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Description

Arthritis is an inflammation (swelling and irritation) of the lining of the joints (such as the knees, shoulders, or knuckles). When the lining becomes inflamed, fluid is produced. The joints can become stiff (difficult to move), swollen (larger in size), painful, and warm to the touch.  If the joints are swollen for 6 weeks or longer, a child may have juvenile arthritis.  Juvenile arthritis is a long-lasting disease.  It affects nearly 250,000 children under the age of 16 years. 
 
There are three types of juvenile arthritis: oligoarticular, polyarticular, and systemic.  Oligoarticular arthritis involves a few joints.  Polyarticular arthritis involves 5 or more smaller joints (like in the hands or feet).  Systemic arthritis involves at least one joint and also involves the internal organs such as the heart, liver, spleen, and the lymph nodes.
 

Symptoms

Sometimes kids with juvenile arthritis may have:
  • Pain in the morning that improves by the afternoon, often with a limp in the morning
  • Stiffness (decreased movement) or swelling (increase in size) in joints
  • A young child may not want to play
  • Joints can be warm to the touch
  • Weakness in the muscles and other soft tissues around the joints
  • Growth problems where joints grow too fast, too slow, or unevenly
  • Eye problems called iridocyclitis (inflammation of the colored portion of the eye) or uveitis (inflammation of the middle layer of the eye)
Sometimes symptoms will go away for a period of time and the arthritis is considered in remission.  This improvement in symptoms may last a short period of time or be long-lasting.
 

Examination

Your doctor will discuss your child’s medical history and perform a physical exam.  The doctor should ask how long the problems with joint pain and swelling have occurred and if the symptoms have gotten better or worse.  It is important to know if there is joint stiffness when the child gets up after rest and if the joints are swollen.  Your doctor will ask about other causes of symptoms such as an injury or other illness.  It is also helpful to know if anyone else in the family has had arthritis.  Your child will be checked for signs of joint swelling, warmth, or stiffness.
 

X-Rays and Tests

X-rays provide images of the bones to look for injuries or abnormalities around the joints. Ultrasound may be ordered to identify joint swelling. An MRI may be ordered to look for signs of joint swelling or inflammation. Tests may be performed on blood or joint fluid to help make the diagnosis or rule out other conditions that can cause similar symptoms.  Your child may also need to see an eye doctor (ophthalmologist) to look for eye inflammation.  If diagnosed with arthritis, regular eye exams with the eye doctor may be necessary to prevent permanent eye damage.
 

Treatment

Juvenile arthritis is usually treated by a pediatric rheumatologist, a doctor who specializes in helping children with arthritis.  Treatment is designed to reduce swelling, maintain joint motion, and relieve pain.  This can include medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen.  Sometimes disease-modifying anti-rheumatic drugs are required to slow or stop progression of juvenile arthritis.  Biologic agents are a newer type of medication that can also slow or stop the progression of the arthritis.  These are usually only given in special conditions.  Corticosteroids can be used to reduce serious symptoms, but are used more rarely because of the potential side effects.
 
Exercise and physical therapy help maintain muscle tone and joint range of motion.  It is important to balance exercise with rest.  When the child is feeling well, they can fully participate in sports and physical activity.  Sometimes splints are used to help reduce inflammation and prevent joint from getting stuck in one position.  Warm baths or hot compresses may also help soothe sore joints.
 
Surgical treatment is rarely needed for juvenile arthritis except to correct the position of a deformed joint or replace a joint in adults with advanced arthritis.
 

Outcomes

The goal for treatment of juvenile arthritis is to cause remission of the arthritis as well as to preserve quality of life by making it possible for children to participate in normal activities.  With treatment, most children with juvenile arthritis will develop normally.  When untreated, about half of children with juvenile arthritis we will continue to have symptoms 10 years after diagnosis.
 

More Information

Q:  What is juvenile arthritis?

Juvenile arthritis (JA) is an autoimmune disease in which the body attacks the tissue that lines the joints.  It can be diagnosed when a child's joints are swollen for 6 weeks or longer.  There are 3 main types involving one joint, several joints, or the whole body.
 

