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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. Your child may have symptoms for only a few months, or for the rest of his life. JA develops 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. Your child may have any of 6 subtypes of JA. Ask your child's healthcare provider for more information about the type your child has.

What are the signs and symptoms of JA?

Your child will have any of the following for at least 6 weeks:

  • Joint pain or stiffness, especially in the morning
  • High fever or a skin rash
  • Swollen lymph nodes
  • Eye pain or a 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

What increases my child's risk for JA?

  • Being a female
  • A family history of arthritis
  • Certain infections, such as rubella or parvovirus
  • Problems with your child's immune system
  • A protein called immunoglobulin G, or IgG

How is JA diagnosed?

Your child's healthcare provider will examine your child. He may ask about other medical conditions your child has and medicines he is taking. Healthcare providers 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 are used to check your child's blood for signs of infection or inflammation.
  • X-ray or MRI pictures may be taken of your child's joints. Your child may be given contrast liquid to help the joints show up better on the x-ray. Tell the healthcare provider if your child has ever had an allergic reaction to contrast dye. A joint x-ray with dye is called an arthrogram. Do not let your child enter the MRI room with anything metal. Metal can cause serious injury. Tell the healthcare provider if your child has any metal in or on his body.
  • Arthrocentesis is a procedure used to drain fluid out of a joint. The fluid is tested for infection or other problems that can cause arthritis.
  • Synovial biopsy may be used if your child's joint fluid cannot be drained or if he has signs of an infection. A piece of tissue is removed from the lining of a joint. The tissue is tested for possible causes of your child's arthritis.

How is JA treated?

  • Medicines:
    • NSAIDs , such as ibuprofen, help decrease swelling, pain, and 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 healthcare provider.
    • Antirheumatics may slow the progress of JA, and reduce pain, stiffness, and inflammation. These are used when NSAIDs alone do not control symptoms.
    • Steroids are given to decrease inflammation.
    • Biologic therapy may help decrease joint swelling, pain, and stiffness. These medicines can increase the risk of serious infections and require careful monitoring.
  • Surgery 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.

How can I help manage my child's symptoms?

  • Eye exams are used to check for uveitis (eye inflammation). Have your child's eyes examined regularly. Ask your child's healthcare provider or rheumatologist for more information about eye checks and how frequently your child should have them.
  • 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 his daily activities.
  • 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 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 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.
  • Splints may be given for your child to wear on his hands. Splints can help his joints rest and decrease inflammation.
  • Physical activity can help increase strength and flexibility. Keep your child as active as possible while avoiding things that increase his pain. Ask your child's healthcare provider or rheumatologist about the best exercise plan for your child.

When should I seek immediate care?

  • 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.

When should I contact my child's healthcare provider?

  • 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.

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 healthcare providers 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.

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