Juvenile Rheumatoid Arthritis (JRA)

Juvenile Rheumatoid Arthritis (JRA) affects children under 16. It is an idiopathic disease with unknown causes. Arthritis is a disease in which the tendons and tissues of the body are badly affected by germs and viruses. It is an autoimmune disorder disease in which the immune system is damaged. White blood cells increase, and red blood cells decrease. The virus starts eating the tendons and tissues of the body without distinction, causing pain to parts of the body. The most affected parts are the joints which become stiff, painful, inflamed, and red.

JRA is the most common type of arthritis and affects more than 50,000 young adolescents in the United States.

Types 

There are six types of JRA:

Pauciarticular or Oligoarthritis

It affects four joints or fewer, affecting about half of the patients suffering from JRA. It targets knees, wrists, and eyes.

Polyarticular

It affects more than five joints and targets smaller joints such as those in the hands. It is classified into rheumatoid factor (RF)-negative, which affects girls more than boys, and RF-positive, which has similar symptoms to adult rheumatoid arthritis.

Systematic

This type of JRA targets the entire body, including joints, skin, and internal organs. Most affected patients experience a sharp increase in fever and frequent rashes.

Psoriatic Arthritis

This is when unusual redness occurs on sensitive areas such as near the ears, eyelids, elbows, knees, belly button, and skin of the head. It may affect one or two organs.

Spondylarthritis

It is also known as enthesis-related arthritis and affects the muscles, ligaments, or tendons attached to the bones and usually targets the hips, knees and elbows, lower limbs, and digestive tract. This type of JRA is more common in children between 8-15 years.

Undeferential Arthritis

Symptoms of this type of JRA don’t match up perfectly with any of the subtypes.

Causes

No specific cause has been found so far. Some scientists believe that it runs in families, and some put emphasis on stressful environmental triggers such as trauma, stress, tension, and depression, which accelerate this disease. It has been established that the child’s defense system, which fights against viruses and germs (autoimmune system), must be seriously disturbed for the disease to occur. In JRA, the white blood cells (WBC) which fight against viruses start destroying the healthy red blood cells indiscriminately, resulting in increased WBCs and decreased RBCs.

Symptoms and Risks 

JRA patients complain of mild, moderate, and acute pain in joints. When affected children wake up in the morning or after a nap, they experience stiffness in their limbs, and they can’t stand without pain. The patient limps and resumes normal walking. The patient’s joints, large organs, mouth, jaw, tongue, fingers, wrists, cervical region, and lymph nodes swell with severe rashes on the body. This delays the child’s growth; their bones get thinner and weaker and might be more prone to breaking. Some patients feel sleepy, drowsy, and exhausted. Children suffering from JRA can also experience glaucoma, cataract, dry eyes, inflammation, redness, sensitivity to light, and vision problems.

JRA also manifests as inflammation in the lungs and heart. This causes shortness of breath, further damage to the organs, and disturbance of the digestive system with symptoms such as indigestion, diarrhea, and pain. JRA may lead to infertility and weight loss or gain.

JRA is diagnosed when symptoms persist for at least six weeks. This is confirmed with clinical exams and laboratory tests.

Benefits and Types of Laboratory Tests 

The following information will make it easier to learn about the many benefits of the different types of lab tests used to screen, diagnose, and monitor the condition.

Antinuclear Antibody (ANA)

This lab test is used to find out if there is any presence of autoantibodies. Almost 80% of patients showing symptoms related to eye diseases test positive for this test, and it has positive results for most children affected by JRA.

Rheumatoid Factor (RF)

The results of this test are dependent on the type of JRA the patient has.

Erythrocyte Sedimentation Rate (ESR) or C-reactive Protein (CRP)

Both laboratory tests are used to find the presence and level of inflammation in the patient’s body.

Complete Blood Count (CBC)

This is used to determine the red and white blood cell count as well as the patient’s hemoglobin level. This helps diagnose conditions such as anemia associated with the inflammation due to JRA.

Comprehensive Metabolic Panel (CMP)

As JRA can also affect the child’s kidneys and liver, this test is necessary to monitor the function of these vital organs. A vital step in diagnosing JRA is eliminating other similar conditions.

HLA-B27

This test helps differentiate between the types of arthritis.

Synovial Fluid Analysis

This detects any crystals that might be present in the joint and determines if there is any joint inflammation.

Types of Non-Laboratory Tests

• X-rays can detect joint inflammation, fluid build-up, fractures, tumors, or infections, etc.

• A thorough eye exam is necessary to monitor any eye inflammation.

• An EKG can identify any heart inflammation.

Treatment

Although juvenile rheumatoid arthritis is incurable, a combination of treatments effectively alleviates pain or prevents bone damage. This treatment includes:

• Medication

• Surgery

• Physiotherapy

• Chiropractic therapy (massage, swimming, exercise, joint support, or use of splints to protect joints)

• Occupational therapy

• Psychotherapies (cognitive behavior therapy, REBT, and other modern approaches)

• Alternative therapies

• Diet control

• Hot massages (to soothe joint inflammation) or use of cold elements (to numb organs)

• Acceptance of the severity of the disease and help in applying positive thinking techniques to provide physical and mental comfort to the patient.

In short, interdisciplinary approaches need to be used to reduce the pain and suffering that accompanies JRA. Strong family support and positivity of the patient’s peer group play a vital role as well for the patient to respond to the medication.

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