What Is JRA?
You may have heard about arthritis (say: ar-thry-tis), which is a disease that causes swelling and pain in a person's joints. But isn't it something that only old people get? Actually, kids can get a kind of arthritis called juvenile rheumatoid arthritis, or JRA for short. "Juvenile" means young. It's also called juvenile idiopathic arthritis or JIA, to highlight that it is different than the arthritis that adults get. Kids can have many different types of arthritis, but JRA is the most common.
Joints are the places where bones meet. Arthritis can prevent people from moving their joints properly. Juvenile rheumatoid (say: roo-muh-toid) arthritis affects kids under age 16. These kids have arthritis in one or more joints. Many problems can cause pain and swelling of the joints, so a doctor will want to know how long these problems have been going on. To be considered JRA, a kid must have swelling and pain for at least 6 weeks.
Although it has a similar name, juvenile rheumatoid arthritis is not the same as the kind of arthritis that affects adults. Although some of the symptoms may be similar, JRA doesn't damage bones as quickly as the rheumatoid arthritis that affects older people.
Three Kinds of JRA
Three different types of juvenile rheumatoid arthritis can affect kids:
- Oligoarticular (say: awl-li-go-ar-tik-yoo-lur) JRA. Oligoarticular JRA is the name that's used when four or fewer joints are affected. (Oligo means few and articular means having to do with the joints, so oligoarticular means having to do with few joints.) Usually larger joints such as a knee or ankle are affected by this type of JRA.
- Polyarticular (say: pah-lee-ar-tik-yoo-lur) JRA. Poly means many, so polyarticular means having to do with many joints. This kind of JRA affects five or more joints. Although this kind of JRA usually involves large joints, such as knees, wrists, elbows, and ankles, small joints of the hands and feet are also often involved. Additionally, the joints of the neck (cervical spine) and jaw (temporomandibular joints) may also be affected.
Polyarticular JRA is often symmetrical (say: sih-met-rih-kul). Symmetrical means that something is the same on each side, kind of like a butterfly's wings. In polyarticular JRA, the same joints on both sides of the body are involved. For example, a kid with polyarticular JRA might have problems with the joints in both the left and right hands.
- Systemic (say: si-stem-ik) JRA. Systemic means it affects many parts of the body, rather than just a few specific places. A kid with this type of JRA may have swelling, pain, and limited motion in joints, as well as other symptoms. Rashes and high fevers that come and go can happen for weeks at a time. Other organs, such as the heart, lungs, and liver, can be affected.
Why Do Kids Get JRA?
No one really knows what causes JRA. Something in the environment such as a virus may trigger the disease in kids that already have certain genes that make it more likely for them to get JRA. JRA is not contagious, so you can't catch it from someone else.
JRA is an autoimmune (say: aw-toe-i-myoon) disease. Normally, a kid's immune system sends out white blood cells to protect the body and fight outside invaders like bacteria and viruses that can make a kid sick. With JRA, the immune system makes a mistake and targets healthy cells as if they were harmful.
Instead of recognizing the healthy cells and saying, "Hi, nice to see you," the immune system thinks the healthy cells need to be destroyed and releases chemicals to fight the healthy cells. The chemicals the immune system releases cause the pain and swelling that a kid with JRA experiences.
What Do Doctors Do?
Just because a joint hurts doesn't mean a kid has JRA. A joint might hurt for a lot of different reasons, which is why it's important to see a doctor to figure out what the problem is.
The doctor will ask a lot of questions. How long has the kid had joint problems? Does he or she feel stiff when getting up or after resting? Are the joints swollen? Was there an injury? Could another problem be causing arthritis, such as Lyme disease? Is there a family history of arthritis or other autoimmune diseases?
Knowing these answers and doing a physical exam, blood tests, and X-rays will help the doctor figure out if it is JRA. If your doctor suspects that you may have JRA, he or she may send you to see a doctor who specializes in the diagnosis and treatment of arthritis. This kind of doctor is called a rheumatologist (say: roo-muh-tol-oh-jist).
How Is JRA Treated?
Some kids who have JRA may take medicine such as ibuprofen to help control pain and inflammation. If the arthritis is more severe, they may need to take additional medicines to decrease pain and inflammation and to slow the progression of the disease. Some of these medicines are pills, but others are shots.
It is important that kids with JRA keep their joints moving. Often a kid will see a physical therapist or occupational therapist. In addition to working with children to move their joints and strengthen their muscles, these therapists can help create special exercise programs for home or school that can help a kid with JRA stay active.
In addition to joint problems, JRA may cause uveitis (say: yoo-vee-eye-tus), an inflammation of the eye that can lead to problems with vision if it's not treated. It is more common in children with oligoarticular arthritis but all children diagnosed with JRA should get their eyes checked by an ophthalmologist, a doctor who specializes in diagnosing and treating eye problems. If the eyes are affected, they may be treated with eyedrops.
There are some things a kid can do to reduce the symptoms of JRA in addition to taking medicines. Keeping joints warm and staying active can help maintain mobility. Warm baths can make a kid's joints hurt less. An electric blanket on a timer that turns on 1 hour before a child wakes up can help warm the joints so he or she can move better. Some kids dip their hands in a special warm wax called paraffin that helps their joints ache less.
Living With Juvenile Rheumatoid Arthritis
Kids with JRA can have a lot of stiffness when they first wake up in the morning. Once their joints warm up, they can usually move more easily. That's why you might notice that someone with JRA has trouble moving early in the day, but seems better later on.
It's important for kids with JRA to find a good balance between activity, which helps them stay flexible, and rest, which everyone needs. Swimming is a great exercise for someone with JRA. It stretches a lot of different muscles and tendons and helps keep the person moving and flexible. It's important for kids with JRA to stay active even when they are not having symptoms.
Sometimes kids with JRA can go a long time, even months or years, without the disease bothering them. Then it comes back. This is called a flare-up or flare. Flare-ups just happen and can't be prevented. It can be frustrating if a flare-up happens on a day when the kid would like to be doing something fun, like attending a birthday party. If you know someone with JRA, you may offer to carry books or give other help, if needed. It's also OK if the person doesn't want help.
The good news is that many kids with JRA will outgrow it. Kids with oligoarticular JRA generally do better than kids with polyarticular arthritis, but as many as 7 out of 10 kids with polyarticular JRA may not require treatment as adults. And although the arthritis is active, almost all kids with JRA can control it with medicine and other treatments, which means they can do most things that other kids can do.
Reviewed by: AnneMarie C. Brescia, MD
Date reviewed: June 2008