Juvenile Rhematoid Arhritis

Juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis, is a disease of the joints in children. It can affect a child over a long period of time. JRA often starts before the child is 16 years old.

In JRA, the joint becomes swollen. It will make the joint painful and difficult to move. JRA can also lead to long term damage to the joint. For some, JRA can interfere with the child's growth and development.

There are 5 major types of JRA:

  • 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 Still disease)—affects the entire body, least common type of JRA

Rheumatoid ArthritisCopyright © Nucleus Medical Media, Inc.

Causes

JRA is caused by a problem of the immune system. The normal job of the immune system is to find and destroy items that should not be in the body, like viruses. With JRA, the immune system attacks the healthy tissue in the joint. It is not clear why this happens. The immune system problems may be caused by genetics and/or factors in the environment.

Risk Factors

Girls are more likely to get JRA than boys.

There are no clear risk factors for JRA. Factors that may be associated with some types of JRA include:

  • 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)

Symptoms

Symptoms may include:

  • Joint stiffness, especially in the morning or after periods of rest

  • Pain, swelling, tenderness, or weakness in the joints

  • Fever

  • 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

Some symptoms are specific to each type of JRA. For example:

  • 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.

Often, there are remissions and flare-ups. Remission is a time when the symptoms improve or disappear. Flare-ups are times when symptoms become worse.

Diagnosis

You will be asked about your child’s symptoms. You will also be asked about your family medical history. A physical exam will be done. An eye examination may also be done to check for swelling in the eye. Your child may be referred to a specialist if JRA is suspected. The specialist is a doctor who focuses on diseases of the joints.

Images may be taken of your child's bodily structures. This can be done with x-rays .

Your child's bodily fluids may be tested. This can be done with:

  • Blood tests

  • Urine tests

  • Tests of joint fluid

Osteoarthritis

Cartilage is smooth tissue that covers the bone in a joint. Osteoarthritis (OA) is the wearing down of cartilage over time. OA can cause pain and limit movement.

Joints Affected by OsteoarthritisCopyright © Nucleus Medical Media, Inc.

Causes

Cartilage acts as a cushion for the bones. It also helps bones move smoothly over each other. High impact, stress, and pressure on the joint can wear down the cartilage. The damage worsens over time. For some, the cartilage may completely wear away. This leaves the bone surfaces bare which causes pain and trouble moving.

Wear and tear of the joint is a part of aging. Injuries to the joint, weak muscles, or other health problems can speed up and worsen the damage.

Risk Factors

OA is more common in older adults. Other factors that may increase your chance of OA include:

  • Excess body weight

  • Family history of OA

  • Having an injury or surgery to the cartilage

  • Having a job or doing physical activities that put stress on the joints

  • Certain endocrine, metabolic, or neuropathic disorders

  • Avascular necrosis—death of bone from lack of blood flow

Symptoms

OA is most common in larger joints that support weight such as the spine, hips, and knees. It is also common in active joints like the hand and feet. Common symptoms include:

  • Mild to severe pain in a joint, especially after overuse or long periods of rest

  • Creaking or grating sound in the joint

  • Swelling, stiffness, and problems moving the joint, especially in the morning

  • Decreased stiffness after starting activity

Diagnosis

You will be asked about your symptoms and past health. A physical exam will be done. The doctor can often diagnose OA based on your symptoms.

Other tests are not always needed. The doctor may do more tests if your symptoms are not typical. They can help to rule out other issues like a new injury. Test options may include:

  • X-ray —damage from OA can be seen on x-ray

  • Blood tests—to look for signs of infection or markers of joint disease

  • MRI scan —to rule out injuries

  • Ultrasound

Psoriatic Arthritis

Psoriatic arthritis is a long-term problem of the joints. It causes pain and swelling in the joints. Over time, it can be damaging to the joints and lead to disability.

PsoriasisCopyright © Nucleus Medical Media, Inc.

Causes

Psoriatic arthritis is linked to a skin condition called psoriasis. Not everyone with psoriasis will develop psoriatic arthritis. The exact cause is not known. A combination of genes and factors in the environment may play a role.

The damage to the joints is caused by the body's own immune system. The immune cells target and attack joint tissue. Conditions like this are called auto-immune diseases. It is not clear why it happens in some people.

