• Diseases&Conditions
• Procedures & Tests
• Injuries & Symptoms
• Special Topics
• Nutrition

Juvenile rheumatoid arthritis, or JRA, is a condition characterized by joint inflammation and stiffness in children under the age of 16.

What is going on in the body?

JRA is an autoimmune disorder. This is a condition in which the body's immune system directly attacks or produces antibodies against its own tissues. The autoimmune response can attack the joints, eyes, heart, liver, and other body organs.

What are the signs and symptoms of the disease?

Children with JRA have joint inflammation and stiffness. The inflammation makes the joints red, warm, sore, and swollen. Some children with JRA have joint pain, while many do not. There are three kinds of JRA, each with its own characteristic symptoms.

• About half the children with JRA have a pauciarticular form of the disease. This type involves four or fewer joints. It usually involves large joints, such as the knees. Twenty to 30% of the children with this form of JRA have eye disease. They may have iritis, which is inflammation of the colored part of the eye. Some have uveitis, which involves the inner eye.

• The polyarticular form of JRA is found in about 1/3 of the children with JRA. This form involves five or more joints. It usually involves small joints, such as those in the hands and feet. It often involves the same joints on either side of the body. For example, it may involve the large joint of each thumb. Some children with polyarticular JRA have a special antibody called IgM rheumatoid factor. These children have a more severe form of JRA, similar to adult rheumatoid arthritis.

• About 20% of the children with JRA have a systemic, or bodywide, form of the disease. This is also known as Still's disease. Children with this form may have inflammation and stiffness of most or all their joints. In addition, the child may have high fevers and light pink rash. Still's disease may also affect the heart, liver, spleen, and lymph nodes. .

What are the causes and risks of the disease?

Juvenile rheumatoid arthritis is an autoimmune disorder. Many experts believe that this autoimmune response in children has two parts. Some children may have a genetic makeup that makes them vulnerable to the condition. When these children are exposed to a factor in the environment, such as a virus, it triggers the autoimmune response of JRA.

What can be done to prevent the disease?

There are no known ways to prevent JRA.

How is the disease diagnosed?

• antibody titer and other blood tests
• joint aspiration, in which a thin needle is used to get a sample of joint fluid for study in the lab
• joint X-rays

What are the long-term effects of the disease?

JRA may cause severe joint abnormalities and arthritis. This may make a child unable to participate in regular activities. The child's growth may be slow, and limbs may be uneven in length. Severe eye damage may cause blindness and other visual impairments.

What are the risks to others?

JRA is not contagious and poses no risk to others.

What are the treatments for the disease?

• corticosteroids, such as prednisone, that suppress the immune response
• disease-modifying antirheumatic medicines, such as methotrexate and biologic agents (such as etanercept {i.e., Engrel})
• nonsteroidal anti-inflammatory medicines, or NSAIDs, such as ibuprofen (i.e., Advil, Motrin), naproxen (i.e., Aleve, Naprosyn), diclofenac (i.e., Cataflam, Voltaren), and tolmetin

Physical therapy can be used to maintain joint function and mobility. Occupational therapy can teach the child to use adaptive equipment or methods for activities of daily living. Rarely, surgery is needed to correct severe joint deformities.

What are the side effects of the treatments?

The medicines used to treat JRA may cause stomach upset, allergic reactions, and increased risk for infection. Corticosteroids may cause weight gain and slow growth. During surgery, the medicines can increase the risk of abnormal bleeding and infection

What happens after treatment for the disease?

The course that JRA takes is hard to predict. It may go away for long periods of time or permanently. If the disease goes away, no further treatment is usually required. Some children continue to have the disease as adults and require lifelong treatment.

When the child's symptoms are under control, an exercise program tailored to fit his or her disabilities is important. Sports for children with disabilities can promote social interaction with exercise.

How is the disease monitored?

The child will have regular visits with the healthcare provider. Blood tests, joint X-rays, and eye exams may be done regularly. Any new or worsening symptoms should be reported to the healthcare provider.