Juvenile Rheumatoid Arthritis
With contributions from Marlene Wallace.
Arthritis in children is called juvenile arthritis or childhood arthritis. The most common type of childhood arthritis is juvenile rheumatoid arthritis (JRA), also called juvenile idiopathic arthritis (JIA).
Juvenile arthritis may cause permanent joint damage and make it hard for children to do everyday things like running, walking, playing or getting dressed. It can also cause disability.
While there is no cure for JRA, some children will achieve permanent remission when they are older. Remission means the disease is no longer active, but any joint damage is permanent.
Unfortunately, some children will continue to have symptoms into adulthood. It is important to note that while JIA was previously known as JRA, it is a not a childhood version of adult rheumatoid arthritis (RA).
JRA may appear in children as young as 6 months old to as old as 16 years old.
According to the Genetics Home Reference of the U.S. National Library of Medicine, it is estimated that JRA affects from 4 to 16 of 10,000 children in North America and Europe. In the United States, one in 1,000 children are affected.
The most common type of JRA is oligoarticular JRA (or pauciarticular JRA), which is at least half of the cases. While oligoarticular JRA affects more girls than it does boys, boys are more affected by enthesitis-related JRA than their counterpart.
What Causes Juvenile Rheumatoid Arthritis?
A malfunctioning immune system may be to blame for the development of JRA in children. The immune system’s overaction causes inflammation, which eventually leads to joint damage.
Researchers think children may have a genetic predisposition to JRA, that is they have certain genetic markers that potentially could trigger it. Triggers can include viruses or bacteria but having genetic markers does not mean a child will develop the disease.
There is no way to prevent the development of JRA, as researchers have not been able to confirm an exact cause of juvenile rheumatoid arthritis.
Juvenile Rheumatoid Arthritis Symptoms in Children
Fever is one of the earliest signs of JRA. These types of fevers tend to appear and disappear quickly and are worse at night.
Joint pain, swelling, and stiffness are common and worse in the morning and after periods of activity.
In addition, children may experience the following additional symptoms:
- Eye inflammation
- Reduced physical activity
- Swollen lymph nodes
- Loss of appetite
- Increased levels of fatigue
Children with JRA will experience periods of flare-ups, where the disease is active and periods of remission, where symptoms are reduced, and/or the disease is inactive.
Differences Between Juvenile RA and Adult RA
Much like adult RA, JRA causes painful inflammation throughout the body. However, these two conditions are very different.
One main difference is that JRA is a group of chronic arthritis disorders, while RA is one single disease. Moreover, JRA affects a child’s bone development and growth whereas RA doesn’t affect growth because it affects adults.
JRA also gets better with age, while RA causes lifetime symptoms that may get worse with time. Moreover, JRA treatment is often successful causing long periods of remission and lower incidences of disability.
Last, most people with RA may have a rheumatoid factor (RF), an antibody that causes the immune system to malfunction. Very few children with JRA have a positive RF, and a positive RF in a child with JRA indicates an increased risk for symptoms continuing into adulthood, or a higher risk for developing RA as an adult.
Treatment for JRA and RA is similar and includes disease-modifying antirheumatic drugs (DMARDs) and anti-TNF (tumor necrosis factor) medications. Physical therapy is another treatment to help joints feel and function better.