Risk Factors

The risk of psoriatic arthritis is increased with:

  • Psoriasis for 5 to 12 years

  • Psoriasis with symptoms such as lesions on the scalp and pitted or dented nails

  • Certain genetic factors

  • A family member with psoriatic arthritis

Symptoms

Psoriasis is often present. Symptoms of psoriatic arthritis include:

  • Joint pain and tenderness in one or more joints (usually feet and hands but can be any other joint)

  • Joint swelling

  • Joint stiffness, especially in the morning

  • Red or warm joints

  • Swelling of fingers or toes

  • Changes in fingernails and toenails (pitting in the nails, crumbling nails, or nails separating from the nail bed)

  • Pain and inflammation of tendons where they join muscles

  • Back pain

  • Fatigue

  • Redness and pain of the eye

Diagnosis

You will be asked about your symptoms and health history. The doctor may ask about psoriasis history. A physical exam will be done. Your doctor will rule out other joint problems with the physical exam.

To look for signs of inflammation and a cause your doctor may order:

  • Blood tests

  • Test of the fluid in the joints

Images of the joint may also be done to look for damage. Tests may include:

  • X-rays

  • Ultrasound

  • MRI scan

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is a disorder of the joints. It causes pain, swelling, stiffness, and loss of function in the joints.

Rheumatoid Arthritis© Nucleus Medical Media, Inc.

Causes

RA is caused by a problem with the immune system. It begins to attack healthy tissue. It is not clear what makes this happen. It is most likely a combination of factors in your genes and environment. Some known factors include:

  • Genes—people with RA often have a specific genetic defect

  • Defects in the immune system—may stop the immune cells from recognizing the body’s own tissues

  • Infection with specific viruses or bacteria—may start an abnormal immune response

  • Chemical or hormonal imbalances in the body

Risk Factors

RA is more common in:

  • Women

  • People aged 30 to 60 years

Other factors that may increase your chance of developing RA include:

  • Family members with RA

  • Heavy or long term smoking

Symptoms

Symptoms involve two or more joints which are usually:

  • Smaller joints

  • The same joints on both sides of the body

Symptoms include:

  • Increased pain and stiffness in the morning and after inactivity that lasts more than 30 minutes

  • Red, swollen, warm joints

  • Deformed, misshapen joints

RA may also cause:

  • Intense fatigue, decreased energy

  • Muscle aches

  • Decreased appetite

  • Weight loss

  • Fever and sweats

  • Insomnia

  • Small lumps or nodules under the skin

Inflammation may also occur in:

  • Eyes

  • Mouth

  • Skin

  • Lungs

  • Blood and blood vessels

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. There are many diseases that can mimic RA. Tests will help to rule out other conditions.

Tests may include:

  • Blood tests to look for:

    • Rheumatoid factor—can be found in conditions other than RA

    • Signs of an autoimmune disorder or inflammation

  • Imaging tests:

    • X-rays

    • Ultrasound

    • MRI scan

  • Tissue sample such as:

    • Synovial biopsy—a piece of the lining of the joint

    • Arthrocentesis —fluid from the joint

The doctor will look at all your symptoms and test results to reach a diagnosis.

Septic Arthritis

Septic arthritis (SA) is a joint infection. The joint reacts to it by filling with pus. It may also become swollen.

Causes

Bacteria is the most common cause of SA. It attaches to tissue and spreads.

Viruses and fungi can also cause SA. It is not as common.

The infection may be started by an organism:

  • That has entered the blood from an infection somewhere else in the body

  • That entered the bloodstream from IV drug use

  • That is outside the body and entered through a wound or incision from surgery

Joint Damage in KneeCopyright © Nucleus Medical Media, Inc.

Risk Factors

SSA is more common in older adults and children 2-3 years old.

Here are some factors that may raise your risk:

  • Taking medicines or having diseases that weaken the immune system, such as HIV

  • A history of joint problems or having other types of arthritis

  • A history of IV drug use

  • Long-term health problems, such as diabetes

  • Joint replacement or organ transplant surgery

  • Recent joint injections

Risk factors in children are:

  • Trauma

  • Weakened immune system

  • Respiratory distress syndrome

  • Umbilical artery catheterization

  • History of a urinary tract infection

Symptoms

The knee and hip are the most common site for SA in children. The knee, hip, shoulder, ankle, elbow, and wrist are the most common sites in adults.

Symptoms may include:

  • Adults:

    • Warm, red, painful joint

    • Joint swelling

    • Problems moving the joint or limb

    • Fever

  • Children:

    • Crying when a joint is moved, such as during a diaper change

    • Warmth and redness

    • Swelling

    • Problems moving a joint or limb

    • Problems walking

    • Fever

Diagnosis

You will be asked about you or your child’s symptoms and health history. A physical exam will be done. Your doctor may refer you to a specialist.

Body fluids may need to be tested. This can be done with:

  • Testing joint fluids

  • Blood tests

Pictures may be taken of your bodily structures. This can be done with:

  • X-rays

  • MRI scan



This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

RESOURCES

Arthritis Foundation http://www.arthritis.org