Juvenile Rheumatoid Arthritis: Causes, Classifications & Complications

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Juvenile Rheumatoid Arthritis

Overview

Juvenile rheumatoid arthritis is a type of arthritis affecting younger children and children less than 16 years of age. It causes inflammation, tenderness, and stiffness of joints and can involve one, two, three, or multiple joints. Any joint can be affected the result in stiffness and reduced mobility of joints. Small joints of hands are affected first and then involves the joints of other parts of the body.

Juvenile Rheumatoid Arthritis

Causes of Juvenile Rheumatoid Arthritis

The exact cause is not known, however, it is thought to occur as a result of the autoimmune disease process. Autoimmune diseases refer to diseases in which antibodies are formed against one’s own body tissues and destroy them. The cause of these antibody formation and processes involved in their formation is not known. The immune system of our body is responsible for protecting the body against conditions unfavorable for the body and also protects against bacteria. The immune system is hence weakened and the body is prone to the vast majority of diseases.

Genetic factors play an important role in Juvenile rheumatoid arthritis and one or more family member of the child may be affected. It, therefore, has a hereditary tendency and runs in families. Various environmental causes have also been ruled out to cause Juvenile rheumatoid arthritis.

Classification of Juvenile Rheumatoid Arthritis

1- Pauciarticular:

It is the most common type of arthritis. It means four or less than four joints of the body are affected. More than half of children have this form of the disease. It is associated with increased levels of Anti nuclear antigen (ANA).

2- Polyarticular:

The type of arthritis in which five or more joints are affected. This type is present in 25% of children. It mostly affects small joints of hands and feet but large joints may also be involved. It is associated with increased levels of antibody i.e Rheumatoid Factor (RF) antibody.

3- Systemic Disease:

This type of arthritis is characterized by systemic features like fever, rash, and myalgia. It can also affect various internal organs like heart, kidney, liver, spleen. It can affect blood cells and causes anemia, thrombocytopenia, and leukopenia. This type of arthritis causes long term joint damage. 50% of the children having this type recover while 50% suffer long term sequelae of the disease.

4- Spondyloarthritis:

This type of Juvenile rheumatoid arthritis resembles adult disease and affects pelvis and lower part of the spine i.e lumbar vertebra.

Signs and Symptoms

  • Pain: the child himself may not be able to tell about the pain if he is small to talk. The pain is identified when the child cried and limps while he walks.
  • Joint swelling: one or the more joints may be swollen. It mostly affects the small joints of hands and feet and they may be swollen.
  • Heat: joints may be hot and tender to touch.
  • Joint stiffness: morning stiffness of joints is diagnostic for rheumatoid arthritis. Stiffness improves over the day and the child may be clumsy.
  • Systemic features: fever, rash, lymph node enlargement, hepatitis, nephritic syndrome, anemia, thrombocytopenia, leukopenia, carditis, seizures, pulmonary fibrosis, or nodules may be associated with Juvenile rheumatoid arthritis.

How to Diagnose?

Rheumatoid arthritis is usually diagnosed by clinical tests. The doctor will ask about the history and may ask the following questions:

  • When the disease started?
  • How many joints were involved?
  • Were the joint tender or hot to touch?
  • Do your child limp or cries while walking?
  • Is the morning stiffness present?
  • Is the disease associated with systemic signs like fever, rash, and lymph node enlargement?

After talking history he may examine the child and will require some clinical tests some of which are:

  • X-ray of small joints of hands and feet
  • Antibody detection tests e.g Anti Nuclear Antibody (ANA)
  • Detection of Rheumatoid Factor (RF)
  • Anti-CCP
  • Complete blood count for determination of levels of RBCs, WBCs, and platelets.
  • Erythrocyte Sedimentation rate (ESR)
  • C reactive protein (CRP)
  • MRI of small joints of hands

There is not a single specific blood test for diagnostic purposes of Rheumatoid arthritis. It is diagnosed when a joint is swollen and is not associated with any other disease.

Treatment of Juvenile Rheumatoid Arthritis

There is no single therapy for definitive treatment of arthritis. The treatment depends on controlling symptoms. Doctors may prescribe

  • Nonsteroidal anti-inflammatory drugs(NSAIDs) e.g ibuprofen which lessen inflammation and joint swelling.
  • Corticosteroids to prevent inflammation.
  • Immunosuppressive therapy e.g methotrexate. This therapy aids to lower immunity so the antibodies will not attack body tissues. It is associated with high risks of co-infections as the immune system is weakened and pathogens attack the body.

Conservative Management

  • Hot baths
  • Sleeping in a warm bed to lessen stiffness and pain
  • Analgesics to relieve pain
  • Mild exercises to reduce stiffness
  • Stretching to increase flexibility
  • Exercise at the same time daily to improve outcomes
  • Emotional support to children
  • Psychotherapy of parents as it is a chronic disease and depresses parents

Complications of Juvenile Rheumatoid Arthritis

Joints related:

  • Joint stiffness
  • Limping
  • Immobilization
  • Polyarticular type involving more than 5 joints

Heart complications:

  • Myocarditis
  • Endocarditis
  • Myocardial infarction

Pulmonary complications:

  • Pulmonary nodules
  • Pulmonary fibrosis
  • Pulmonary edema
  • Pulmonary effusions

Kidney diseases:

  • Nephrotic syndrome
  • Glomerular diseases
  • Parenchymal diseases

Hematologic complications:

  • Anemia
  • Thrombocytopenia
  • Leukopenia

CNS diseases:

  • Seizures
  • Meningitis
  • Depression

Lymph nodes enlargement

Eye diseases:

  • Uveitis
  • Episcleritis
  • Loss of vision

Liver diseases:

  • Hepatitis
  • Hepatic fibrosis

How Juvenile Rheumatoid Arthritis Can Be Prevented?

There is no cure for rheumatoid arthritis but it can be managed conservatively by changing lifestyles and dietary modifications. Regular exercise at one time daily can improve flexibility and range of motion. A child is made to learn swimming exercises and biking. Sleeping in a warm bed and heat therapy can reduce inflammation and pain. Physiotherapy helps a lot to improve joint stiffness and pain. It aids in flexibility and reduces the tendency of locked joints.

When to Call Your Healthcare?

Juvenile rheumatoid arthritis is a chronic condition with severe exacerbations at some time. Immediately seek medical help if your child is limping, is clumsy, more than two joints are involved, Morning stiffness is increasing with time and if arthritis is associated with systemic signs like fever, rash, lymph node enlargement and anemia.