Arthritis is a disease affecting the elderly and the middle aged. However, children and adolescents can also be affected by arthritis in some specific conditions. Juvenile arthritis includes several types of arthritis including spondyloarthropathies and reactive arthritis that affect the children and adolescents.
Juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis (JIA), has some distinctive features that include early onset during childhood or adolescence and more prevalence among females.
Key component of JRA
The key component of this disease is joint inflammation. In this condition the lining of a joint produces too much fluid resulting in a swollen joint that has features like warmth, pain and stiffness. The stiffness is often more pronounced in the morning or after a nap.
Joint Symptoms of JRA
- Joint pain
- Warmth over the affected joint
- Stiffness that is worse after periods of inactivity like after a nap or in the mornings upon waking up
- Age of onset less than 16 years.
- Children might limp or complain of pain.
- The child might hold on to the affected joint in an attempt to reduce pain
- Prolonged lack of use of the affected joint may lead to weakening, thinning and tightening of the muscles around the affected joint
- Tendons also might tighten and shorten, causing a deformity called a joint contracture
- For a diagnosis to be made the joint symptoms must last for 6 weeks or longer
According to type of JRA:-
- In Polyarthritis type more than 5 inflamed joints are seen
- In Oligoarthritis (pauciarticular disease) less than 4 inflamed joints are seen
- In Systemic-onset arthritis is seen with characteristic fever
Symptoms of JRA with a systemic disease
There are several varieties of manifestations and types of JRA. Those with a systemic disease have features like:-
- Fever – there may be once or twice daily spikes of fever that may go on for over two weeks. The fever may be absent during the mornings.
- Swollen lymph nodes
- Pauciarticular JRA may be associated eye disorders including chronic uveitis that affects the anterior chamber of the eyes. This may cause permanent damage to the eye. Uveitis eventually affects up to 20% of children with this condition.
Aggravation and remission
There are episodes of flare ups with severe aggravation of the symptoms followed by episodes of remission where the symptoms improve or disappear.
JRA is different in each child. While in some children there may be one or two flare ups with no symptoms ever again in life, in others there may be multiple flare ups and permanent symptoms.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)