What is juvenile rheumatoid arthritis?
Juvenile rheumatoid arthritis (JRA) is the continuous inflammation and stiffness of one or more joints, lasting longer than six weeks, for which no other cause can be found. It occurs in children six months to 16 years old. Juvenile rheumatoid arthritis is not caused by an injury or other illness, although another illness may be partially responsible for its onset.
The majority of children with this illness are affected in only a few joints, while a minority have arthritis affecting many joints. Some children are affected in areas other than joints, such as eyes, skin, tendons and body tissues, all to varying degrees.

Unlike adult rheumatoid arthritis, which is chronic and lasts a lifetime, children often experience periods of remission and can eventually become free of symptoms. However, the disease can affect bone development in the growing child.

How common is juvenile rheumatoid arthritis?
Juvenile rheumatoid arthritis affects more than 50,000 children in the United States, about one in 1,000, and is more frequent in girls than in boys. JRA is among the most common of chronic childhood disorders.

What causes juvenile rheumatoid arthritis?
Like adult rheumatoid arthritis, JRA is an autoimmune disease, which means the body's immune system stops working properly and attacks its own healthy cells and tissues. (The immune system's job is to fight off germs and disease.)
The exact cause of juvenile rheumatoid arthritis is unknown, as experts are not sure why the body creates inflammation and stiffness in joints and other areas. Researchers believe that something in the environment, such as a virus, may trigger the illness in children who already have certain genes. It appears that the arthritis is probably caused by a reaction of the body against its own joint tissues.
Juvenile rheumatoid arthritis is considered a multifactoral condition, meaning that "many factors" are involved. These factors include a combination of genes from both parents, and environmental factors, some of which may be unknown, to produce the trait or condition.
Juvenile rheumatoid arthritis is not contagious, so you cannot catch it from someone else. The illness does not usually run in families and cannot be passed from one person to another.
 
How is juvenile rheumatoid arthritis diagnosed?
If your doctor suspects JRA, he or she will probably refer your child to a pediatric rheumatologist. This specialist will give your child a physical, ask about symptoms, review the medical history, take blood tests, and possibly order X-rays. The lab tests will not diagnose the JRA, but can help to rule out other causes for your child's symptoms and help the doctor to classify the type of JRA. Your child may be diagnosed with JRA if he or she has symptoms for longer than six weeks and no other causes have been identified.
Some children with systemic JRA may have high fever, rash and lymph node enlargement, initially, with no joint involvement. While these children may go on to develop arthritis at a later time, the systemic symptoms usually come first. 
What are the types of juvenile rheumatoid arthritis?
Children can develop almost all types of arthritis that affect adults. But the most common type in children is juvenile rheumatoid arthritis. JRA is divided into subtypes, based on the number of joints involved during the first six months of the illness. These subtypes help to define the type of arthritis your child has. The three most common types are:

Pauciarticular JRA
This is the most common form of JRA, accounting for about half of the cases. It affects four or fewer joints, commonly the large joints, such as the knees. Ten to 20 percent of children with pauciarticular JRA also develop inflammation in the eyes, called uveitis, which can lead to vision loss. It is therefore important that a child with this condition see an ophthalmologist regularly. Many children with pauciarticular JRA grow out of the condition by adulthood.

Polyarticular JRA
This form of JRA affects five or more joints, including both small joints (hands and feet) and larger ones (knees and shoulders). It frequently affects the same joints on either side of the body. Polyarticular JRA is more likely to persist beyond childhood, and accounts for thirty percent of all JRA cases. Children with polyarticular JRA often become anemic (the condition of having less than the normal number of red blood cells).

Systemic JRA
Alsoknown as Still's disease, systemic JRA is the least common and most serious form of the illness. It can cause joint pain and swelling, a high fever (103 degrees F or higher), and a light rash on the chest, thighs, or other parts of the body. It can also cause inflammation of the liver, spleen, and lymph nodes. A child with systemic JRA may become anemic. He or she may also continue to have rheumatoid arthritis into adulthood.

Is JRA Hereditary?
While it is very unusual to see two cases in the same family, some genes seem to increase the chance of developing JRA. However, arthritis is almost never passed from a parent to a child. Therefore, the chance of your child passing the illness on to his or her children is extremely rare.

What are the warning signs of juvenile rheumatoid arthritis?
Because children do not always complain of pain, it may be difficult to tell if your child's joints are inflamed. If your child has juvenile rheumatoid arthritis, warning signs might be: stiffness when waking up; walking with a limp; or having trouble using an arm or leg.

The following are the most common symptoms of juvenile rheumatoid arthritis. (However, each child may experience symptoms differently.)

Swollen, stiff and painful joints, especially in the morning or after a nap (joints in the knees, hands and feet are most commonly affected).
Decreased use of one or more particular joints.
Fatigue.        
High fever and rash, if systemic juvenile rheumatoid arthritis.
Swollen lymph nodes, if systemic juvenile rheumatoid arthritis.
Eye inflammation.
Decreased appetite, poor weight gain, and slow growth.