Q: Is it the same as rheumatoid arthritis in adults? 

No.  There are several types of juvenile arthritis, but nearly all of them are different from rheumatoid arthritis in adults.
 

Q: What causes juvenile arthritis? 

plant teahow to plant tea for Doctors do not know exactly what causes juvenile arthritis.  We know there is a problem with the immune system.  The immune system has difficulty telling the difference between the body's own tissues and damaging germs. This confusion causes the immune system to attack and damage the body's healthy tissues on the inside of the joints, as well as in other places.  This causes inflammation, swelling, and extra fluid that make the joints swollen and painful.
 

Q:  Is there more than one type? 

There are several types.  Here are some of the most common:
  1. Systemic Juvenile Arthritis (JA) affects the whole body. It is often diagnosed when a child has high fevers that increase in the evenings and then suddenly drop to normal. During the onset of fever, the person may feel very ill or develop a rash that comes and goes.  Eventually many of the body's joints are affected by swelling, pain, and stiffness.  This type can also affect the internal organs.
  2. Oligoarthritis affects four or fewer joints. A person will notice pain, stiffness, or swelling in larger joints like knees. It can be associated with eye problems.
  3. Polyarticular arthritis, rheumatoid factor (RF) negative has swelling or pain in five or more joints. The small joints of the hands are usually affected as well as bigger joints. In addition, a person may have a low-grade fever.
  4. Polyarticular arthritis, rheumatoid factor positive is the type of JA that's most like adult arthritis.  It is less common, but more likely to cause joint damage.
 

Q:  How long does juvenile arthritis last?

JA is a chronic condition - it can last for months and years. Sometimes the symptoms just go away with treatment, which is known as remission.  This can last for months, years, or forever.  The best way to achieve remission is medical treatment.
 

plant teahow to plant tea for Q:  How is juvenile arthritis diagnosed? 

Your doctor will discuss your child’s medical history and perform a physical exam.  The history should include how long the problems with joint pain and swelling have been present and if the symptoms have gotten better or worse.  It is important to know if there is joint stiffness when the child gets up after rest and if the joints are swollen.  Your doctor will ask about other causes of symptoms such as an injury or other illness.  It is also helpful to know if anyone else in the family has had arthritis.  Your child will be checked for signs of swelling, warmth, or changes in range of motion.
Tests on blood or joint fluid can help rule out other conditions that can cause similar symptoms.  These tests might also help identify juvenile arthritis.  X-rays provide images of the bones to look for injuries or abnormalities around the joints. MRI may be used to assess for joint swelling and inflammation.
 

Q:  How is juvenile arthritis treated?

Juvenile arthritis is usually treated by a pediatric rheumatologist, a doctor who specializes in helping children with arthritis.  Treatment is usually designed to reduce swelling, maintain joint motion, and relieve pain.  This can include medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen.  Sometimes disease-modifying anti-rheumatic drugs are required to slow or stop progression of juvenile arthritis.  Biologic agents are a newer type of medication that can also slow or stop the progression of the arthritis.  These are usually only given in special conditions.  Corticosteroids can be used to reduce serious symptoms, but are used more rarely because of the potential side effects.
 
Exercise and physical therapy help maintain muscle tone and joint range of motion.  It is important to balance exercise with rest.  When the child is feeling well, they can fully participate in sports and physical activity.  Sometimes splints are used to reduce inflammation and prevent joint contractures.  Warm baths or hot compresses may also help soothe sore joints.
 
Surgical treatment is rarely needed for juvenile arthritis except to correct the position of a deformed joint or replace a joint in adults with advanced arthritis.
 

Q:  How can I help my child with juvenile arthritis?

Gentle massage and stretching can help soothe the muscles and sore joints.  Heat is also very helpful.  Getting up and moving helps lessen the discomfort that comes from stiffness. Exercise helps maintain normal joint motion and muscle strength. A physical therapist can help with this.  Nutrition is also important and you may ask to see a dietician to learn about a healthy diet.  It is also important to keep a positive mental outlook.  Children with JA should try to attend school and stay involved with activities and other children.