Pediatric Rheumatoid Arthritis
What is pediatric rheumatoid arthritis?
Juvenile arthritis (JA) is a broad term that describes a group of conditions that involve various types of arthritis. It affects children 16 and under but rarely affects children under 6 months of age. It is not the same disease as Rheumatoid arthritis in adults.
JA is a chronic disease that can lead to short and long-term disability. It affects 5-15% of children in the U.S. One in 1000 children develop JA. It can last for months to years.
JA can affect one or more joints, including the hands and feet, and also cause silent eye inflammation. Early diagnosis and treatment can help to prevent permanent joint damage. Most children with JA live normal lives, and some even experience disease remission. There are state and federal programs that provide for school accommodations and assistance services.
- Arthritis accompanied or preceded by fever of at least two weeks
- Painful, swollen and warm joints for more than six weeks. Young children may not complain but are irritable or tired and uninterested in play
- A characteristic light pink rash that disappears, but not all children have a rash
- Swollen lymph nodes in the neck
- Internal organs can become inflamed
- Pain and stiffness in the morning
- Abnormal joint growth
- Eye problems called iridocyclitis
The course of JA
JA begins with inflammation, progresses to contracture or stiffness, damages the affected joints and soft tissues, and can cause joint deformity. Over 50% of children diagnosed with JA will have active disease in the ten years after diagnosis. Aggressive treatment can alter this prognosis.
What causes JA?
JA is an autoimmune disease. The immune system targets and inflames the lining of the joints called the synovial membrane causing joint inflammation and swelling. The cause of this immune reaction is unknown. Scientists believe there is a genetic component that creates a risk, but JA is not inherited.
How is JRA diagnosed?
Your Rheumatologist will review your child’s medical history, conduct a physical examination, and discuss your child’s symptoms. They will order blood tests and x-rays to detect joint damage and rule out other conditions with similar symptoms such as Lyme disease. Ultrasound imaging is noninvasive and can scan the joints to assess synovitis and related abnormalities.
How is JRA treated?
Optimal management requires a multidisciplinary team including a pediatric rheumatologist, pediatric orthopedic surgeon, physical and occupational therapist and others who create a treatment plan for your child. The goal is to support normal psychosocial development and to control symptoms including reducing pain and swelling, preventing joint damage and maintaining mobility.
Nonsurgical management involves the use of anti-inflammatory drugs to manage symptoms (primarily inflammation and pain) but are not recommended while the arthritis is active. Injection of corticosteroids into the affected joints are used to treat severe arthritis and serious symptoms. Oral steroids can be used for a short time but have significant side effects. Disease modifying drugs called DMARDs may be added to slow or stop progression.
Physical therapy can help to maintain muscle tone and strength and protect range of motion and mobility. Splints and braces can help prevent stiffness and contractures.
Surgery may be recommended to treat irreversible joint contractures and dislocations and to improve joint deformity. Arthroscopic synovectomy is a surgical treatment for inflammation of the synovial membranes and can prolong remission.
At Ortho Illinois we have a multi-specialty practice that includes a fellowship- trained pediatric orthopedic surgeon who has the expertise to provide advanced orthopedic care including rehabilitation for children and teens. Contact Ortho Illinois with offices in northern Illinois and around the Chicago area, to obtain the correct diagnosis and the most appropriate treatments.