When Your Child Has Juvenile Rheumatoid Arthritis (JRA)Your child has been diagnosed with juvenile rheumatoid arthritis (JRA). JRA is also know as juvenile idiopathic arthritis (JIA). JRA means that the lining of one or more of the child's joints is inflamed, causing pain and swelling. JRA affects children between the ages of 1 and 16. Most often it develops in children under age 5. JRA is a chronic condition, meaning that there is no cure. But the symptoms of the condition can be managed to help your child live a normal life. A child with JRA may be referred to a pediatric rheumatologist (a doctor who treats musculoskeletal disorders, including arthritis, in children) or to a pediatric orthopaedist (a doctor who treats bone and joint problems in children).
What causes JRA?
JRA is an autoimmune disease. With this type of disease, the body's immune system (system that fights infection) starts attacking the body's own cells. Why this happens is not understood. JRA tends to run in families. And girls develop JRA twice as often as boys.
What are the symptoms of JRA?
JRA has flare-ups and remissions. This means that the symptoms come and go over time. Symptoms may include:
- Swollen, stiff joints, especially after waking from sleep
- Sore or painful joints, often knees or joints in the hands or feet
When the disease first appears, the child may have whole-body (systemic) symptoms. These can include a fever that spikes and then goes down, a pink rash that comes and goes, and swollen lymph nodes.
How is JRA diagnosed?
- The doctor will examine your child. He or she will also ask about your child's health history and symptoms. For a diagnosis of JRA, joint swelling or pain must last for at least 6 weeks at a time.
- There is no one test to diagnose JRA. But certain tests can be helpful with the diagnosis:
- An X-ray or bone scan looks for changes in bones or swelling in joints.
- Blood tests are sometimes done to check for certain "markers" (signs) of the disease. Blood tests can also rule out other conditions that may cause joint pain.
- Other tests may be done to rule out other possible conditions.
- An eye exam is done when JRA is diagnosed. JRA can affect the eyes, so the child's eye health will need to be monitored regularly.
How is JRA treated?
A team of healthcare providers is often involved in treating JRA. This team may include the child's pediatrician or family doctor, an orthopaedist, and a rheumatologist. The goal of JRA treatment is to control symptoms and prevent damage to the joints. Treatment options include one or more of the following:
- Exercise. Staying active helps maintain healthy muscles. It also helps keep good range of motion in the joints. During flare-ups, pain may limit activity. Certain activities should be avoided during flare-ups to protect the joints. Your child's doctor can discuss this with you.
- Medicines. Your child may need to take medicines regularly to prevent and control symptoms. They include:
- NSAIDs (non-steroidal anti-inflammatory drugs). These include aspirin, ibuprofen, and other medicines that are available over the counter. The doctor will prescribe the dose. (Note: Do not give aspirin to a child with a fever.)
- DMARDs (disease-modifying anti-rheumatic drugs). These may be prescribed if NSAIDs do not relieve symptoms of JRA. DMARDs slow the progression of JRA. But they take weeks or months to relieve symptoms. Because of this, they are often taken along with an NSAID.
- Corticosteroid medicines. These medicines are taken during flare-ups:
- Injection. The doctor removes fluid from the joint. He or she then injects corticosteroid medicine into the joint.
- Medicine by mouth or IV. These medicine help control severe symptoms: Corticosteroids shouldn't be used for long periods or stopped suddenly. So you will be given specific instructions about how your child should take these medicines and how to safely reduce the dose.
- Physical therapy. A program of regular exercises, joint movement, and massage may help relieve symptoms and prevent flare-ups. You and your child will work with a rehabilitation specialist (physiatrist) or a physical therapist to design this program. During flare-ups, physical therapy can help relieve symptoms.
- Splinting. A splint worn over the affected joint may help protect the joint and relieve symptoms. If a splint is prescribed, it is usually worn only at home so the child doesn't have to feel "different" in school or at play.
What are the long-term concerns?
A child with JRA needs regular monitoring throughout childhood to help prevent problems. This includes regular eye exams and monitoring of the kidneys. The healthcare team will watch for growth problems in the affected joints. And the affected joints need continued checkups throughout the child's life. Damage to the joint may eventually lead to the need for a joint replacement. Good management of symptoms and physical therapy can help the child avoid this damage.
Coping with JRA
JRA can affect the child's progress in school and social development. It also may affect other members of the family. To help make things easier:
- Treat the child normally and the same as other siblings. Avoid giving the child with JRA "special" treatment.
- Explain to the child that JRA is not his or her fault. Nothing he or she did caused the disease.
- Follow all instructions and don't change the treatment plan without talking with your child's doctor or other member of the healthcare team. Don't make changes based on another parent's suggestion-what works for one child may not work for another.
- If prescribed medicines cause side effects or don't relieve symptoms, ask your child's doctor about other choices.
- Work closely with your child's school to educate the teacher and the child's classmates about JRA. Some children with JRA are absent from school for long periods during flare-ups. Work with your child's school and teachers to help keep the child from falling behind. (For instance, keeping an extra set of textbooks at home may be an option.)
- Encourage your child to participate in exercise and activities. Team sports or other group activities help keep the joints strong and flexible and also help the child develop social skills.
- Look into joining a support group for parents and children with JRA. These groups give your child the chance to meet other children with JRA. They also allow you to talk to other parents who are coping with JRA.
- Consider counseling for you and your child. Having a chronic disease can be very hard to deal with. Talking with a professional can help you and your child work through emotions like fear, sadness, and anger.
- For more information, contact the Arthritis Foundation at www.arthritis.org/ja-fact-sheet.php