA
Antinuclear antibody is used to detect autoimmunity and the possibility of eye disease with JRA
Bone scan to determine alterations in bone and joints to analyze the reasons of unexplained bone and joint pain

Treatment

The primary care physician, rheumatologist, and the physical therapist collaborate and design a combination of medication, physical therapy, and exercise.
Medication

Non-steroidal, anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil, Motrin, or Nuprin), aspirin, naproxen or naproxen sodium (Naprosyn or Aleve) limits the release of harmful chemicals from white blood cells, and thereby, decreases inflammation and pain. If NSAIDs are not effective, the doctor may recommend other new medications. Sometimes, Disease-modifying anti-rheumatic drugs (DMARDs), like methotrexate are used to slow the progression of JRA. However, these require weeks or months to relieve the symptoms. Those having severe JRA are treated with Corticosteroids, like prednisone to control severe symptoms, like inflammation of the sac surrounding the heart. This medication is given through the mouth or directly into the vein.
Physical Therapy

Certain range-of-motion exercises are recommended to regain flexibility in stiff and sore joints. Other exercises enable to build strength and endurance.
Regular Exercise

In the presence of pain, children desire to lie down still. However, it is vital to follow a regular exercise program. Strong and healthy muscles support and protect joints. Walking, swimming, and bicycling (outdoor or indoor stationary) must be executed. Before exercise, a warm-up is necessary. A balanced diet involving a lot of calcium promotes bone health.

Disclaimer: This Buzzle article is for informative purposes only, and should not be used as a replacement for expert medical advice.