Juvenile Arthritis

Although we usually associate arthritis (Read about "Arthritis and Rheumatic Diseases") with aging, anyone can develop the disease, including children. Juvenile arthritis is a general term for any of the dozens of different types of arthritis when they occur in children.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) and the Arthritis Foundation (AF) say children can develop almost all types of arthritis that affect adults, including but not limited to:

• juvenile ankylosing spondylitis (Read about "Ankylosing Spondylitis")
• juvenile reactive arthritis (Read about "Reactive Arthritis")
• juvenile psoriatic arthritis (Read about "Psoriasis")
• juvenile scleroderma (Read about "Scleroderma")
• juvenile systemic lupus erythematosus (Read about "Lupus")

However, according to NIAMS, the most common type of arthritis that affects children is juvenile rheumatoid arthritis (JRA).

Juvenile rheumatoid arthritis (JRA)

JRA is an autoimmune disorder, which means that the body mistakenly identifies some of its own cells and tissues as foreign. The immune system (Read about "The Immune System"), which normally helps to fight off harmful, foreign substances such as bacteria or viruses, begins to attack healthy cells and tissues. (Read about "Microorganisms") The result is inflammation, marked by redness, heat, pain and swelling.

NIAMS says there are different types of JRA:

• Pauciarticular - Pauciarticular means that four or fewer joints are affected. Pauciarticular is the most common form of JRA; about half of all children with JRA have this type. Eye disease affects about 20 to 30 percent of children with pauciarticular JRA. (Read about "The Eye") Regular examinations by an ophthalmologist are necessary to prevent serious eye problems such as uveitis. (Read about "Uveitis")
• Polyarticular - About 30 percent of all children with JRA have polyarticular disease. In polyarticular disease, five or more joints are affected. The small joints, such as those in the hands and feet, are most commonly involved, but the disease may also affect large joints. Polyarticular JRA often is symmetrical; that is, it affects the same joint on both sides of the body.
• Systemic - Besides joint swelling, the systemic form of JRA is characterized by fever and a light skin rash, and may also affect internal organs such as the heart, liver, spleen and lymph nodes.

Several types of medication are available to treat JRA:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) - NSAID's often are the first type of medication used. Among the non-steroidal anti-inflammatory drugs (NSAIDs) are aspirin, ibuprofen and naproxen sodium. However, NIAMS says many doctors do not treat children with aspirin because of the possibility that it will cause bleeding problems, stomach upset, liver problems or Reye's syndrome. (Read about "Gastrointestinal Bleeding" "Gastritis" "The Liver")
• Disease-modifying anti-rheumatic drugs (DMARDs) - If NSAIDs do not relieve symptoms of JRA, DMARD's such as methotrexate may be prescribed. DMARDs slow the progression of JRA, but because they take weeks or months to relieve symptoms, they often are taken with a NSAID.
• Corticosteroids - In children with very severe JRA, corticosteroids like prednisone may be added to the treatment plan to control severe symptoms. This medication can be given either intravenously (directly into the vein) or by mouth. Corticosteroids can interfere with a child's normal growth and can cause other side effects, such as a round face, weakened bones and increased susceptibility to infections. Long-term corticosteroid use has also been linked to a condition called osteonecrosis in which a portion of bone loses its blood supply and begins to die. (Read about "Osteonecrosis")
• Biologic agents - a class of drug treatments called biologic agents may be used in some cases to reduce inflammation.

Physical therapy and exercise are also important parts of a child's treatment plan. (Read about "Rehabilitation") They can help to maintain muscle tone and preserve and recover the range of motion of the joints. A physiatrist (rehabilitation specialist) or a physical therapist can design an appropriate exercise program for a person with JRA. The specialist also may recommend using splints and other devices to help maintain normal bone and joint growth.