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Juvenile Arthritis

What is juvenile arthritis?

Juvenile arthritis (JA) is a long-term autoimmune disease that causes pain and inflammation in one or more joints. Some children have symptoms for only a few months, others for the rest of their lives. It happens when the immune system attacks the tissues in the joints. Most children with JA have periods of remission with minimal joint deformity or loss of function.

What are the types of JA?

  • Oligoarthritis: Fewer than 5 joints with arthritis are affected during the first 6 months of the disease. It is called persistent oligoarthritis when the number of joints involved remains fewer than 5 after 6 months. Extended oligoarthritis happens when the joints involved increases to 5 or more after 6 months. Oligoarthritis tends to occur in large joints of the lower limbs, such as the knees and ankles.

  • Polyarthritis: Five or more joints are affected within the first 6 months of the disease. This may occur in very young children or adolescents. The large and small joints of the hands, feet, neck bones, or jaw may be involved.

  • Systemic arthritis: Fever and rash are often present. Your child's organs and lymph nodes may also be affected. The arthritis usually involves many joints and may affect both large and small joints.

  • Enthesitis-related arthritis: This type includes other conditions such as juvenile ankylosing spondylitis and arthritis associated with inflammatory bowel disease. This arthritis often occurs in the lower limb joints and places where tendons attach to a bone. Your child's hips and spine (back bone) may become affected.

  • Psoriatic arthritis: This type is related to a skin condition called psoriasis. Psoriatic arthritis often affects one of the knees or ankles, and the small joints. It also commonly causes inflammation of the sheath (cover) of a tendon.

  • Undifferentiated arthritis: This term means that caregivers cannot easily identify the type of arthritis your child has. His arthritis may fall into more than one type, or his symptoms may be too hard to classify.

What are the signs and symptoms of JA?

  • Joint pain or stiffness

  • Fever or skin rash

  • Eye pain or headache

  • Swelling or nodules (growths) on or around the joints

  • Nail changes, or bent or crooked fingers

  • Fatigue or muscle weakness

  • Loss of appetite, weight loss, abdominal pain, or diarrhea

How is JA diagnosed?

Your child's caregiver will examine your child. He may ask about your child's medical history, including other diseases, and medicines he is taking. Caregivers will also need to know when the joint problems and other symptoms started. Your child may also need any of the following tests:

  • Blood tests: Your child's blood is tested for signs of infection or inflammation.

  • Joint x-ray: This is a picture of the bones and tissues in your child's joints. Your child may be given dye as a shot into the joint before the x-ray. This dye will help your child's joint show up better on the x-ray. Tell the caregiver if your child has ever had an allergic reaction to contrast dye. A joint x-ray with dye is called an arthrogram.

  • MRI: This scan uses powerful magnets and a computer to take pictures of your child's joints. An MRI may show inflammation or joint damage. Your child may be given dye to help the pictures show up better. Tell the caregiver if your child has ever had an allergic reaction to contrast dye. Do not let your child enter the MRI room with anything metal. Metal can cause serious injury. Tell the caregiver if your child has any metal in or on his body.

How is JA treated?

  • Medicines:

    • NSAIDs help decrease swelling and pain or fever. This medicine is available with or without a doctor's order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If your child takes blood thinner medicine, always ask if NSAIDs are safe for him. Always read the medicine label and follow directions. Do not give these medicines to children under 6 months of age without direction from your child's doctor.

    • Antirheumatics: These may slow the progress of JA, and reduce pain, stiffness, and inflammation. These are used when NSAIDs alone do not control symptoms.

    • Steroids: These are given to decrease inflammation.

    • Biologic therapy: These may help decrease joint swelling, pain, and stiffness. These medicines can increase the risk of serious infections and require careful monitoring.

  • Surgery: This may be needed if your child's joints become severely affected. Surgery can be done to take out all or part of the joint and replace it with an artificial joint. This may be done to ease pain and repair the joint. It may also be done if the bones in your child's spine are pressing on the nerves.

What are the risks of JA?

Surgery may cause your child to bleed or get an infection. If left untreated, JA can be very painful and cause problems with your child's growth and daily activities. JA may involve other organs in the body, such as the eyes, heart, or liver.

How can I help manage my child's symptoms?

  • Eye checks: Have your child's eyes examined regularly. Ask your caregiver for more information about eye checks and how frequently your child should have them.

  • Physical therapy: A physical therapist can teach your child exercises to help improve movement and strength, and to decrease pain. An occupational therapist can teach him skills to help with play and daily activities.

  • Rest: Rest is important if your child's joints are painful. Limit his activities until his symptoms improve. Gradually let him start his normal activities when he can do them without pain. Have him avoid motions and activities that cause strain on his joints, such as heavy exercise and lifting.

  • Ice or heat: Both can help decrease swelling and pain. Ice may also help prevent tissue damage. Use an ice pack, or put crushed ice in a plastic bag. Cover it with a towel and place it on your child's joint for 15 to 20 minutes every hour or as directed. You can also apply heat to his joints for 20 minutes every 2 hours. Heat treatment includes hot packs, heat lamps, warm baths, or showers.

  • Support devices: Your child may be given splints to wear on his hands to help his joints rest and to decrease inflammation.

Where can I find support and more information?

  • Arthritis Foundation
    P.O. Box 7669
    Atlanta , GA 30357-0669
    Phone: 1- 404 - 872-7100
    Phone: 1- 800 - 568-4045
    Web Address: http://www.arthritis.org
  • National Institute of Arthritis and Musculoskeletal and Skin Disease
    Information Clearinghouse
    National Institutes of Health
    1 AMS Circle
    Bethesda , MD 20892-3675
    Phone: 1- 301 - 495-4484
    Phone: 1- 877 - 226-4267
    Web Address: http://www.niams.nih.gov

When should I contact my child's caregiver?

Contact your child's caregiver if:

  • Your child has a fever.

  • Your child has problems eating or you feel he is not eating enough.

  • Your child begins to lose weight, thinks more slowly, or seems sad most of the time.

  • Your child has a severe headache or pain around the eyes.

  • You have questions or concerns about your child's condition or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

  • Your child has severe eye pain or changes in vision.

  • Your child's pain becomes worse.

  • Your child has severe redness, swelling, or pain in one of his joints.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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