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Juvenile Rheumatoid Arthritis: Causes, Classifications & Complications

A doctor examining a child
Contents

Photo by Spc. Ethan Mccubbins, U.S. Army, Public domain, via Wikimedia Commons

Overview

Juvenile rheumatoid arthritis is the older name for what doctors now call juvenile idiopathic arthritis (JIA). It is the most common type of chronic arthritis in children, and it begins before age 16.

JIA causes joint pain, swelling, warmth, stiffness and loss of motion. It can affect one joint or many, and any joint can be involved.

The joints affected depend on the type. In the most common type, larger joints like the knees and ankles are often involved, while other types affect the small joints of the hands and feet.

Juvenile Rheumatoid Arthritis

Causes of Juvenile Rheumatoid Arthritis

The exact cause is not known. JIA is thought to be an autoimmune condition, in which the immune system becomes overactive and attacks the body's own healthy tissue, causing inflammation.

The immune system normally protects the body against germs like bacteria and viruses. In JIA, it is misdirected rather than weakened.

Scientists think a mix of genes and environmental factors plays a role.

Classification of Juvenile Rheumatoid Arthritis

1- Pauciarticular:

Now called oligoarticular JIA, this is the most common and mildest type in North America. It affects four or fewer joints, often the knees or ankles. About half of children with JIA have this form.

Many of these children test positive for antinuclear antibodies (ANA). These children have a higher risk of eye inflammation (uveitis) and need regular eye exams.

2- Polyarticular:

This type affects five or more joints in the first six months. It is the second most common type.

It often affects small joints of the hands and feet, though large joints may also be involved. Some children test positive for rheumatoid factor (RF), which is most common in preteen and teenage girls.

3- Systemic Disease:

This type affects the whole body, with daily fevers, a rash that comes and goes, and joint inflammation. It is the least common type but can be the most severe.

It can affect internal organs, cause swollen lymph nodes and an enlarged liver or spleen, and lead to anemia. A serious complication called macrophage activation syndrome can occur with this type.

4- Enthesitis-Related Arthritis:

This type causes inflammation where tendons and ligaments attach to bone, along with arthritis. It resembles adult spondyloarthritis, often involves the hips, lower back and the sacroiliac joints in the pelvis, and is more common in boys.

Other types include psoriatic arthritis, which occurs with psoriasis, and undifferentiated arthritis, which doesn't fit one category.

Signs and Symptoms

  • Pain: a young child may not be able to describe pain. You may notice crying, or a limp when the child walks, especially in the morning.
  • Joint swelling: one or more joints may be swollen.
  • Heat: joints may be warm and tender to touch.
  • Joint stiffness: morning stiffness is common and tends to ease over the day. The child may seem clumsy.
  • Eye inflammation: uveitis can occur with no symptoms at all, which is why regular eye exams matter.
  • Systemic features: in some types, fever, rash, swollen lymph nodes, anemia, or inflammation around the heart or lungs.

How to Diagnose?

JIA is diagnosed mainly from the history and physical exam, after ruling out other causes. The doctor may ask:

  • When did the symptoms start?
  • How many joints are involved?
  • Are the joints tender or warm to touch?
  • Does your child limp or cry while walking?
  • Is there morning stiffness?
  • Are there other signs like fever, rash, or swollen lymph nodes?

After taking a history, the doctor will examine the child and may order tests such as:

  • X-rays of affected joints
  • Antinuclear antibody (ANA) test
  • Rheumatoid factor (RF)
  • Anti-CCP antibodies
  • Complete blood count (red cells, white cells and platelets)
  • Erythrocyte sedimentation rate (ESR)
  • C-reactive protein (CRP)
  • HLA-B27 for suspected enthesitis-related arthritis
  • MRI or ultrasound of affected joints
  • An eye exam by an eye specialist, even without eye symptoms

No single blood test confirms JIA, and results can be normal in a child who has it. It is diagnosed when arthritis lasts at least six weeks in a child under 16 and other causes have been ruled out.

Treatment of Juvenile Rheumatoid Arthritis

There is no cure, but treatment can bring many children into remission and prevent joint damage. A pediatric rheumatologist usually guides care. Doctors may prescribe:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, to ease pain and swelling. These may be enough when few joints are involved.
  • Corticosteroids for severe flares, either as joint injections or by mouth. Long-term use by mouth is avoided because of side effects.
  • Disease-modifying drugs such as methotrexate, which calm the overactive immune system.
  • Biologic drugs that block specific inflammation signals, such as TNF, IL-1 or IL-6 inhibitors.

Medicines that suppress the immune system can raise the risk of infections, so children taking them are monitored closely.

Conservative Management

  • Warm baths
  • Sleeping in a warm bed to lessen stiffness and pain
  • Pain relievers recommended by the child's doctor
  • Gentle exercise to reduce stiffness
  • Stretching to increase flexibility
  • Regular daily activity, such as walking, biking or swimming
  • Emotional support for the child
  • Support or counseling for parents, since caring for a child with a chronic illness can be stressful

Complications of Juvenile Rheumatoid Arthritis

  • Joint stiffness and damage
  • Limping
  • Reduced mobility
  • Slowed growth or uneven limb length

Heart complications:

  • Pericarditis (inflammation of the lining around the heart)
  • Myocarditis (rare)

Pulmonary complications:

  • Pleuritis or pleural effusions (fluid around the lungs)
  • Lung inflammation or scarring (rare)

Kidney diseases:

  • Kidney problems are uncommon and can be side effects of medicines

Hematologic complications:

  • Anemia
  • Macrophage activation syndrome (with systemic JIA)

Other complications:

  • Chronic pain
  • Missed school
  • Depression or anxiety

Lymph nodes enlargement

Eye diseases:

  • Uveitis
  • Cataracts or glaucoma from untreated uveitis
  • Loss of vision

Liver diseases:

  • Enlarged liver (in systemic JIA)
  • Liver effects from medicines, which doctors monitor with blood tests

Can Juvenile Rheumatoid Arthritis Be Prevented?

There is no known way to prevent JIA, but it can be managed. Many children's disease becomes inactive with little joint damage, especially when few joints are involved.

MedlinePlus recommends activity like walking, biking and swimming to keep joints flexible and muscles strong. Warmth can ease stiffness 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?

JIA is a chronic condition that can flare at times. See a doctor if your child is limping, seems clumsy, has swollen or stiff joints, or has morning stiffness that keeps getting worse.

Seek care promptly if joint symptoms come with fever, rash, swollen lymph nodes, or eye redness, pain or vision changes.

HP Thoughts: Your knees could be experiencing some swelling and pain without you knowing it. Read our post to learn more: Rheumatoid Arthritis Of Knee.

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