Juvenile Rheumatoid Arthritis (cont.)
Medical Author:
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACRDr. 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. Medical Editor:
Catherine Burt Driver, MD
Catherine Burt Driver, MDCatherine 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. IN THIS ARTICLE
Pictures of Juvenile Rheumatoid Arthritis
Media type: Photo Media file 2: Active polyarticular arthritis. Notice the swelling of only certain finger joints. Image courtesy of Barry L. Myones, MD. 
Media type: Photo Media file 3: Wrist x-rays of active polyarticular arthritis (same person as Image 2). X-ray shows severe loss of cartilage, bone erosion, and joint fixation and narrowing. Image courtesy of Barry L. Myones, MD. 
Media type: X-RAY Media file 4: Close-up of the affected joints in a person with active polyarticular arthritis (same person shown in Images 2 and 3). Image courtesy of Barry L. Myones, MD. 
Media type: Photo Media file 5: Inactive polyarticular arthritis. Long-term symptoms of polyarticular disease include partial joint dislocation (subluxation) of both wrists and thumbs, joint contractures, boney overgrowth, and finger deformities (for example, swan-neck or boutonniere deformities). Image courtesy of Barry L. Myones, MD. 
Media type: Photo Media file 6: Hand and wrist X-rays of inactive polyarticular arthritis (same person shown in Image 5). Long-term symptoms of polyarticular disease include decreased bone density around joints, bone fusion, accelerated bone age, narrowed joint spaces, boutonniere deformities (at left third and fourth interphalangeal joints), and partial dislocation (subluxation) of joints. Image courtesy of Barry L. Myones, MD. 
Media type: X-RAY Media file 7: Eye inflammation (chronic anterior uveitis). Note the weblike attachments of the pupillary margin to the anterior lens capsule of the right eye. This patient has a positive antinuclear antibodies (ANAs) and initially had a pauciarticular course of her arthritis. She now has polyarticular involvement but no active uveitis. Image courtesy of Barry L. Myones, MD. 
Media type: Photo Media file 8: One set of suggested algorithms for the treatment of patients with juvenile rheumatoid arthritis (JRA). This treatment is not standardized. Treatment of JRA is based on experience and observation, and it can be controversial. 
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