Juvenile rheumatoid arthritis (JRA) is a term used to describe a common type of arthritis in children. It is a long-term (chronic) disease resulting in joint pain and swelling.
Juvenile chronic polyarthritis; JRA; Still's disease; Juvenile idiopathic arthritis
The cause of JRA is not known. It is thought to be an autoimmune illness. This means the body's immune system mistakenly attacks and destroys healthy body tissue.
JRA usually occurs before age 16. Symptoms may start as early as 6 months old.
It is divided into several types:
Symptoms of JRA may begin with a swollen joint, limping, a spiking fever, or a new rash.
Symptoms can include:
Body-wide JRA symptoms:
JRA can also cause eye problems called uveitis, iridocyclitis, or iritis. There may be no symptoms, or the person may have:
The physical examination may show swollen, warm, and tender joints that hurt to move. The child may have a rash. Other signs include:
Blood tests that may be done include:
Any or all of these blood tests may be normal in patients with JRA.
The health care provider may place a small needle into a swollen joint to remove fluid. This can help to find the cause of the arthritis and help relieve pain, too. Sometimes, the health care provider will inject steroids into the joint to help reduce swelling.
Other tests that may be done include:
When only a small number of joints are involved, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen may be enough to control symptoms.
Corticosteroids may be used for more severe flare-ups to help control symptoms.
Children who have arthritis in many joints, or who have fever, rash, and swollen glands may need other medicines. These medicines are called disease-modifying antirheumatic drugs (DMARDs). They can decrease or prevent swelling in the joints or body. DMARDs include:
It is important for children with JRA to stay active and keep their muscles strong.
Exercise will help keep their muscles and joints strong and mobile.
Support and help for children who have sadness or anger about their arthritis is also very important.
Some children with JRA may need surgery, including joint replacement.
Long periods with no symptoms are more common in those who have only a small number of joints involved. Many children with JRA eventually go into remission with very little loss of function and joint damage.
The greater the number of joints affected, the more severe the disease and the less likely that the symptoms will eventually go into total remission.
Children with JRA who have many joints involved, or who have a positive rheumatoid factor are more likely to have chronic pain, disability, and poor school attendance. The greater the number of joints affected, the more severe the disease and the less likely that the symptoms will eventually go into total remission.
For additional information and resources, see: Arthritis support group
Call for an appointment with your health care provider if:
There is no known prevention for JRA.
Long AR, Rouster-Stevens KA. The role of exercise therapy in the management of juvenile idiopathic arthritis. Curr Opin Rheumatol. 2010 Mar;22(2):213-7.
Prince FH, Otten MH, van Suijlekom-Smit LW. Diagnosis and management of juvenile idiopathic arthritis. BMJ. 2010 Dec 3;341:c6434.
Ruperto N, Lovell DJ, Quartier P, et al; Paediatric Rheumatology International Trials Organization and the Pediatric Rheumatology Collaborative Study Group. Long-term safety and efficacy of abatacept in children with juvenile idiopathic arthritis. Arthritis Rheum. 2010 Jun;62(6):1792-802.