Rheumatoid Arthritis in Children

Rheumatoid arthritis in children is called juvenile rheumatoid arthritis or JRA. There are mainly three types of JRA, according to their beginning. They are pauciarticular, in which less than four joints are affected, polyarticular, in which four or more joints are affected, and systemic-onset, in which joints are inflamed along with high fever and rash.

Pauciarticular JRA –

Pauciarticular rheumatoid arthritis in children is defined by inflammation of four or less joints after an illness prolonged for six months. It usually starts in young girls as swelling of ankle or knee without apparent cause. Normally it is painless, but there is apparent swelling on the knee or walking of the child is awkward. This arthritis causes morning stiffness, and hence parents usually think that the child is normal when she or he gets going, and remain carefree. This condition is often very mild and is treated with mild nonsteroidal anti-inflammatory drugs (NSAIDs), but can result into two serious problems. One of them is inflammation of eye, i.e. iridocyclitis. This inflammation is not painful, but if not diagnosed and treated, may lead to scarring of the lens and forever visual damage or even loss of vision. Iridocyclitis is more common in children having antinuclear antibodies (ANA) and so they require their eyes examined every six months.

The second problem is that it may give rise to different growth rate of leg bones, resulting into difference in lengths of the two legs and the child has to walk with a limp. This leads to damaged knee and hip, thereby premature arthritis and till the child is an adult, the joint wears out completely. Therefore, this should be taken care of in time. However, this problem is recognizable at an early stage luckily.

Polyarticular JRA –

Polyarticular rheumatoid arthritis in children starts after six months of illness and involves four or more joints. This is a rather dangerous type of arthritis in terms of number of joints involved and also, the damage it causes over time. Therefore, it needs aggressive treatment, and needs to be controlled as soon as possible. The treatment includes at least nonsteroidal anti-inflammatory drugs (NSAIDs) and may also require quite strong medicines. Steroids like prednisone may make the patient feel wonderful, but their long term use brings about severe problems. Therefore, they should be stopped on time. Second-line medicines, like gold shots, methotrexate or sulfasalazine, may be necessary in some children. These drugs, and even steroids, should be administered under the supervision of experienced physician.

A new generation of medicines, biologics, named TNF-blockers, is available now. TNF, i.e. tumor necrosis factor alpha is produced by cells and is responsible for inflammation. TNF-blockers block it and decrease signs and symptoms of inflammation.

Rheumatoid Arthritis in Children

Systemic-onset JRA –

Systemic-onset rheumatoid arthritis in children is also called Still’s disease. It starts with high fever and a rash. It is very crucial at this stage to decide whether the child is really suffering from systemic-onset JRA or some other disease, like infection. It has been observed that the fever is high once or twice everyday and goes away for a part of the day. Sometimes the fever may go completely and never return and sometimes, the fever and rash go away, but the arthritis carries on and can become very severe eventually. This form of JRA may involve internal organs and very rarely a life-threatening disease too.

Treatment of systemic-onset JRA includes NSAIDs, cortisone medications, methotrexate and anakinra (for resistant disease). It is suggested by some research that thalidomide may prove to be effective in systemic-onset rheumatoid arthritis in children.