Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
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.
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.
The goals of medical treatment for juvenile idiopathic arthritis (JIA) are to reduce your child's joint pain and to prevent disability. Physical therapy and medicine are the basis of medical treatment for JIA.
Treatment is determined by the type and severity of JIA. Even when JIA is uncomplicated, an affected child may need years of medical treatment or checkups. To make sure your child's care is appropriate for the stage of disease, work closely with the medical team. Learn as much as you can about your child's disease and treatments, and stay on schedule with medicine and exercise.
Because pain, stiffness, and swelling can change from day to day, be sure to learn how to assess your child's condition. It can be hard to know if children are having pain. Some children are not able to say what they feel, while others are afraid to say they feel pain if they think they will have to go to the doctor or think they will make their parents upset. Children also simply learn to cope with pain by sleeping or playing. To know a child is in pain, you may need to look for changes such as stiff movements, rubbing a joint or muscle, or avoiding movement. You may also notice your child is irritable or easily upset.