Juvenile Arthritis Symptoms
The American College of Rheumatology defines juvenile arthritis as a
chronic condition that causes inflammation in one or more joints and begins before the age
of 16. There are several different symptom patterns of juvenile arthritis. Though all have
joint inflammation in common, they behave very differently and may require different
Juvenile Arthritis Symptoms
- Systemic onset type begins with very high fevers, frequently as a skin rash and
shows evidence of inflammation in many internal organ systems as well as the joints. About
10 percent of children with arthritis have this type.
- Pauciarticular onset disease affects fewer than five joints. About half of all
children with arthritis are in this category. Some of these are very young, from infancy
to about age 5, and have a risk of developing inflammatory eye problems. Regular eye exams
- Polyarticular disease affects more than five joints (often many more), and can
begin at any age. Some of these children have adult-type rheumatoid arthritis that begins
at an earlier age than usual.
We usually think of arthritis as an old person disease, said
Robert S. Katz, MD, a Rheumatologist with Rheumatology Associates in Chicago. But
arthritis, especially rheumatoid arthritis, can happen at any age. Even a baby can have
inflammation of a joint that could be rheumatoid arthritis.
How is juvenile rheumatoid arthritis symptoms different from adult rheumatoid
Although children can develop many of the same types of arthritis that affect adults,
the most common in children is juvenile rheumatoid arthritis (JRA). According to the National
Institute of Arthritis and Musculoskeletal and Skin Disease, the main difference
between juvenile and adult rheumatoid arthritis is that many children with JRA outgrow the
illness, while adults usually have lifelong symptoms. Studies estimate that by adulthood,
JRA symptoms disappear in more than half of all affected children. Additionally, unlike
rheumatoid arthritis in an adult, JRA may affect bone development as well as the child's
Another difference between JRA and adult rheumatoid arthritis is the percentage of
patients who test positive for the rheumatoid factor (RF). RF is an antibody found in the
blood of many people with rheumatoid arthritis and is believed to play a role in tissue
destruction associated with this disease. The Yale University School of Medicine
Patients Guide to Medical Tests shows about 70 to 80 percent of adults with
rheumatoid arthritis show signs of RF, but fewer than half of all children with rheumatoid
arthritis are RF positive. Presence of the RF factor means theres an increased
chance that JRA will continue into adulthood.
What causes juvenile arthritis Symptoms?
The causes of juvenile arthritis are unknown, according to the American College
of Rheumatology. The cause of juvenile arthritis is thought to be associated
with an autoimmune problem, said Dr. Katz. Some genetic markers are more common in
certain types of childhood arthritis or in children who develop particular complications
from it. These conditions are not regarded as hereditary and rarely affect more than one
What are the symptoms of juvenile rheumatoid arthritis?
The most common symptom of JRA is persistent joint swelling, pain, and stiffness that
are typically worse in the morning or after a nap. The pain may limit movement of the
affected joint, although many children, especially younger ones, will not complain of
pain. JRA commonly affects the knees and joints in the hands and feet. One of the earliest
signs of JRA may be limping in the morning because of an affected knee. Besides joint
symptoms, children with systemic JRA may have a high fever and a light pink rash. The rash
and fever may appear and disappear very quickly. Systemic JRA also may cause the lymph
nodes located in the neck and other parts of the body to swell. In some cases, internal
organs including the heart and very rarely the lungs may be involved.
If your child has swelling of a joint over an extended period of time and pain is
persistent, youll want to have your child see your family physician or the
childs pediatrician, Dr. Katz said. Your primary care physician may refer you to a
specialist, such as a Pediatric Rheumatologist.
Eye inflammation is a potentially severe complication that sometimes occurs in children
with pauciarticular JRA. Eye diseases often are not present until some time after a child
first develops JRA.
Typically, there are periods when the symptoms of JRA can be in remission and times
when symptoms flare up. JRA is different in each childsome may have just one or two
flare ups and never have symptoms again, while others experience repeated flare ups or
even have symptoms that never go away.
How is juvenile rheumatoid arthritis symptoms diagnosed?
The American College of Rheumatology reports that juvenile arthritis may
be difficult to diagnose because children often compensate well for loss of function and
may not complain of pain. Observations of limping, stiffness when awakening, reluctance to
use a limb or reduced activity level may be clues. Tests commonly positive in
adult arthritis (rheumatoid factor in the blood or changes on x-rays) are often
negative in childhood types. A number of other conditions can mimic juvenile
arthritis, such as infections, childhood malignancies, musculoskeletal conditions or other
less common rheumatic diseases, and further evaluation to exclude these may be necessary
before a diagnosis is confirmed.
Who treats juvenile rheumatoid arthritis symptoms?
A pediatrician, family physician, or other primary care doctor frequently manages the
treatment of a child with JRA, often with the help of other doctors. Depending on the
patient's and parents' wishes and the severity of the disease, the team of doctors may
include pediatric rheumatologists (doctors specializing in childhood arthritis),
ophthalmologists (eye doctors), orthopaedic surgeons (bone specialists), and Physiatrists
(rehabilitation specialists), as well as physical and occupational therapists.
The main goals of treatment are to preserve a high level of physical and social
functioning and maintain a good quality of life. To achieve these goals, doctors recommend
treatments to reduce swelling; maintain full movement in the affected joints; relieve
pain; and manage complications.
Several types of treatment
There are some very effective treatments now available for children with arthritis. The
American College of Rheumatology reports that the choices of drugs for
children are similar to those for adult arthritis and include nonsteroidal
anti-inflammatory agents such as ibuprofen and slower acting agents such as methotrexate,
sulfasalazine, and hydroxychloroquine for more severe cases. The doses must be adjusted
for the size and gender of the child. Certain drugs such as steroids (cortisone) must be
used with caution because of adverse effects on growth and other side effects. Some drugs
for adults are not FDA-approved for use in children.
In addition to medications, physical therapy can be an important part of a child's
treatment plan. Exercise can help to maintain muscle tone and preserve and recover the
range of motion of the joints. A physical therapist can design an appropriate exercise
program for a child with JRA. The physical therapist also may recommend using splints and
other devices to keep joints growing evenly.
What are researchers trying to learn about juvenile rheumatoid arthritis?
Scientists are investigating the possible causes of JRA. Researchers suspect that both
genetic and environmental factors are involved in development of the disease. To help
explore the role of genetics, the National Institute of Arthritis and Musculoskeletal and
Skin Disease has established a research registry for families in which two or more
siblings have JRA. The institute also funds a Multipurpose Arthritis and Musculoskeletal
Diseases Center that specializes in research on pediatric rheumatic diseases, including
Research scientists are continuing to try to improve existing treatments and find new
medicines that will work better with fewer side effects.