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Juvenile rheumatoid arthritis (JRA) is a term used to describe a common type of arthritis in children. It is a long-term (chronic) disease resulting in joint pain and swelling.
Juvenile chronic polyarthritis; JRA; Still's disease; Juvenile idiopathic arthritis
The cause of JRA is not known. It is thought to be an autoimmune illness. In this type of condition, the body's immune system mistakenly attacks and destroys healthy body tissue.
JRA usually occurs before age 16.
It is divided into several categories:
Many other medical problems can cause symptoms similar to those of juvenile rheumatoid arthritis, including:
Body-wide JRA symptoms:
JRA can also cause eye inflammation called uveitis. This problem can occur without any eye symptoms, or someone may have:
The physical examination may show swollen, warm, and tender joints that hurt to move. The child may have a rash. Other signs include:
Blood tests may include:
Any or all of these blood tests may be normal in patients with JRA.
The doctor may need to tap a joint. This means putting a small needle into a joint that is swollen. This can help to find the cause of the arthritis. By removing fluid, the joint may feel better, too. Sometimes, the doctor will inject steroids into the joint to help decrease the swelling.
When only a small number of joints are involved, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be enough to control symptoms.
Corticosteroids may be used for more severe flare-ups to help control symptoms.
Children who have arthritis in many joints, or who have fever, rash, and swollen glands may need other medicines. These medicines are called disease-modifying antirheumatic drugs (DMARDs). They can decrease or prevent swelling or inflammation in the body. DMARDs include:
It is important for children with JRA to stay active and keep their muscles strong. Walking, bicycling, and swimming may be good activities. Children should learn to warm up before exercising.
Support and help for children who experience sadness or anger about their arthritis is also very important.
Some children with JRA may need surgery, including joint replacement.
JRA is seldom life threatening.
Children who have many joints involved, or who have a positive rheumatoid factor are more likely to have chronic pain and poor school attendance, and to be disabled.
Long periods with no symptoms are more common in those who have only a small number of joints involved. Many patients with JRA eventually go into remission with very little loss of function and deformity.
For additional information and resources, see arthritis support group.
Call for an appointment with your health care provider if:
There is no known prevention for JRA.
Miller ML, Cassidy JT. Juvenile rheumatoid arthritis. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007: chap 154.
Lovell DJ, Ruperto N, Goodman S, Reiff A, Jung L, Jarosova K, et al. Pediatric Rheumatology Collaborative Study Group: Pediatric Rheumatology International Trials Organisation. Adalimumab with or without methotrexate in juvenile rheumatoid arthritis. N Engl J Med. 2008;359:810-820.
Cespedes-Cruz A, Gutiérrez-Suárez R, Pistorio A, Ravelli A, Loy A, Murray KJ, et al. Pediatric Rheumatology International Trials Organization (PRINTO). Methotrexate improves the health-related quality of life of children with juvenile rheumatoid arthritis. Ann Rheum Dis. 2008;67:309-314.
Ravelli A, Martini A. Juvenile idiopathic arthritis. Lancet. 2007;369:767-778.