Constant pain is the major and most bothering symptom. The causes for the pain vary and depend on many factors [1]. Despite low disease activity, many children appear to have hand and/or wrist related symptoms and impairment, with resulting moderate to severe activity limitations and participation at school [5]. Patients present with painful, swollen joints with or without the presence of fever and rash.

Workup consists of a detailed history and physical examination.

Laboratory tests

Laboratory tests are not diagnostic but are performed to both confirm the presence of infection and to eliminate the possibility of other diseases.

They include:

• Complete blood count
• Erythrocyte Sedimentation Rate
• Serum ANA
• Serum C Reactive Protein assay
• Liver function tests
• Kidney function tests
• Urinalysis
• Angiotensin Converting Enzyme levels (to rule out sarcoidosis)

Imaging 

Synovial thickness, and volume of effusion monitored by ultrasound is used to examine the progression, and prognosis of the disease [6]. Imaging studies include X-Ray of involved joints, CT scan and MRI (highly sensitive). MRI can give details about the status of soft tissue, cartilage of the joint, synovial membrane, and joint integrity as a whole [7].

Test results

On the basis of physical examination and history and by eliminating all other diseases with the help of laboratory tests, a diagnosis of juvenile rheumatoid arthritis can be made.

Pain management

It includes non-steroidal antiinflammatory drugs (NSAIDs) and opioids. Counselling plays an important role in the pain management. Physical therapy and psychological interventions are of great benefit for the patient [1].

Other medications

Many new drugs have been prepared to help manage rheumatic diseases. They include methotrexate, a DMARD, etanercept [8] and Tumor Necrosis Factor alpha blockers. Celecoxib has been found effective in one study [9].

Physiotherapy

Regular physiotherapy sessions may help improve movement and functioning of the affected joints.

Prognosis depends upon the subtype. Generally, JIA has a good prognosis, provided it is appropriately treated. Polyarticular JIA has the worst prognosis of all subtypes and needs to be treated aggressively to improve patient's health.

Complications

Complications of JIA are rarely serious. They mainly involve a restricted life style due to physical impairment of motion. In polyarticular JIA, involvement of internal organs may complicate the disease. Overall, children suffering from JIA have weak bones and muscles and slower growth.

High adiposity: According to a study, patients with severe JIA have high adiposity accompanied by increased bone resorption [4]. Such children become obese and remain short in height.

As the name indicates, JIA has no known etiology. It is an autoimmune reaction which may or may not be triggered by genetic as well as external factors. Whatever the precipitating cause may be, JIA affects young children and usually persists for life.

Incidence

JIA affects between 8-150 out of every 100,000 children, depending upon the analysis [2].

Age

JIA may occur anywhere between the 1st year of life to age 16. It is however, more common between 1-3 years of age.

Sex

Like other rheumatic diseases, JIA is more common in females.

Juvenile arthritis consists of various conditions that start before the age of 16 years and last for longer than 6 weeks [3]. It may be classified into 3 subtypes. They include:

• Oligoarticular JIA

This subtype is also known as pauci-articular JIA. In this type, there is only involvement of 4 or less than 4 joints. The affected joints are asymmetrical, more often than not affecting just one side of the body. Larger joints are more frequently involved, however, smaller joints such a those of fingers and toes may sometimes become involved as well. High serum ANA levels are a marker for oligo articular JIA.

• Polyarticular JIA

This subtype occurs when there is involvement of 5 or more joints in the first 6 months of development of disease. Large as well as small joints are symmetrically involved and there is even involvement of the jaw and neck. Due to the aggressiveness of this subtype, prognosis is worse.

• Systemic JIA

In this subtype, as the name indicates, there are systemic signs of infection and inflammation such as fever, maculopapular rash on the trunk and extremities as well as both large and small joint involvement. Internal organs may become involved, commonly hepatosplenomegaly occurs. The fever and rash come and go making diagnosis difficult. Serum ANA levels are also low.

Since JIA is an autoimmune disease of unknown etiology, it cannot be easily prevented. An increased consumption of omega 3 fatty acids has proved to be beneficial in 2 small studies [10].

Juvenile rheumatoid arthritis (JRA) is the most common cause of chronic rheumatic disease in childhood [1]. It is an autoimmune, noninfective condition in which inflammation of one or more joints occurs at an early age. This name, JRA, has been replaced by the more appropriate term: Juvenile idiopathic arthritis (JIA).

Definition

Juvenile rheumatoid arthritis (JRA), also known as JIA, is inflammation of at least one joint that persists for at least 6 weeks, even after other causes are excluded, in an individual younger than 16 years.

Cause

JRA is a disease of unknown etiology. It is an autoimmune disorder in which our body's immune system, that normally protects our body, turns against our own cells.

Symptoms

JRA presents with pain and swelling of a joint, most commonly the knee, elbow, wrist and ankle joint. Pain and swelling are accompanied with stiffness and restricted movement, and sometimes there may be presence of rash on the trunk and extremities, and fever.

Treatment

Immunosuppressive medications and painkillers taken along with physiotherapy can help relieve symptoms.

1. Weiss JE, Luca NJ, Boneparth A, Stinson J. Assessment and management of pain in JIA. Peadiatr Drugs. 2014 Oct 21. PMID 25331986.
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3. McKeever K, Kelly MM. Growing up with juvenile idiopathic arthritis. MCN Am J Matern Child Nurse. 2014 Oct 18. PMID 25333886.
4. Markula-Patjas KP, Ivaska KK, Pekkinen M, Andersson S, Moilanen E, Viljakainen HT, Makitie O. High adiposity and serum leptin accompanied by altered bone turnover markers in severe juvenile idiopathic arthritis. J Rheumatol. 2014 Oct 15. pii:jrheum.131107. PMID 25320222.
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9. Foeldvari I, Szer IS, Zemel S, et al. A prospective study comparing Celecoxib with Naproxen in children with Juvenile Rheumatoid Arthritis. J Rheumatol. Nov 2008;36(1):175-82 doi 10.3899/jrheum.080073. PMID 19012356.
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