Other problems may occur but might not be noticeable right away. For instance, inflammation in a knee might cause one leg to grow more slowly than the other. While inflammation might also be affecting your child’s eyes, he or she might not be aware that something is wrong. The inflammation associated with juvenile rheumatoid arthritis can be worse at some times (called flares-ups) and appears to go away at others (called remissions).

Symptoms of juvenile rheumatoid arthritis may resemble other medical conditions or problems. Always consult your child's physician for a diagnosis.

Will JRA affect my child's growth?
One of the unique issues in JRA is the effect of inflammation on the growing child. Occasionally, if the arthritis is severe, a slowing of growth may occur. The growth will usually return to normal once the arthritis has improved. In addition, there may be changes in the growth of the individual joints that are affected by arthritis. For example, knee inflammation may cause the corresponding leg to grow slightly faster than the other leg. Jaw inflammation may result in a small chin. Your healthcare team will pay careful attention to all aspects of your child's growth.

How long will it last?
About 50 percent of children with juvenile rheumatoid arthritis recover after several months to three or four years. In about 15 percent of the cases, the arthritis may be severe from onset, or may become severe later. At the time of onset, it is very difficult to predict how long the illness will last. In many children, the inflammation may become inactive after a number of years. In some children there will be damage to growing joints, and these effects may persist into adult life, causing difficulties with movement and joint use.
Some children have only one or a few joints affected, and the illness is easy to control. With others, it is more severe and difficult to control. Early aggressive treatment with medication, physical therapy and other methods can prevent crippling and enable your child to grow into a productive adult.
Can it be cured?
While there is no known cure for JRA, there are many effective treatments for the illness, and many children outgrow the symptoms. Long-term use of drugs in children who begin treatment promptly is now known to reverse the course of the illness. Approximately half of all JRA patients still have the illness after 10 years. For others, the illness can go into remission, then come back in adulthood. As more research is done into various treatments for JRA, more and more children are becoming symptom free.

How is JRA treated?
The majority of children with juvenile rheumatoid arthritis will require medications at one time or another. Medications play a major role in the management of JRA. The goal of treatment is to reduce swelling, relieve pain, help your child maintain movement in his or her joints, and deal with any complications. Your pediatric rheumatologist will most likely prescribe drugs to relieve the inflammation and to slow or prevent joint damage. Options include nonsteroidal anti-inflammatory drugs (NSAIDS), disease-modifying anti-rheumatic drugs (DMARDS), corticosteroids and biologic agents. Your child may need to try several different kinds of drugs before finding the most effective treatment with the fewest side effects.

Because some children take a combination of medications, it may take time before the right combination of medications is reached. Changes will be made from time to time, depending on the development of your child's JRA, as well as side effects from the illness. Treatment must be individualized because your child may respond to a drug differently than does another child with the same arthritis type.

The doctor may also recommend exercises or suggest physical therapy sessions to help your child maintain muscle tone and range of motion in the joints. Swimming is by far the best exercise for your child. Other exercises that are not stressful on the joints can also be very helpful. (Please see “Treatment” in the website for other options.”

Will a special diet help?
A normal well-balanced diet is always recommended. Juvenile rheumatoid arthritis increases your child's risk of osteoporosis (a condition in which the bones are weak). In addition, long term treatment for JRA can deplete bone mass. To minimize osteoporosis during treatment, experts recommend adequate daily intake of vitamin D and calcium.    

500 mg for children 1 to 3 years old.
800 mg for children 4 to 8 years old.
1,300 mg for children, age 9 and older.

Foods high in calcium include dairy products such as milk, cheese, yogurt, calcium-fortified orange juice, and broccoli. Vitamin D is found in dairy products. Exposure to sunlight without sunscreen for at least 15 minutes each day will also help with vitamin D intake.

How active should my child be?
No matter how severe the JRA, your child should take part in household chores, school, social and sport activities, as these are important for physical improvement and emotional development.

Will my child be able to go to school?
Most children with juvenile rheumatoid arthritis are able to participate in regular school activities. A few children require modifications such as being exempted from some competitive sports. Determined children often rise above pain and discomfort to play sports. Teach your child to not give up. Do not give into this illness it can be overcome.

Should my child have a special exercise program?
If your child has JRA, it is very important that he or she exercises. Exercise can help reduce pain and prevent further joint damage. Not using a sore joint will cause the muscles around it to become weak, resulting in pain. Your child may require special exercises to keep joints moving normally, to build muscles and help prevent permanent disabilities. A physical therapist can work with you and your child to help develop an exercise program best suited to your child's needs.

Always remember water, water, water and swimming, swimming, swimming. It is great for the body.

Will my child be required to wear splints (bracing)?
Braces are devices, designed to stabilize a joint, reduce pain and inflammation, and help the child build stronger muscles. Your doctor may prescribe splints for your child to wear when resting in order to keep joints in the best possible position.
 
Are there other ways a parent can help?
Parents are an important part of the overall health care team, and should be as well informed as possible. Parents make sure that all medications are taken, special exercises are done, watch for physical or emotional changes that may develop between visits to the doctor, and help your child accept and handle this illness.
 
Always remember to be positive and help your child to be strong.