When to worry about JIA

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Focus on Health

When to worry about juvenile arthritis

Thursday, July 9, 2009 10:00 AM EDT

http://yournabe.com/articles/2009/07/09/brooklyn/brooklyn_newsdgrzzfw07092009.tx\

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Children sometimes complain about aches in their joints. These aches could

result from a variety of causes. But, if a child's joints are swollen for six

weeks in a row or longer, he or she may have juvenile arthritis (JA).

Juvenile arthritis is a long?lasting (chronic) disease. It is the most common

form of arthritis in children. In the United States, it affects nearly 250,000

people under the age of 16 years.

There are several types of juvenile arthritis. Nearly all of them are different

from rheumatoid arthritis in adults. This is why the term " juvenile rheumatoid

arthritis (JRA) " is no longer widely used.

Types of Juvenile Arthritis

There are three types of juvenile arthritis. The classification is based on

symptoms, the number of joints involved, and the presence of certain antibodies

in the blood. Doctors classify juvenile arthritis in order to help predict how

the disease will progress.

The three types of juvenile arthritis are pauciarticular, polyarticular, and

systemic.

Pauciarticular (paw?see?are?tick?you?lar): Pauciarticular means " few joints. "

This means that the pauciarticular type of juvenile arthritis involves only a

few joints. About half of children with juvenile arthritis have the

pauciarticular type. Girls younger than 8 years of age are more likely to

develop it.

For half of the children with pauciarticular juvenile arthritis, only one joint

will be involved, usually a knee or ankle. This is called monoarticular juvenile

arthritis. These patients usually have a very mild arthritis and the symptoms

may go away or become less noticeable (remit).

For some children, this arthritis affects four or fewer larger joints. Joints

affected include the knee, ankle, or wrist. Involvement of fingers or toes is

unusual.

Pauciarticular juvenile arthritis may also cause eye inflammation. To prevent

blindness, your child may need regular eye examinations from a doctor who

specializes in eye diseases (ophthalmologist). Eye problems may continue into

adulthood.

Polyarticular: In juvenile arthritis, swelling of some of the fingers and toes

may be significant. About 30 percent of children with juvenile arthritis have

the polyarticular type. This type of arthritis is more common in girls than in

boys.

Polyarticular juvenile arthritis affects five or more smaller joints (such as

the hands and feet). Usually, the joints are all on the same side of the body.

This type of juvenile arthritis can also affect large joints.

Children with a certain antibody in their blood, called IgM rheumatoid factor

(RF), often have a more?severe form of the disease. Antibodies are proteins in

the blood usually used by the body to fight off infection through an immune

response. Doctors believe that this is the same type as adult rheumatoid

arthritis.

Systemic: About 20 percent of children with juvenile arthritis have the systemic

type.

This type of juvenile arthritis causes swelling, pain, and limited motion in at

least one joint, rash, and inflammation of internal organs such as the heart,

liver, spleen, and lymph nodes. A fever of at least 102 degrees each day for a

minimum of two weeks suggests this diagnosis.

A small percentage of children with systemic juvenile arthritis develop

arthritis in many joints and have severe arthritis that continues into

adulthood.

Cause

Juvenile arthritis is an autoimmune disease. This means that the body attacks

its own healthy cells and tissues. Arthritis results from ongoing joint

inflammation in four steps:

.. The joint becomes inflamed

.. The joint stiffens (contracture)

.. The joint suffers damage

.. The joint's growth is changed

No one knows exactly what causes juvenile arthritis. Researchers believe some

children have genes that make them more likely to get the disease. Exposure to

something in the environment (for example, a virus) triggers juvenile arthritis

in these children. Juvenile arthritis is not hereditary, so it is very rare for

more than one child in a family to get it.

Symptoms

In some cases, symptoms of juvenile arthritis are mild and do not progress to

more severe joint disease and deformities. For many years it was believed that

most children eventually outgrow juvenile arthritis. Now, it is known that half

of the children diagnosed with juvenile arthritis will continue to have active

arthritis 10 years after diagnosis unless they receive aggressive treatment.

In severe cases, JA can produce serious joint and tissue damage. It can also

cause problems with bone development and growth.

Juvenile arthritis affects each child differently and can last for indefinite

periods of time. There may be times when symptoms improve or disappear

(remissions). There are other times when symptoms worsen (flare?ups). Sometimes,

a child may have one or two flare?ups and never have symptoms again. Other

children may have frequent flare?ups and symptoms that never go away.

One sign of juvenile arthritis is the presence of painful joints in the morning

that improve by afternoon. Sometimes, the first sign of the disease is a morning

limp, caused by an affected knee. Hands and feet may also be affected.

Swelling and pain may also be noted. Although young children may not complain of

pain, a child may feel irritable or tired and not want to play. Sometimes

juvenile arthritis may cause lymph node swelling in the neck and other parts of

the body.

Joints may become inflamed and warm to the touch. In fewer than half of cases of

juvenile arthritis, internal organs may become inflamed.

Muscles and other soft tissues around the joint may weaken.

In certain cases, children with juvenile arthritis show signs of a high fever

and light pink rash, which may disappear very quickly .

Some children develop growth problems caused by juvenile arthritis. Joints may

grow too fast or too slow, unevenly, or to one side. This can make one leg or

arm longer than the other. Overall growth also may slow.

Some children with juvenile arthritis have eye involvement, called

iridocyclitis. This is treatable by an ophthalmologist (eye doctor). The

presence of eye problems helps to confirm the diagnosis. Without treatment,

iridocyclitis can result in eye damage that cannot be cured. The only symptom of

iridocyclitis is pain during exposure to bright light. The absence of this

symptom, however, does not guarantee that eye problems are not present.

Diagnosis

Early diagnosis and treatment can control inflammation, relieve pain, prevent

joint damage, and maintain a child's ability to function.

The doctor will review the child's complete medical history. A physical

examination, laboratory tests, and imaging studies will also be done. A wide

range of tests is needed because juvenile arthritis is diagnosed based as much

on what is present as what is not present. A complete medical history and

physical examination, blood tests, and X?rays will help to exclude other

conditions that cause arthritis.

The doctor will want to learn the child's medical history. He or she will want

to know how long the child has had problems with joint pain and swelling and

whether the symptoms have gotten better or worse. The doctor will want to know

whether the child feels stiff when getting up after rest and whether the joints

are swollen. He or she will look for other causes of the symptoms, such as

whether there was any injury, another illness, such as Lyme disease, or a family

history of autoimmune diseases.

The physical examination will examine the child's joints for signs of swelling

and warmth. The joints will be checked for signs of decreased range of motion.

Muscles near the affected joints will be checked for signs of shrinkage

(atrophy).

Tests on blood, joints, and tissue fluids can help to rule out other conditions

that might cause similar symptoms. These tests may also be used to classify the

type of juvenile arthritis.

X?rays would are used to look for injuries to bone or for any unusual

development of bone.