Juvenile rheumatoid arthritis, or JRA, is the most common type of arthritis in children. It develops before the age of 16 and can take one of three forms: Pauciarticular JRA, the mildest type, affects only a few joints, especially large ones such as the knees, ankles, and elbows. Different joints on either side of the body are usually involved. Polyarticular JRA, a more severe type, generally attacks five or more joints, often those of the fingers and hands, as well as weight-bearing joints, such as the hips, knees, and ankles. This form of JRA affects the same joints on both sides of the body. SystemicJRA, or Still’s disease, the most severe form, attacks many joints, usually the large ones, as well as some organs, often the heart and eyes. The first typical symptoms are joint stiffness and discomfort upon arising in the morning. Systemic JRA, however, may begin with symptoms like those of an infection: high fever, especially at night; a rash on the chest and thighs; and swollen lymph nodes. As in the adult form of rheumatoid arthritis, symptoms may come and go over many months or years. In severe cases, the swollen, inflamed joints become distorted. Though the disorder may disappear by early adulthood, in some people it recurs throughout life. The cause is unknown, but many medical researchers believe it is an autoimmune disease, in which the immune system attacks normal body tissue as if it were a foreign invader.
Diagnostic Studies And Procedures
There is no single test that can diagnose juvenile rheumatoid arthritis. When doctors suspect the disease, they usually refer the child to a rheumatologist for additional blood tests, X-rays, and an analysis of synovial fluid taken from the affected joints.
Treatment depends on the type and severity of the disease. If only a few large joints are mildly affected, a doctor may inject cortisone or another steroid drug directly into them. This can reduce inflammation and alleviate pain without the growth problems, weight gain, bleeding problems, and other side effects of taking oral steroids. In most cases, aspirin is the drug of choice. However, it must be taken on a regular schedule and in high doses, which can cause ringing in the ears and possible hearing loss. Because a young child may not be able to report such problems, parents should be alert for signs, such as tugging of the ears and poor response to normal sounds. If aspirin proves insufficient, a doctor may recommend stronger nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen, available in both prescription and over-the-counter strength. For severe cases, the more potent drugs used to treat adult rheumatoid arthritis, such as injections of gold salts and systemic steroids, may be tried. Because steroids interfere with normal growth and development, their use must be carefully monitored. The child should be checked every few months for any complications of the disease. These include pericarditis, inflammation of the outer lining of the heart; pleuritis, inflammation of the membrane covering the lungs; and blood abnormalities, such as anemia. Because the eyes are often affected, an ophthalmologist should be seen regularly. A pediatric orthopedist may be called in to evaluate joint deformity and if necessary, do corrective surgery.
Although medical treatment is essential to control the disease, supplemental techniques can be helpful.
Herbalists often recommend capsules of evening primrose oil to control joint inflammation; feverfew tea to alleviate fever and other symptoms; and garlic, fresh or in capsules, to reduce joint damage.
Hot baths or cold compresses help many patients. For others, contrast baths work best; these involve sitting in a hot tub for about 10 minutes, then standing in a cool shower for 2 or 3 minutes.
A child with JRA often lacks self-esteem and becomes lonely and withdrawn. Providing a gentle, companionable pet can foster a sense of responsibility and help compensate for not being able to engage in overly strenuous activities.
Physical and Occupational Therapy
Physical therapists teach patients special exercises that can strengthen muscles and help maintain mobility without causing joint damage. They also provide splints and other devices to protect inflamed joints. Occupational therapists teach new approaches to daily tasks, such as getting dressed, that minimize aggravation of painful, inflamed joints.
Children with JRA should be encouraged to take part in physical activities, but these may have to be modified. Finding the right balance of rest and exercise is important. See that the child sleeps at least eight hours each night and takes a nap during the day. Make sure that the child maintains normal weight, because excess weight increases the burden on joints. To help prevent stomach irritation, always give aspirin or nonsteroidal anti inflammatory drugs with milk or food.
Other Causes of Joint Pain
Rheumatic fever, Lyme disease, and bone or joint infections can produce joint pain and inflammation.