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Juvenile Rheumatoid Arthritis
(JRA; Juvenile Chronic Polyarthritis; Still’s Disease)
- Pauciarticular JRA—four or less joints are affected in the first 6 months of illness
- Polyarticular JRA—five or more joints are affected in the first 6 months of illness
- Systemic onset JRA (also called Still’s disease)—affects the entire body, least common type of JRA
- Enthesitis associated arthritis—there is also swelling of the tendon at the bone
- Psoriatic arthritis—associated with a skin disease called psoriasis
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- Girls are more likely to get JRA than boys
Family history of:
- Anterior uveitis with eye pain
- Inflammatory back arthritis (ankylosing spondylitis)
- Inflammatory bowel disease
- Arthritis and a family history of psoriasis in a first-degree relative (for psoriatic arthritis)
- Joint stiffness, especially in the morning or after periods of rest
- Pain, swelling, tenderness, or weakness in the joints
- Weight loss
- Fatigue or irritability
- Swelling in the eye—especially associated with eye pain, redness, or sensitivity to light
- Swollen lymph nodes
Growth problems, such as:
- Growth that is too fast or too slow in one joint (may cause one leg or arm to be longer than the other)
- Joints grow unevenly, off to one side
- Overall growth may be slowed
Symptoms common with
pauciarticular JRA include:
- Problems most often found in large joints. These joints include knees, ankles, wrists, and elbows.
- If left-side joint is affected the right-side similar joint will not be affected. For example, if right knee is affected the left knee will be healthy.
- May also have swelling and pain at on the tendons and ligaments attached to the bone.
Symptoms common with
polyarticular JRA include:
- Problems found most often in small joints of the fingers and hands. May also affect weight-bearing joints like the knees, hips, ankles, and feet.
- Joints on both sides of the body are affected. For example if left hand is affected the right hand will also be affected
- May also have a blood disorder called anemia . This is an abnormally low number of red blood cells.
One type of polyarticular JRA may occur with:
- A low-grade fever
- Nodules—bumps on parts of body that receive a lot of pressure such as elbows
Symptoms common with systemic onset JRA include:
- Some of the first signs may be a high fever, chills, and a rash on the thighs and chest. May appear on and off for weeks or months.
- May have swelling in heart, lungs, and surrounding tissues.
- Lymph nodes, liver, and/or spleen may become enlarged.
- Children with enthesitis arthritis often have tenderness over joint where the pelvis and spine.
- Children with psoriatic arthritis often have finger or toe swelling. There may also be damage on fingernails.
- Images of joints and bones such as x-rays
Laboratory tests on blood, urine, and/or joint fluid:
- May be used to eliminate other health conditions such as physical injury, infections, other autoimmune diseases, and some forms of cancer
- Can also help to determine specific type of JRA
- Eye examinations—to look for swelling in the eye
- Nonsteroidal anti-inflammatory drugs (NSAIDs)—to help swelling and pain
- Disease-modifying antirheumatic drugs (DMARDs)—to slow the progression of the disease
- Tumor necrosis factor (TNF) blockers —to decrease swelling, pain, and joint stiffness
- Interleukin inhibitors—to reduces disease activity
- Corticosteroids through IV or by mouth—for swelling
- Steroid injections into the joint—may help relieve swelling and pain in some children
American College of Rheumatology http://www.rheumatology.org
Arthritis Foundation http://www.arthritis.org
The Arthritis Society http://www.arthritis.ca
Health Canada http://www.hc-sc.gc.ca
Hofer MF, Mouy R, Prieur AM. Juvenile idiopathic arthritides evaluated prospectively in a single center according to the Durban criteria. J Rheumatol. 2001. 28:1083.
Juvenile idiopathic arthritis (JIA) enthesitis related. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated June 4, 2012. Accessed August 2, 2012.
Juvenile idiopathic arthritis (JIA) oligoarticular. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated June 4, 2012. Accessed August 2, 2012.
Juvenile idiopathic arthritis (JIA) polyarticular. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated June 4, 2012. Accessed August 2, 2012.
Juvenile idiopathic arthritis (JIA) systemic-onset. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated June 4, 2012. Accessed August 2, 2012.
JAMA Patient Page. Juvenile idiopathic arthritis. JAMA. 2005;294:1722.
Petty RE, Southwood TR, Baum J, et al. Revision of the proposed classification criteria for juvenile idiopathic arthritis: Durban, 1997. J Rheumatol.1998; 25:1991.
2/5/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed : De Benedetti F, Brunner HI, Ruperto N, et al. Randomized trial of tocilizumab in systemic juvenile idiopathic arthritis. N Eng J Med. 2012;367(25):2385-95.
2/24/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Limenis E, Grosbein HA, et al. The relationship between physical activity levels and pain in children with juvenile idiopathic arthritis. J Rheumatol. 2014 Feb;41(2):345-351.
9/2/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Guzman J, Oen K, et al. The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-Out cohort. Ann Rheum Dis. 2014 May 19.
- Reviewer: Kari Kassir, MD
- Review Date: 12/2013
- Update Date: 09/02/2014