HEALTH GUIDE INDEX / A / ARTHRITIS, JUVENILE RHEUMATOID

BASIC INFORMATION

DESCRIPTION

An inflammatory disease of connective tissue, mostly joints, that affects children. May be confused with the arthritis of Lyme disease. Joints usually involved are the knees, elbows, ankles and neck. It also can involve adjacent muscles, cartilage and membranes lining the joints. JRA starts at 2 to 5 years, and often disappears by young adulthood. It is 4 times more frequent in girls.

FREQUENT SIGNS AND SYMPTOMS

  • Pain, swelling and stiffness in the toes, knees, ankles, elbows, shoulders or neck joints. The pain may begin suddenly or gradually and may involve only one or many joints. The child may refuse to walk without being able to explain why.
  • Daily temperature rises to about 103° F (39.4° C) usually in the evening. Fever is frequently accompanied by a body rash and chills.
  • Poor appetite, weight loss.
  • Anemia.
  • Irritability, listlessness.
  • Swollen lymph glands.
  • Eye pain and redness.
  • Chest pain is severe enough to affect the heart.

    • CAUSES

    Probably caused by an autoimmune disorder in which the body's immune system attacks its own normal tissues. The first symptoms often are associated with physical or emotional stress.

    RISK INCREASES WITH

    An inherited tendency.

    PREVENTIVE MEASURES

    Cannot be prevented at present.

    EXPECTED OUTCOMES

  • Juvenile rheumatoid arthritis is currently considered incurable. However, in 75% to 80% of cases, the disease is in complete remission by puberty or young adulthood.
  • Attacks usually last a few weeks and occur off and on throughout childhood. Symptoms can usually be controlled with treatment.

    • POSSIBLE COMPLICATIONS

  • Involvement of tissues other than joints, producing uveitis (eye inflammation), an enlarged spleen, pericarditis or inflammation of the heart muscle.
  • Permanent joint deformity.

    • TREATMENT

    GENERAL MEASURES

  • Laboratory blood studies, including autoimmune assays.
  • X-rays of the involved joints. Changes may not appear on X-rays until the late stages.
  • Psychotherapy or counseling to help the family cope with the child's long-term illness. Emotional support may be the most important factor in a child's treatment.
  • Surgery to correct deformed joints (sometimes).
  • If the child doesn't have a firm mattress, place 3/4-inch plywood between the box springs and mattress to provide better support.
  • Request eye examinations at least twice a year to detect uveitis.
  • It is important for children to attend regular school on a daily basis. Where necessary, the school system should provide extra services to accommodate the child's needs.
  • Additional information available from the American Juvenile Arthritis Foundation, 1314 Spring Street N.W., Atlanta, GA 30309. Telephone (800)283-7800.

    • MEDICATIONS

  • Aspirin or other nonsteroidal anti-inflammatory drugs to reduce pain and inflammation.
  • Disease-modifying antirheumatic drugs, corticosteroids or gold salts may be prescribed.

    • ACTIVITY

  • During an attack, keep the child in bed, except to use the bathroom, until fever and other symptoms subside.
  • Splints may be necessary to support and protect an inflamed joint.
  • After an attack passes, the child may gradually resume normal activities with rest periods during the day. The child should not become overtired and should sleep at least 10 to 12 hours each night.
  • Physical therapy exercises will be prescribed. Some the child can do alone, and some the parents will perform for the child. It is important that the child does the exercises because they help minimize pain and the crippling effects of rheumatoid arthritis.
  • Because of periodic changes in the symptoms, the physical therapy program will need revising occasionally.
  • In general, contact sports should be avoided, but the child should be encouraged to participate in other school, home or community activities.

    • DIET

    Provide a nutritious, balanced diet and encourage the child to eat.

    NOTIFY YOUR PHYSICIAN IF

    • Your child has symptoms of juvenile rheumatoid arthritis.
    • The following symptoms occur during treatment:
      • Chest pain or fever.
      • Appetite loss.
    • New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
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