Juvenile Rheumatoid Arthritis Requires “Team” Treatment

Joint pain and inflammation that lasts for more than six weeks and occurs in children 16 years or younger may be a sign of juvenile rheumatoid arthritis, or JRA. JRA affects about 250,000 children in the United States.

Inflammation due to JRA causes redness, swelling, warmth and soreness in the joints. Any joint may be affected, and inflammation may limit the child’s ability to move that joint. JRA also is a major cause of blindness in children.

“The most common symptom of all types of juvenile rheumatoid arthritis is persistent joint swelling, pain and stiffness that typically is worse in the morning or after a nap,” says Robert Warren, M.D., chief of Texas Children’s rheumatology service and associate professor at Baylor College of Medicine. “The pain may limit movement of the affected joint, although many children, especially younger ones, will not complain of pain.”

The systemic form of JRA has arthritis that is accompanied by fever, rash and sometimes severe organ disease including heart and/or lung disease.

Typically, there are periods when the symptoms of JRA are better (remissions) and times when symptoms are worse (flares). JRA is different for each child – some may have just one or two flares, and then never have symptoms again, while others experience many flares or even have symptoms that never go away.

Some children with JRA may look different because they have growth problems. Depending on the severity of the disease and the joints involved, growth in affected joints may be too fast or too slow, causing one leg or arm to become longer than the other. Overall growth also may be slowed.

“No one test can be used to definitively identify a child as having JRA,” says Warren. “A doctor diagnoses JRA by carefully examining the patient, considering the patient’s history, and evaluating certain laboratory tests. X-rays are needed to evaluate bone damage or abnormal bone development.”

Much improved diagnosis of JRA in recent years has lead to improved treatment. Several types of medication are available to treat JRA, including a promising new class of drugs know as TNF inhibitors. Physical therapy also is very important to maintain muscle tone and preserve and recover the joints’ range of motion. Splints and other devices may be used to keep joints growing evenly.

Depending on the parents’ and child’s wishes and the severity of the disease, treatment may need a team of doctors, including pediatric rheumatologists, ophthalmologists, orthopedic surgeons, as well as physical and occupational therapists.

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©2006 Texas Medical Center

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