ARTHRITIS, JUVENILE RHEUMATOID

General Information

DEFINITION--An inflammatory disease of connective tissue--mostly joints--that affects children. May be confused with the arthritis of Lyme Disease.

BODY PARTS INVOLVED--Joints, usually knees, elbows, ankles and neck. It may also involve adjacent muscles, cartilage and membranes lining the joints.

SEX OR AGE MOST AFFECTED--Starts at 2 to 5 years and usually disappears by young adulthood. It is 4 times more frequent in girls.

> Daily temperature rise to about 103F (39.4C)--

usually in the evening. Fever is frequently accompanied by a body rash and chills.

• Poor appetite; weight loss.
• Anemia.
• Irritability; listlessness.
• Swollen lymph glands.
• Eye pain and redness.
• Chest pain (if the disease is severe enough to affect the heart).

CAUSES--Probably caused by an autoimmune disorder, in which the body's immune system attacks its own normal tissues. The first symptoms are often associated with physical or emotional stress.

RISK INCREASES WITH--There may be an inherited tendency.

HOW TO PREVENT--Cannot be prevented at present.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.
• Laboratory blood studies, including autoimmune assays.
• X-rays of the involved joints. Changes may not appear on x-rays until the late stages.

APPROPRIATE HEALTH CARE

• Home care after diagnosis.
• Doctor's treatment.
• Psychotherapy or counseling to help the family cope with the child's long-term illness. Emotional support may be the most important factor in a child's treatment.
• Surgery to correct deformed joints (sometimes).

POSSIBLE COMPLICATIONS

• Involvement of tissues other than joints, producing uveitis (eye inflammation), an enlarged spleen, pericarditis or inflammation of the heart muscle.
• Permanent joint deformity.

PROBABLE OUTCOME--

• Juvenile rheumatoid arthritis is currently considered incurable. However, in 75% to 80% of cases, the disease is in complete remission by puberty or young adulthood.
• Attacks usually last a few weeks and occur off and on throughout childhood. Symptoms can usually be controlled with treatment.
• See Resources for Additional Information.

How To Treat

GENERAL MEASURES--

• Both child and parents need to be involved in therapy.
• Ongoing care will include medications, physical therapy and attention to nutrition.
• Request eye examinations at least twice a year to detect uveitis.
• Encourage the child to be as independent as possible.
• See Resources for Additional Information.

MEDICATION--Your doctor may prescribe aspirin or other nonsteroidal anti-inflammatory drugs to reduce pain and inflammation.

ACTIVITY--During an attack, keep the child in bed, except to use the bathroom, until fever and other symptoms subside. Splints may be necessary to support and protect an inflamed joint. After an attack passes, the child may gradually resume normal activities with rest periods during the day. The child should not become overtired and should sleep at least 10 to 12 hours each night. Your doctor will probably recommend exercises when the child is well enough to do them.

DIET--Regular diet with attention to adequate nutrition.

Call Your Doctor If

• Your child has symptoms of juvenile rheumatoid arthritis.
• The following symptoms occur during treatment: Chest pain. Fever. Appetite loss.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.