Juvenile Rheumatoid Arthritis

Juvenile arthritis
"Juvenile" or "childhood" arthritis is a disease occurring in children below the age of sixteen. The affected children experience pain, stiffness and swelling in one or more joints. This trio is called inflammation. This inflammation is present for more than six weeks. The prevalent form of juvenile arthritis is "juvenile rheumatoid arthritis" (JRA). Almost, 50000 children in the United States are suffering from this disease.

Types of Juvenile rheumatoid arthritis
There are three major types:

1. polyarticular arthritis
2. pauciarticular JRA
3. systemic JRA

The first type affects more girls than boys. The small joints of the hand and the weight-bearing joints are affected. There is swelling or pain in minimum 5 joints.

In the second type, the knee and wrist joints are generally affected. Inflammation of maximum four joints is observed. Additionally, the iris may be inflamed with or without active joint symptoms.

In the third type, there is initial fever that increases in the evening and abruptly comes back to normal. During fever, the child may develop a rash. This rash may all of a sudden disappear and reappear. The spleen and lymph nodes increase in size. Finally, many joints of the body are inflamed.

Symptoms

• limping or a sore wrist, knee or finger
• joints may swell and appear enlarged
• stiffness in the neck, hips and other joints
• appearance and disappearance of rashes
• high fevers that rise during evening and suddenly disappear

Causes
JRA (also called Juvenile Idiopathic arthritis) is an autoimmune disease. The white blood cells in the body cannot differentiate between the body's own healthy cells and harmful invaders like viruses and bacteria. The immune system instead of attacking the invaders releases chemicals that may damage healthy tissues. This causes inflammation and pain.

Diagnosis
The doctor demands a detailed medical history and conducts a thorough physical examination. X-rays and blood tests are done to exclude other conditions that have similar symptoms. Other tests are as follows:

1. Complete blood count to evaluate basic cellular components of blood like red blood cells, white blood cells and platelets
2. Blood culture to determine the presence of bacteria in the bloodstream
3. Bone marrow examination to test blood in the bone marrow for deciding about leukemia
4. Erythrocyte sedimentation rate increases with inflammation
5. Rheumatoid factor is an antibody produced in the blood of children with some type of JRA
6. Antinuclear antibody is used to detect autoimmunity and possibility of eye disease with JRA
7. Bone scan to determine alterations in bone and joints to analyze the reasons of unexplained bone and joint pain

Treatment
The primary care physician, rheumatologist and the physical therapist collaborate and design a combination of medication, physical therapy and exercise.

Medication
Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil or Motrin or Nuprin), aspirin, naproxen or naproxen sodium (Naprosyn or Aleve) limits the release of harmful chemicals from white blood cells and thereby decreases inflammation and pain. If NSAIDs are not effective, the doctor may recommend other new medications. Sometimes Disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate are used to slow the progression of JRA. However, these require weeks or months to relieve the symptoms. Those having severe JRA are treated with Corticosteroids like prednisone to control severe symptoms like inflammation of the sac surrounding the heart. This medication is given through the mouth or directly into the vein.

Physical Therapy
Certain range-of-motion exercises are recommended to regain flexibility in stiff and sore joints. Other exercises enable to build strength and endurance.

Regular Exercise
In the presence of pain, children desire to lie down still. However, it is vital to follow a regular exercise program. Strong and healthy muscles support and protect joints. Walking, swimming and bicycling (outdoor or indoor stationary) must be executed. Before exercise, a warm-up is necessary. A balanced diet involving a lot of calcium promotes bone health.