Juvenile rheumatoid arthritis (JRA), formally known as juvenile idiopathic arthritis (JIA), is one of the most common chronic diseases in childhood and the etiology is unknown to date. This childhood arthritis is highlighted by joint swelling, fevers, and a salmon-pink skin rash. The arthritis must be present for at least six weeks before a diagnosis can be made in individuals younger than 16 years of age.
Joint pain is usually not the predominant symptom in this disease, but children often present with joint deformities such as contractures or decreased range of motion because they do not want to use their joints properly. Common physical behaviors such as limping in the morning or the inability to stand in the crib after an afternoon nap should be red flags for the development of JIA.
A tricky diagnosis
Diagnosing JIA can be tricky, as no specific laboratory test or imaging study can rule in or rule out this rheumatologic disease. A very detailed history and physical examination are needed to clinically diagnose JIA. This rheumatoid chronic disease often goes undiagnosed, leaving children not wanting to bear weight on their joints, causing them to become weak and to miss out on school and physical activities.
Other disorders that can often resemble JIA are systemic lupus, acute lymphoblastic leukemia, and pediatric sarcoidosis. Once JIA is diagnosed, there are many treatment modalities that can be used to help with the inflammation to prevent joint damage and to decrease pain (if the child is presenting with pain).
Pharmacological treatments and physical therapy
Treatment approaches to juvenile idiopathic arthritis include pharmacologic therapy, physical therapy and psychosocial therapy. Pharmacologic therapy includes non-steroidal anti-inflammatory medications commonly known as NSAIDs, which include agents such as ibuprofen and ketorolac. NSAIDs work to alleviate pain and reduce inflammation without having adverse effects on the child’s immune system or adrenal system.
Other agents that can be used if NSAIDs are not effective are disease-modifying antirheumatic drugs (DMARDs) such as methotrexate. These agents can lower the immune response and, as a result, the individual is at increased risk of infections.
Other pharmacological agents include intra-articular steroids, which help with acute flare-ups.
Physical therapy can greatly increase range of motion and strength in patients with JIA. Strength training, range of motion exercises and even recreational activity such as physical education classes, sports and outdoor activities are great ways to prevent this chronic disease from worsening.
Addressing psychosocial issues
This disease can be life altering such that children may not want to attend school due to excessive fatigue, fevers, or joint pain and swelling and, as a result, addressing the psychosocial underlying issue is a very important part of the treatment plan. Both the parents and the children can benefit from counseling so they understand the full gravity of this disease. Pediatric chronic diseases can have dramatic effects on the family unit and it is important to counsel and provide emotional support to the parents as well as the pediatric patient. Attending a counseling session can provide tips and support on how to cope with the multiple doctor visits, communicate with teachers and school, and provide positive support to the child.
July is Juvenile Arthritis Awareness Month, and this chronic disease often goes unrecognized. By shedding light on this disease and providing a full spectrum of treatment options, this condition can become more recognized by the general public.
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About the author
Kristen Fuller, M.D., is a senior staff writer and enjoys writing about evidence-based topics in the cutting-edge world of medicine. She is a physician and author, who also teaches, practices medicine in the urgent care setting and contributes to medicine board education. She is also an outdoor and dog enthusiast.