Juvenile Rheumatoid Arthritis

Definition

Juvenile rheumatoid arthritis is a medical condition usually affecting children below 16 years and characterized by swollen, stiff and painful joints. The symptoms may resolve in some children within ust a few months or may progress to rheumatoid arthritis in others. Along with joint problems juvenile rheumatoid arthritis may lead eye problems even may interfere with normal growth and development of children.

Juvenile rheumatoid arthritis is a type of autoimmune disease, where the immune system of the body mistakenly produces antigens against self proteins and destroys them. Treatment options include drugs like methotrexate and steroids and regular exercise to improve joint function and reduce stiffness.

Symptoms

Common symptoms include :

  • Joint pain. Initially the child may not complain of pain but limps during movement especially in the morning after waking up or may avoid using the affected joints.
  • Joint swelling. Usually the symptoms starts with involvement of one of the major joints, like knee, with progression of disease other joints even all the joints of the body may be affected. The swelling is often warm and appear red.
  • Stiffness of the affected joint.

Sometimes inflammatory changes (uveitis) may occur in the eyes leading to :

  • Redness
  • Excessive tearing
  • Intolerance to light
  • Eye pain
  • Defective vision

Untreated uveitis may progress to :

  • Iridocyclitis
  • Cataract
  • Glaucoma
  • Blindness

Juvenile rheumatoid arthritis may impair growth of a child. The drug used for treatment especially corticosteroids may also hamper growth which contributes to the clinical presentation. Patients with juvenile rheumatoid arthritis often experience symptom free periods in between attacks.

Types

There are several types of juvenile rheumatoid arthritis, namely :

  • Pauciarticular (most common type): affects 4 or less joints. Usually wrist and knee joints are affected.
  • Polyarticular type which affects multiple joints, usually 5 or more joints. Joints of upper and lower limbs along with neck and jaw are affected.
  • Systemic where joints throughout the body are involved along with high fever, rashes, pale skin, swollen neck glands (lymph nodes) and weight loss.

Causes

The exact cause of juvenile rheumatoid arthritis is not known, however, it is considered as an autoimmune disease.

The immune system of the body protects the body against attack of foreign organisms by production of antibodies, various chemicals and stimulation of number of killer cells. In autoimmune diseases the immune system mistakenly recognizes self proteins as foreign and starts destroying the organ.

Synovium is the sac like structure surrounding the joints that lubricates the surfaces and prevents injury to the bony surfaces during movement.

In juvenile rheumatoid arthritis, synovium is affected at first by the immune system leading to its thickening (inflammatory damage). Gradually inflammation damages the adjacent joints, cartilages, tendons and ligaments producing symptoms of juvenile rheumatoid arthritis.

Treatment

The principal goal of treatment is to help the child maintain normal social and physical activities as much as possible. Options include :

  • Drugs:
    – Painkillers like NSAIDS.
    – Disease modifying agents to alter the progression of disease like methotrexate and sulfasalazine.
    – Immunosuppressant agents like rituximab, anakinra.
    – Corticosteroids

Physical therapy is recommended to maintain flexibility, movement of the stiff joints and muscle tone. Surgery may be required to correct deformed joints.

 

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