What is JRA?

JRA is rheumatoid arthritis in children. Like in adults, the disease is due to an auto-immune disorder. Unlike in adults, the clinical pattern can differ markedly.

What are the symptoms?

JRA can present in several different ways.

1. Pauciarticular arthritis. In these children, four or fewer joints are involved. The commonest joints involved are the knee and ankle. In 50% of cases, only one joint, commonly the knee is involved. The pain and swelling of the joint comes on gradually in a child typically 2 to 4 years of age. Girls are more frequently involved than boys. The child has no fever, is not sick, and has no other generalized problems.
2. Polyarthritis with minimal systemic problems. The child could be very young, from 1 to 3 years of age, or older, from 8 to 10 years of age. There is no sex predilection in the younger age group, but a definite predilection for girls in the older age group. Five or more joints are involved, which could be any joint in the body. These children have only mild symptoms of low grade fever, malaise, and mild anemia.
3. Polyarthritis with systemic problems. These children acutely with high fever and red swollen joints that mimic infection. The spleen and liver are enlarged, a skin rash is common, and there may be subcutaneous nodules over the elbow and leg. The heart may be enlarged, with inflammation of the pericardium or covering of the heart (called pericarditis).

What does your doctor do about it?

Blood tests are often normal in the Pauciarticular type of JRA. The polyarticular JRA tends to have increased white cell count and elevated sedimentation rate (ESR). Rheumatoid factor (RA) and Antinuclear antibody tests are usually negative, except in the more serious cases. So a negative RA test does not exclude JRA.

X-rays are usually negative unless in the advanced case, where there is cartilage destruction. In the absence of a positive RA test, the diagnosis is often clinical. Treatment in the pauciarticular case is usually with nonsteroidal anti-inflammatory medications. The polyarticular arthritis may need more potent medications like steroids. The eye should always be checked by an ophthalmologist to rule out iridocyclitis or uveitis. Physical therapy and splinting may be required for the more severe cases.

What of the future?

The pauciarticular type has a benign course, and may resolve after a few years. Occasionally, it progresses to become polyarticular.

The polyarticular type of JRA is more serious. It goes through periods of exacerbation and remission, but some will continue to have serious problems of joint destruction and stiffness with crippling effects.