Topic Overview
What is juvenile rheumatoid arthritis?
Juvenile rheumatoid arthritis (JRA), sometimes called juvenile chronic arthritis, is a childhood disease that causes inflamed, swollen joints that are often stiff and painful. JRA affects about 1 in 1,000 children aged 16 and younger. 1

There are three types of JRA. Each type is based on the number of joints affected during the first 6 months of active disease: 2, 3

Pauciarticular JRA (also called oligoarthritis) is the most common type, affecting about 60% of all children with JRA. In this type, 1 to 4 joints are affected.
Polyarticular JRA (also called polyarthritis) affects about 30% of children with JRA. Five or more joints are affected in this type.
Systemic JRA affects 10% of children with JRA. It causes whole-body symptoms, such as fever and rash, which usually occur before joint symptoms appear. Systemic JRA may affect any number of joints.
?BR>Unlike adults with rheumatoid arthritis, most children with JRA do not have long-term disease and disability, and go on to lead healthy adult lives. To reflect this usually good prognosis, an increasing number of international experts are no longer using the term rheumatoid to describe this disease. JRA is now often referred to as juvenile idiopathic arthritis (JIA); idiopathic means of unknown cause.

What causes juvenile rheumatoid arthritis?
The cause of JRA is not well-understood. Most experts believe JRA is caused by a combination of factors, including an overly active immune system that inappropriately attacks joint tissues, viral or bacterial infections that may trigger the autoimmune process, and genetic factors that make a child's immune system more likely to react inappropriately.

What are the symptoms?
Symptoms common to all three forms of JRA include joint pain, a disturbance in the way a child walks (abnormal gait), and joint stiffness that lasts longer than 1 hour in the morning. In JRA, the membranes or tissues (synovial membranes) lining the joints become inflamed (synovitis) for more than 6 weeks. Many children with JRA are more aware of joint swelling and problems with mobility (gait disturbances) than pain. 4

Inflammatory eye disease can develop as a complication of juvenile rheumatoid arthritis (JRA) and if untreated can lead to blindness. All children diagnosed with JRA need regular eye examinations by an ophthalmologist. Girls with pauciarticular JRA, particularly those who have a positive antinuclear antibody (ANA) test result, are at high risk for eye disease and need the most frequent eye examinations. Eye disease associated with JRA may not cause symptoms but may cause blurred vision early in its development.

How is juvenile rheumatoid arthritis diagnosed?
JRA is diagnosed through findings from your child's medical history and a physical examination, including the pattern and nature of joint symptoms, and tests that help to rule out other conditions. Tests that often are helpful in isolating the cause of symptoms include a complete blood count (CBC), erythrocyte sedimentation rate (ESR, or sed rate), rheumatoid factor, ANA, urinalysis, and strep test.

How is it treated?
Children with JRA can often be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and occasional corticosteroid injections into a joint (first-line treatment). Children who do not respond to NSAID treatment are treated with methotrexate or other disease-modifying antirheumatic drugs (DMARDs), considered second-line treatment. Surgery is reserved for unusual cases when medical and physical therapy have failed and a severe deformity has developed.