Overview
Arthritis means “joint inflammation” and refers to a group of diseases that cause pain, swelling, stiffness, and loss of motion in the joints and supporting structures of the body such as muscles, tendons, ligaments, and bones. Some rheumatic diseases can affect other parts of the body, including eyes, liver, heart, and lungs. Children can develop almost all the same types of arthritis as adults, but the most common type that affects children is juvenile rheumatoid arthritis (JRA).
JRA is a chronic condition, meaning it usually lasts for a relatively long period of time. Symptoms can change from day to day or from morning to afternoon. Flares are periods of time when the condition becomes more active and symptoms worsen. Sometimes the signs and symptoms just go away on their own, which is called remission. Remission may last for months, years, or for a person's lifetime. Some may have just one or two flare-ups and never have symptoms again, while others experience many flare-ups or even have symptoms that never go away. JRA sometimes causes only minor symptoms and problems, but in some cases it can cause serious joint damage or limit growth.
The most common symptom of all types of JRA is persistent joint swelling, pain, and stiffness that typically is worse in the morning or after a nap. This pain may limit movement of the affected joint although many children, especially younger ones, will not complain of pain. JRA commonly affects the knees and joints in the hands and feet. One of the earliest signs of JRA may be limping in the morning because of an affected knee. Besides joint symptoms, children with systemic JRA have a high fever and a light skin rash. The rash and fever may appear and disappear very quickly. Systemic JRA also may cause the lymph nodes located in the neck and other parts of the body to swell. In some cases (less than half), internal organs including the heart and, very rarely, the lungs may be involved.
The onset of arthritis may be slow or extremely rapid. An early sign of slow onset may be stiffness on arising in the morning.
There are three major types of JRA:
Pauciarticular (pronounced: paw-see-are-tick-yoo-lur) JRA. This kind of JRA involves four or fewer joints and usually affects larger joints such as the knee.
Polyarticular (pronounced: pa-lee-are-tick-yoo-lur) JRA. The prefix poly means “many.” Polyarticular JRA affects five or more joints, usually the small ones in the hand and fingers. It also can affect the knees, hips, ankles, feet, and neck. Polyarticular JRA may strike the same joint on each side of the body, often causing swelling of the involved joints. Symptoms may include a low-grade fever, tiredness, poor appetite, and rheumatoid nodules (bumps) on the affected joints. This form of JRA can lead to long-term joint problems and frequently requires treatment with powerful medications.
Systemic (pronounced: sis-teh-mick) JRA. Systemic JRA can affect several parts of the body, including internal organs and joints. This is the least common form of JRA. The first signs of systemic JRA are usually high fevers, chills, and a rash. Joint problems may begin with the fevers, or fever may start weeks or months later. Fever usually occurs late in the afternoon or evening and can go up to 103 degrees Fahrenheit (39.4 degrees Celsius) or higher and return to normal within a few hours. The person may feel very sick when his or her temperature is high but just fine during the rest of the day. About half of the kids and teens with systemic JRA recover nearly completely. On the other hand, half of children affected systemic JRA will have some problems into adulthood.
