Juvenile Arthritis.

Last updated Wednesday, December 22, 2004

Figure 1 - Normal joint versus inflamed joint

Symptoms

What are symptoms of juvenile arthritis?

Arthritis is characterized by four major observable changes in the joints.

However, since JRA affects each child differently, your child may not experience all of these changes. Children also vary in the degree to which they are affected by any particular symptom. The most common features of JRA are:

• joint inflammation
• joint contracture
• joint damage
• altered growth

Other symptoms your child may experience include joint stiffness following decreased activity and muscle (and other soft-tissue) weakness.

Joint inflammation is the most common symptom of JRA. It causes heat, pain, swelling, and stiffness in joints. The lining of the joint, called the synovium, becomes swollen and overgrown and produces too much fluid (see figure 1). This causes swelling, stiffness, pain, warmth, and sometimes redness of the skin over the affected joints.

Since it usually hurts to move an inflamed joint, the child will often hold it still in a bent position. If she holds a sore joint in a fixed position for a long time, the muscles around the joint will become stiff and weak. After a while, the tendons (tissues which connect the muscles to the bone) may tighten up and shorten, causing a deformity called a joint contracture. Doctors usually prescribe an exercise program to help the child keep full motion in her joints and to keep her muscles strong.

In some children with severe disease, long-lasting inflammation damages the joint surfaces. This is called joint erosion, and can cause pain and limitation of motion.

Sometimes joint inflammation either speeds up or slows down the growth centers in bones. This can make the affected bones longer, shorter, or bigger than normal. If the growth centers in many bones have been damaged by inflammation, a child may stop growing entirely. If no damage has occurred, however, the child will usually continue to grow once the JRA is under control.

There are three main types of juvenile rheumatoid arthritis:

Polyarticular JRA

Polyarticular means "many joints". In this form of JRA, five or more joints are affected. Girls get polyarticular arthritis more often than boys. Because it can be severe, the most powerful medications are recommended for this type of JRA. The most common features are:

• usually affects the small joints of the fingers and hands
• can also affect weight-bearing and other joints, especially the knees, as well as hips, ankles and feet, neck, and jaw
• often affects the same joint on both sides of the body
• low fever
• a positive blood test for rheumatoid factor
• rheumatoid nodules, or lumps, on an elbow or other point of the body that receives a lot of pressure from chairs, shoes, etc.

Pauciarticular JRA

Pauciarticular means "few joints". In this form of JRA, four or fewer joints are affected. The most common features are:

• usually affects the large joints (knees, ankles or elbows)
• often affects a particular joint on only one side of the body
• may cause iridocyclitis, an eye inflammation

Systemic JRA

"Systemic" means "affecting the body generally." Systemic JRA affects a child's Internal organs as well as the joints. It may take months to diagnose. This is the least common form of JRA. Boys and girls are equally likely to get this kind of JRA. In some, the systemic symptoms of the disease and the fever may go away completely, although the joint-related symptoms of arthritis may remain. The most common features are:

• high fevers usually starting in the late afternoon or evening (The child's temperature may go up to 103 degrees or higher and then return to normal within a few hours. Chills and shaking often go along with the fever and the child may feel very sick. Periods of fever can last for weeks or even months but rarely go on for more than six months.)
• a rash along with the fever (Pale red spots often appear on the child's chest and thighs and sometimes on other parts of the body. This rash comes and goes for many days in a row.)
• inflammation in many joints (Joint problems may begin with the fever or may not start until weeks or even months later. Some children have severe pain in their joints when they have a fever and then feel much better when their temperature goes down. Joint problems can also go on after the period of fever ends and can be a major long-term difficulty for children with this kind of arthritis.)
• inflammation of the outer lining of the heart (pericarditis), the heart itself, or the lungs (pleuritis)
• anemia (low red blood count)
• a high level of white cells in the blood
• enlarged lymph nodes, liver, and spleen

Regular visits to your doctor are important so these problems can be checked and treated from the beginning.

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