Juvenile Arthritis.
Last updated Wednesday, December 22, 2004
Diagnosis and evaluationHow is juvenile arthritis diagnosed? Children may require considerable evaluation if the diagnosis of juvenile arthritis is being considered.
The signs and symptoms of Juvenile Rheumatoid Arthritis (JRA) vary from
child to child. There is no single test that makes the diagnosis of
JRA. Therefore, your doctor may go though many steps to find out if
your child really does have JRA. The main steps involved in diagnosis
are:
- taking the child's health history
- physical examination
- laboratory tests
- X-ray examinations
- tests of joint fluid and other tissues
In order to make a diagnosis of JRA, the arthritis must have been constantly present for six or more consecutive weeks.
Medical history
To make a correct diagnosis, the doctor will ask questions about
your child's recent symptoms, medications she is taking, and any
previous medical problems.
The doctor may also want to know if other members of the family have
had any other form of arthritis, since some forms may be inherited.
Physical examination
During the physical examination, the doctor will look for:
- joint inflammation
- rash
- nodules
- eye problems
The doctor must be able to find evidence of joint inflammation to be
sure the problem is JRA. A child who complains of aches and pains, but
who shows no joint changes, may not have JRA. In a few cases, a
physically healthy child experiencing acute emotional stress may
complain of sore joints.
An ophthalmologist may also need to examine your child's eyes to check for signs of iridocyclitis.
What tests may be used to diagnose juvenile arthritis?
Although there are several laboratory tests
that may support a diagnosis of JRA, there is no single test that
provides positive proof one way or another. The most common tests are:
- erythrocyte sedimentation rate ("sed" rate)
- rheumatoid factor test
- antinuclear antibody test (ANA)
- HLA-B27 typing
- hemoglobin test
- urinalysis
If the diagnosis is particularly hard to make, the doctor may do
additional tests to rule out other diseases. The diagnosis of JRA is
made by excluding other diseases. For example, many viral infections
can lead to temporary joint problems in children, but in these cases
the arthritis usually goes away rapidly. Other diseases can cause
arthritis. Sometimes a bacterial infection of bone or cartilage can
cause joint swelling or pain. Prompt diagnosis is important to allow
proper antibiotic treatment.
X-rays
X-ray examinations of joints may be helpful early in the course of
the illness to find out if another condition such as a bone infection,
tumor, or fracture is causing the problem. Later on, X-rays may be used
to check on joint damage, or changes in bones. X-rays of the spine help
the doctor tell if ankylosing spondylitis is present.
Your child's physician may also suggest Magnetic Resonance Imaging
(MRI), a new technology that uses magnetic waves to provide images of
the inside of the body without harmful radiation.
Joint fluid and tissue tests
A sample of fluid from one or more joints may be withdrawn by a
needle and examined to find out if there is an infection in the joint.
Sometimes the doctor will take a small bit of tissue from a joint or
a nodule for examination in the laboratory. This is called a biopsy. glossary
- Antinuclear Antibody (ANA)
- A type of protein found
in the blood of some children with polyarticular JRA; ANA is also found
in many girls who have pauciarticular JRA and iridocyclitis.
- Arthritis
- General term that refers to inflammation of a joint.
- Erythrocyte Sedimentation Rate ("sed rate")
- A
blood test which measures how rapidly red blood cells settle to the
bottom of a small tube. The red blood cells of a person who has
inflammation usually settle more rapidly than normal. This test may be
helpful in following the progress of JRA.
- Hemoglobin Test
- Aroutine
test which measures the amount of hemoglobin in the red blood cells.
Hemoglobin is a substance that carries oxygen through the body. The
test is often part of a complete blood count [CBC).
- HLA-B27
- A
protein which can be found on the white blood cells of some people.
This protein has been found in many adults who have ankylosing
spondylitis. It is also sometimes found in children with JRA,
particularly older boys who have arthritis in only a few joints.
- Rheumatoid Factor
- A type of antibody found in the blood of some children with JRA (usually older girls with polyarticular JRA).
- Rheumatoid Nodule
- Lump
on the elbow or on other points of the body which receive a lot of
pressure. These are sometimes seen in children who have polyarticular
JRA and a positive test for rheumatoid factor.
- Urinalysis
- Tests performed on urine to check for possible effects on the kidneys of drugs prescribed for JRA.
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