Juvenile Arthritis.

Last updated Wednesday, December 22, 2004

About

Caring for a child with arthritis

This material is presented mainly for parents of a child with arthritis.

As parents, you carry much of the responsibility for the health care and emotional well-being of your child with arthritis. You will be the ones to:

• make sure she sees all members of her health-care team as needed
• see that she takes her medications as prescribed
• watch for any side effects the drugs may cause
• help her do exercises to relieve pain and stiffness
• provide encouragement and support to her and other family members
• work with teachers and school officials to make sure her needs are met

For this reason, it is very important for parents to know as much as possible about their child's arthritis and its care, as well as the effects it can have on family life. This information provides a starting point for discussions with your child's health-care team.

You may feel a little overwhelmed by all the information presented here. The impact of juvenile arthritis on a particular child may be mild, moderate, or severe. This information tries to cover the whole range. Please remember that your child may never experience all the symptoms described or have to take many of the drugs mentioned. They are presented for the sake of completeness.

What is juvenile arthritis?

The word arthritis refers to inflammation (that is, swelling, heat, and pain) involving the joints.

The most common form of arthritis in children is Juvenile Rheumatoid Arthritis (JRA). However, children may also be affected by arthritis as a feature of other diseases, including:

• Systemic lupus erythematosus: a chronic inflammatory disease characterized by fever and rash that may attack organs such as joints, kidneys, the brain, lungs, and heart.
• Juvenile dermatomyositis: a disease that causes a skin rash and weak muscles in children, and may be accompanied by swollen joints.
• The spondyloarthropathies of childhood: diseases in children that involve the spine. In some (but not all) children with these diseases, a protein called HLA-B27 is found on the white blood cells. The spondyloarthropathies of childhood include:
  1. Ankylosing spondylitis: a type of arthritis which primarily affects the spine and hips. It usually occurs in males.
  2. Reiter's syndrome: a form of arthritis that may cause inflammation of the urinary tract, inflammation of the eyelids, mouth ulcers, and/or skin rash.
  3. B-27 Arthritis: a form of arthritis that occurs more often in older boys and affects only a few joints--usually the back, and large joints of the legs such as hips, knees, and ankles. It occurs more often in children who inherit the HLA-B27 protein. If particular changes are seen in X-rays, B-27 arthritis may be reclassified as Ankylosing Spondylitis.
  4. Psoriatic arthritis: a type of arthritis that may occur with the skin condition, psoriasis. It affects both boys and girls.
  5. Scleroderma: a disease that can affect the skin, joints, blood vessels, and internal organs.
  6. Inflammatory bowel (Crohn's) disease: a disease that can affect the intestines, causing diarrhea and abdominal pain. It can be associated with arthritis and fever; these sometimes appear before the digestive symptoms.

Juvenile Rheumatoid Arthritis (JRA) affects about 71,000 children in the United States. It is a disease of the joints that may also affect other organs.

JRA is often a mild condition which causes few problems, but in severe cases it can produce serious complications. Its signs and symptoms may change from day to day, even from morning to afternoon. Joint stiffness and pain may be mild one day but become so severe the next that the child cannot move without great difficulty.

Periods when the arthritis is particularly active are called "flares".

There are at least three forms of JRA. Each form begins in a different way and has different signs and symptoms. The three forms are:

1. Polyarticular JRA: this type affects five or more joints ("poly" means several or many and "articular" means joint)
2. Pauciarticular JRA: this type affects four or fewer joints ("pauci" means few)
3. Systemic JRA: this type affects both the joints and the internal organs ("systemic" means internal organs and other body parts are involved)

Each of these forms is explained on the next page.

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