About Juvenile Rheumatoid Arthritis:

 Juvenile rheumatoid arthritis (JRA), causes inflammation for at least six weeks in children 16 years old and younger.  The actual cause of JRA is unknown, however, viral, genetic, and immune-system-related factors maybe involved.  You are not alone, there are over 300,000 children in the USA with Juvenile Rheumatoid Arthritis.

 Children with JRA usually deal with it surprisingly well.  Their self-esteem is no different from children without JRA. They also appear to be more driven to achieve, feel just as competent, and function just as well socially.

 Living well with arthritis starts with a partnership between you, your child, their doctor, family, friends, and if needed, understanding from teachers and coaches at school.

Types of Juvenile Rheumatoid Arthritis:

 Symptoms depend upon the category of JRA, so it is important to know the 3 main types.

• Pauciarticular JRA- This affects four or fewer joints – typically larger joints, such as knees.  This is the most common form of JRA.
• Polyarticular JRA- This affects five or more joints – typically, small joints (hands and feet). This form often affects the same joint on both sides of body.
• Systemic JRA- Also known a Stills Disease.  It affects many areas of the body, including joints and internal organs. It is the least common form of JRA.

Signs and Symptoms:

Joint swelling (especially after sleeping or inactivity)

• Fever and rash ( temperature around 102 F and may appear and disappear quickly)
• Swelling of the lymph nodes (systemic JRA)
• Joint warmth
• Fatigue
• Limited motion
• Joint tenderness
• Like other forms of arthritis, JRA is characterized when symptoms are present (FLARE) and times when symptoms disappear (REMISSIONS).

Diagnosis:

Your first stop will be with your pediatrician who then in turn will refer you to a Rheumatologist (a specialist) to confirm the diagnosis and for treatment.

 Medical History and a Physical Exam will be done. The doctor may order some of the following tests:

• Blood tests
• X-rays
• Joint fluid removal

Treatment:

 Treatment for JRA focuses on helping your child maintain a normal level of physical and social activity. A combination of strategies to relieve pain and swelling, maintain full movement, strengthen, and prevent complications.

 Medications: Some children may need only over the counter children’s pain relievers. Others may need the help of prescribed medication designed to limit the progression of the disease. Some typical medications are:

NSAIDS: (non-steroidal anti-inflammatory drugs), i.e. Ibuprofen (adivil,motrin), Naproxen (Aleve). These reduce swelling and pain.

• COX-2  Inhibitors:  i.e. Celebrex
• DMARDS: (disease modifying anti-rheumatic drugs).  I.e. Methotrexate, this could be taken with NSAIDS, if they do not relieve pain and swelling alone.
• TNF Blockers: i.e. Enbrel, Remicade.  These target a protein that contributes to inflammation and can reduce pain, morning stiffness, and swollen joints.
• Cortisteroids: i.e. Prednisone.  These are typically prescribed for children with more severe juvenile rheumatoid arthritis. They are used to help control symptoms until a DMARD takes effect.

Therapies:

Your doctor may recommend physical therapy (PT) to help keep joints flexible and maintain range of motion and muscle tone.  A physical therapist or an occupational therapist may make additional suggestions about the best exercise and protective sports equipment for your child.  Occasionally special supports or splints maybe recommended to help protect joints.

Self-Care:

Get regular exercise

• Apply heat or cold – either with ice packs, heat packs, or warm showers/baths.
• Eat well – some children with arthritis have poor appetites. Others gain weight  due to medication and inactivity.
• Adequate calcium in the diet is important because children with JRA are at risk of developing osteoporosis (brittle bones).

Coping Skills:

 Connecting with others is important for both the child with JRA and parents and family members.  Some modifications may need to be made at home, school, and for scheduling outings.

Communication is the most important form of coping. From accomplishments, frustration, anger, sadness all emotions play a big part in our wellness.  Talking and expressing feelings.  This is for the whole family, because it does, and it will affect everyone. 

Remember, with empathy, encouragement and a little help you can and will live well with arthritis.  There is help, there is hope.