Arthritis has many causes and can present in children in the form a subtype referred to as Juvenile Rheumatoid Arthritis or Juvenile Idiopathic arthritis. Idiopathic, in general, means that no cause can be attributed to the disease, and juvenile in this case refers to the below 16 age group.
Juvenile rheumatoid arthritis (JRA) is an autoimmune disease and may present as a transient, self-limiting or chronic illness. The presentation of JRA amongst different children varies, however the symptoms persistently seen include pain and swelling in the affected joints, lethargy, poor appetite, limping, disinterest in physical activity and often flu like symptoms. The joints most commonly seen involved include the small joints of the hands, knee joints, and ankle and wrist joints. Another commonly presenting symptom is pain, the intensity of which varies subjectively. Many patients also complain of morning stiffness that typically lasts an hour and is seen to consistently improve as the day passes by and daily activity progresses.
Juvenile rheumatoid arthritis also is often accompanied by various extra articular manifestations, which commonly include iridocylcitis (a disease involving the eye, which is often asymptomatic and is detected through slit lamp examination: hence the need for regular eye examinations in children suffering from JRA). JRA is often classified into three subtypes, depending on the number of joints involved. Pauciarticular disease affects less than 5 joints, and the larger joints like knee, shoulder and elbow are most commonly seen to be involved. This is the most common type of JRA and is commonly seen to affect children under the age of 8. Children above 8 years of age, if develop Pauciarticular disease, are believed to be more prone to having arthritis in adulthood as well. Pauciarticular JRA is often seen to involve the eye and frequent eye examinations are warranted in this case.
About 30% children develop Poly-articular disease; this includes involvement of 5 or more joints. The small joints of the hands and feet are frequently involved and this disease is very similar to adult onset arthritis in its presentation and signs/symptoms. About 20% of the cases presented with a much advanced form of the disease with Systemic involvement, sometimes referred to as Stills Disease. This type of JRA presents with involvement of multiple organs in the body including the liver, heart and spleen and children present with a variety of manifestations including skin rashes, high grade fevers etc.
Juvenile rheumatoid arthritis can be challenging to diagnose as there is no one gold-standard test available for the diagnosis of JRA. Doctors often prefer to use a combination of blood tests measuring inflammatory markers and different autoimmune markers, along with x-rays and physical presentation of the patient. Several criteria have also been developed to ease the diagnosis of JRA. The treatment of JRA is best undertaken by a group of specialists including the primary physician ideally a pediatric rheumatologist, nurse specialists, rehab specialists and occupational therapists. The main aim of treatment is to educate parents, siblings and patients themselves adequately about the disease and help the affected individuals remain pain free and regain as much physical activity as possible.
