English | Español

Home > Diseases > Disease Center

Juvenile Rheumatoid Arthritis

What are the effects?

There are three types of juvenile rheumatoid arthritis.

Pauciarticular JRA

Pauciarticular means "few joints." This form of JRA affects 4 or fewer joints. About 50% of all children with JRA have this type. Usually, large joints (knees, ankles or elbows) are most often involved. Other joints such as wrists, spine and even small finger or toe joints can also be affected but less commonly. Pauciarticular JRA often affects a particular joint on one side of the body rather than both sides at the same time (both sides involved is called "symmetrical arthritis").

There are two different types of pauciarticular JRA: one type usually affects little girls under age 7 and is associated with the development of eye inflammation (chronic iridocyclitis or uveitis) in about 1/3 of these children. These children should be tested for antinuclear antibodies (ANA). This tells the rheumatologist and the ophthalmologist (eye doctor) whether your child has a higher risk of developing uveitis (when the ANA is positive the risk is higher). Unfortunately, this eye condition is silent so only proper monitoring by an eye doctor who is familiar with this complication of JA may find the changes in the eyes.

The second type of pauciarticular JRA usually affects boys who are somewhat older, typically after age 8 and tends to involve the lower spine (sacroiliac joints), hips, knees, ankles and tendons. Sometimes, the spots at which tendons and ligaments attach to bones are also inflamed (enthesitis). These children may also develop eye problems, but this is usually acute uveitis (rather than chronic uveitis) and often causes redness and pain in the eyes. This type of JRA may be the first sign of another arthritis-related condition, such as one of the spondyloarthropathies. This group of diseases usually affects the spine, tendons, and eyes, and is associated with a genetic factor, HLA-B27 in some people.

Long-term problems due to pauciarticular JRA are seen in some of the children affected. Many children have no long-term consequences due to this illness. However, chronic damage can occur in the eyes and the eye problems may be much more persistent than any joint problems. On the other hand, some children develop chronic joint problems. This can include: decreased range of motion of a joint, shortening or lengthening of a limb or digit, damaged cartilage and/or enlargement of a joint. In some children, the arthritis spreads to other joints. These children are said to have "extended pauciarticular JRA" which is similar to polyarticular JRA. Speak to your doctor if you have questions or concerns about any of these issues.

Polyarticular JRA

Polyarticular means many joints; this form of arthritis affects five or more joints. Girls are affected by polyarticular JRA more frequently than boys. When polyarticular JRA affects teenagers, it often resembles RA.

Polyarticular arthritis usually affects the small joints of the fingers and hands; it can also affect weight-bearing joints (including the knees, hips and ankles) as well as the neck and jaw. Polyarticular JRA often affects the same joints on both sides of the body (symmetrical arthritis). Other possible symptoms might include: low grade fever, a positive blood test for rheumatoid factor (RF), and/or nodules (bumps on an elbow or other point of the body that receives a lot of pressure from chairs, shoes or other objects). Less often, inflammation of internal organs may occur. Anemia (low red blood cell count) is a common problem for these children.

Children with polyarticular JRA, especially the younger girls with a positive ANA, are at risk to develop chronic uveitis just like those with pauciarticular disease. Ophthalmologists should evaluate these children too.

Children with polyarticular JRA may develop damage to some of their joints. For example, slower growth may occur in the jaw due to arthritis in the TMJ (temporomandibular joint). This may cause jaw pain and discomfort with chewing. It may also affect dental care and eating habits. This may affect how well your child grows.

In the spine, neck stiffness and difficulty turning the head side to side may occur. Special x-rays can help your doctor determine if arthritis has developed in these areas.

Since polyarticular JRA affects many more joints than is seen with pauciarticular JRA, your doctor may need to use several different medications (often taken together) to treat your child successfully.

Systemic Onset JRA

A systemic illness is one that affects the entire person or body systems. This is the least common form of JA. Boys and girls are equally likely to have systemic onset JRA. This type of JA is associated with high fevers, a rash, arthritis and, in some children, inflammation of internal organs. For some children the systemic symptoms of the disease and the fever may go away completely after the first few months of the illness, although the joint-related symptoms of arthritis may remain for a longer period of time.

Symptoms of systemic onset JRA usually include: daily high spiking fevers (103 degrees or higher) that may last for weeks or even months; a rash of pale red or pink spots that appear on the child's chest, thighs and sometimes other parts of the body (the rash may accompany the fever and may come and go for many days in a row); joint pain and inflammation that may accompany the fever or begin weeks or months later. Joint problems can become a major long-term symptom. Other possible features of this form of arthritis include inflammation of the outer lining of the heart (pericarditis) or the lungs (pleuritis); anemia and high white blood cells and platelets (cells that help with clotting); and enlarged lymph nodes, liver or spleen. Blood work is usually checked frequently in the first few weeks and months of this illness to watch your child closely.

In about half the children with systemic JRA, the illness seems to disappear within 1 year of onset. Flare-ups, or a return of the illness, can happen without warning or after some viral infections (mononucleosis and chicken pox, for example). In most children with systemic JA, medications must be used for months to years to control both parts of this illness - the systemic part (fever, rash, anemia, etc.) as well as the arthritis.

Long term problems due to systemic JRA are similar to polyarticular JRA. Uveitis, however, is uncommon, so the eyes only need to be checked only once a year in these children.

Nebo Web Design CMS Tracking