(ARJ, chronic juvenile polyarthritis, Still's disease)

What is Juvenile rheumatoid arthritis (JRA)

Juvenile rheumatoid arthritis (JRA) is a chronic disease of the joints. Chronic diseases develop over a long period of time. In this case, it begins before the age of 16.

In the ARJ, the immune system attacks the tissue that is inside the joints. This causes the joints to swell. The process causes pain and stiffness. Inflammation can cause long-term damage to the cartilage and bones. Cases can vary from mild to severe. In some cases, it can cause changes in growth and development.

There are five primary types of ARJ:

1. Pauciarticular, which affects four joints or less. Polyarticular, which affects five joints or more.
2. Systemic onset ARJ (also called Still's disease), which affects the entire body. It is the least frequent type of ARJ.
3. Arthritis associated with enthesitis, which presents inflammation of the tendons in the bones.
4. Psoriatic arthritis, which is associated with a skin disease called psorias.
5. JRA is a potentially serious condition. It requires medical attention. The faster you try, the better the result will be.

Causes of Juvenile rheumatoid arthritis (JRA)

JRA is an autoimmune disease. This means that it is the body's own immune system that causes the damage. The problems of the immune system may have their causes in genetics or in the environment.

Risk factors of Juvenile rheumatoid arthritis (JRA)

There are no clear risk factors for the JRA. In general:

• Pauciarticular ARJ: The first subtype, generally, affects girls under 7 years of age.
• The other subtype affects, in general, children over 8.
• Polyarticular JRA is more common in girls than in boys.
• Systemic onset ARJ affects boys and girls equally.
• In arthritis associated with enthesitis, risk factors include a family history of:
• Anterior uveitis with pain in the eye
• Inflammatory arthritis of the back
• Inflammatory bowel disease
• Risk factor for psoriatic arthritis: Arthritis and positive family history of psoriasis in a first-degree relative

Symptom of Juvenile rheumatoid arthritis (JRA)

If your child has any of these symptoms, do not assume it is due to ARJ. These symptoms may be caused by other less serious health conditions. Consult your doctor if your child has any of these symptoms:

• Joint stiffness, especially in the mornings or after rest periods
• Pain, inflammation, tenderness or weakness in the joints
• Fever
• Weightloss
• Fatigue or irritability
• Inflammation of eyes
• Inflamed lymph nodes

Growth problems, such as:

• Growth in the affected joints may be too fast or too slow, causing one leg or one arm to be longer than the other
• The joints grow unevenly, on one side
• Growth in general can be slow

Exclusive symptoms of the three main types of ARJ:

Pauciarticular ARJ

• It usually includes large joints, such as knees, ankles, wrists, and elbows.
• The joints are affected in an asymmetrical pattern (if the left side is affected, the right side joint is not).
• Children often develop enthesitis. It is an inflammation in the area where the tendons and ligaments attach to the bones.
• You may have eye problems.

The first subtype is:

• Associated with uveitis: a potentially serious eye condition
  Antinuclear antibody (ANA) assays usually have positive results
  The second subtype includes the bottom of the column

Polyarticular ARJ:

• Includes small joints of the fingers and hands, and joints that support the weight of the body (knees, hips, ankles and feet).
• The joints are affected in a symmetrical pattern (if the left side is affected, the same joint on the right side is affected).
• Anemia is the low red blood cell count. It is a common symptom that is observed in both subtypes.

The first subtype is characterized by:

• Presence of rheumatoid factor (FR) in blood
• Low grade fever
• Nodules (lumps in parts of the body that receive a lot of pressure, such as elbows)
• The second subtype is less serious. It only includes inflammation of the joints.

Systemic start ARJ:

• High fever and chills, usually accompanied by a rash on the thighs and chest. It appears and disappears for weeks or months. These are the first signs of systemic onset ARJ.
• Inflammation and pain in the joints with frequent.
• The heart, lungs and tissues that surround them can become inflamed.
• The lymph nodes, liver and spleen may enlarge.
• Arthritis occurs in many joints.
• Arthritis associated with enthesitis:
• Sensitivity in the sacroiliac joints is frequent. This is the joint in which the pelvis and spine meet.
• The HLA-B27 antigen test will be positive in children.
• Children will often have anterior uveitis. It is associated with eye pain, redness or photophobia (problems with light).

Psoriasic arthritis:

Swelling of the fingers or toes or marked nails. The marks are produced when liquids accumulate in the skin.
In general, there are remissions and sprouts. During remissions, symptoms improve or disappear. During the sprouts, the symptoms get worse.

Diagnosis of Juvenile rheumatoid arthritis (JRA)

There is no clear evidence to detect the JRA. The doctor will work to rule out other diseases. Your doctor will ask about your child's symptoms. It will ask about family and personal medical history. The doctor will perform a physical exam. Once your child's doctor suspects that it is ARJ or makes this diagnosis, your child can be referred to a specialist. Pediatric rheumatologists specialize in diseases of the joints. Tests may include:

• Diagnostic imaging techniques (such as X-rays)
• Laboratory tests for blood, urine, and / or joint fluid, for:
• Discard physical injuries, viral or bacterial infection, other inflammatory diseases, such as Lyme disease,
• inflammatory bowel disease, psoriasis, lupus, dermatomyositis, and some forms of cancer
• Determine which subtype of JRA is present
• Ophthalmological examinations: to rule out inflammatory problems of various parts of the eye

Treatment of Juvenile rheumatoid arthritis (JRA)

Talk to your doctor about the best plan for your child. The objective is to preserve a high level of physical and social performance, and maintain a good quality of life. The plan will be useful in controlling inflammation, relieving pain, preventing or controlling joint damage, and maximizing joint activity. Options include the following:

Medicines

Several types of medications are available to treat JRA:

• Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, diclofenac or tolmetin
• Disease-modifying antirheumatic drugs (DMARD), such as methotrexate to slow the course of the disease
• Corticosteroids: via I. V. (directly in the vein) or by mouth, for inflammation and swelling
• Modulators of the immune response, as inhibitors of TNF, for cases that do not respond well

Physiotherapy

Exercises are performed to maintain muscle strength. It also helps to preserve and regain the range of motion of the joints. It is recommended to perform normal daily activities, such as non-contact sports and recreational activities. Physiotherapy could be used to maintain strong muscles and joint mobility. Children can also develop confidence in their physical abilities through such activities.

Maintenance devices

Splints and other devices are used to maintain normal growth of bones and joints. They can also help prevent contractures due to flexion (permanently bent joints).

Prevention of Juvenile rheumatoid arthritis (JRA)

There is no way to prevent the JRA.