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Juvenile Rheumatoid Arthritis
(JRA; Juvenile Chronic Polyarthritis; Stills Disease)
- Pauciarticular JRA—4 or less joints are affected in the first 6 months of illness
- Polyarticular JRA—5 or more joints are affected in the first 6 months of illness
- Enthesitis associated arthritis—swelling of the tendon at the bone
- Psoriatic arthritis—associated with a skin disease called psoriasis
- Systemic onset JRA (also called Stills disease)—affects the entire body, least common type of JRA
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Family history of:
- Anterior uveitis with eye pain
- Inflammatory back arthritis (ankylosing spondylitis)
- Inflammatory bowel disease
- Arthritis and a family history of psoriasis in a first-degree relative (for psoriatic arthritis)
- Joint stiffness, especially in the morning or after periods of rest
- Pain, swelling, tenderness, or weakness in the joints
- Weight loss
- Fatigue or irritability
- Swelling in the eye—especially associated with eye pain, redness, or sensitivity to light
- Swollen lymph nodes
Growth problems, such as:
- Growth that is too fast or too slow in one joint (may cause one leg or arm to be longer than the other)
- Joints grow unevenly, off to one side
- Overall growth may be slowed
Symptoms common with
pauciarticular JRA include:
- Problems most often found in large joints. These joints include knees, ankles, wrists, and elbows.
- If the left-side joint is affected, then the right-side similar joint will not be affected. For example, if the right knee is affected, then the left knee will be healthy.
- May also have swelling and pain at on the tendons and ligaments attached to the bone
Symptoms common with
polyarticular JRA include:
- Problems found most often in small joints of the fingers and hands. May also affect weight-bearing joints like the knees, hips, ankles, and feet.
- Joints on both sides of the body are affected. For example, if the left hand is affected, then the right hand will also be affected.
- May also have a blood disorder called anemia. This is an abnormally low number of red blood cells.
One type of polyarticular JRA may occur with:
- A low-grade fever
- Nodules—bumps on parts of body that receive a lot of pressure such as elbows
Symptoms common with systemic onset JRA include:
- Some of the first signs may be a high fever, chills, and a rash on the thighs and chest. May appear on and off for weeks or months
- May have swelling in the heart, lungs, and surrounding tissues
- The lymph nodes, liver, and/or spleen may become enlarged
- Children with enthesitis arthritis often have tenderness over the joint where the pelvis and spine meet.
- Children with psoriatic arthritis often have finger or toe swelling. There may also be damage on fingernails.
- Blood tests
- Urine tests
- Tests of joint fluid
- Nonsteroidal anti-inflammatory drugs (NSAIDs)—to help swelling and pain
- Disease-modifying antirheumatic drugs (DMARDs)—to slow the progression of the disease
- Tumor necrosis factor (TNF) blockers—to decrease swelling, pain, and joint stiffness
- Interleukin inhibitors—to reduces disease activity
- Corticosteroids through IV or by mouth—for swelling
- Steroid injections into the joint—may help relieve swelling and pain in some children
- Reviewer: Kari Kassir, MD
- Review Date: 12/2015
- Update Date: 12/20/2014