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Juvenile Rheumatoid Arthritis
(Juvenile Idiopathic Arthritis)

Juvenile Rheumatoid Arthritis Overview

Rheumatoid arthritis, often called RA, is a chronic (long-standing) disease that damages and eventually destroys the joints of the body. The damage is caused by inflammation, a normal response of the body's immune system. Arthritis means "joint inflammation."

  • The inflammation in the joints causes pain, stiffness, and swelling as well as many other symptoms.
  • The inflammation often affects other organs and systems of the body as well.
  • If the inflammation is not slowed down or stopped, it eventually destroys the affected joints and other tissues.

Juvenile rheumatoid arthritis (JRA), or juvenile arthritis, is not a single disease but a group of diseases. What they all have in common is chronic joint inflammation. Besides this common feature, these diseases are very different in their symptoms, their treatments, and their outcomes. Juvenile rheumatoid arthritis is also called juvenile idiopathic arthritis (JIA). The term juvenile idiopathic arthritis encompasses the following three groups of JRA and two additional types of childhood arthritis: enthesitis related arthritis and psoriatic arthritis of childhood.

  • Pauciarticular disease affects only a few joints, fewer than five. The large joints, such as the shoulder, elbow, hip, and knee, are most likely to be affected. This type of JRA is most common in children younger than 8 years of age. Children who develop this disease have a 20%-30% chance of developing inflammatory eye problems that can be serious, and these children require frequent eye examinations. Children who develop this disease when older than 8 years of age have a higher-than-normal risk of developing an adult form of arthritis. Children can outgrow the arthritis. About 50% of all children with JRA have this type.
  • Polyarticular disease affects five joints or more, sometimes many more. The small joints such as those in the hands and feet are most likely to be affected. This type can begin at any age. In some cases, the disease is identical to adult-type RA. This type accounts for about 30% of cases of JRA.
  • Systemic disease affects many systems throughout the body. Children may have high fevers, skin rashes, and problems caused by inflammation of the internal organs such as the heart, spleen, liver, and other parts of the digestive tract. It usually, but not always, begins in early childhood. Medical professionals sometimes call this Still's disease. This type accounts for about 20% of cases of JRA.

Children with JRA may experience complications specific to their type of JRA.

  • The most common complications in children with JRA relate to adverse effects of medications taken to treat the disease, particularly nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin). When taken frequently, these drugs can cause irritation, pain, and bleeding in the stomach and upper intestine. They also can cause problems in the liver and kidneys that often have no symptoms until they are very severe. In some cases, the child must undergo frequent blood tests to screen for these problems.
  • Some children with JRA have emotional or psychological problems. Bouts of depression and problems functioning in school are the most common.
  • The death rate in children with JRA is somewhat higher than in healthy children. The highest death rate in children with JRA occurs among patients with systemic JRA who develop systemic symptoms (such as pleural and pericardial disease). JRA can also evolve into other diseases, such as systemic lupus erythematosus (SLE) or scleroderma, which have higher death rates than pauciarticular or polyarticular JRA.

Treatment for JRA, like that for adult-type rheumatoid arthritis, has improved dramatically in the last 30 years, thanks mainly to the development of new medications.

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Juvenile rheumatoid arthritis (JRA) is not a single disease.

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