JUVENILE RHEUMATOID ARTHRITIS

It is an autoimmune disorder that causes problems in the joints. (Autoimmune disorder is one in which the immune system mistakenly attacks one’s own body tissues). Thus in Juvenile Rheumatoid Arthritis, the body’s cells attack the joints.
       Juvenile Rheumatoid arthritis (JRA) is a chronic disease leading to swelling, pain, stiffness and redness in the joints. Chronic joint affection leads to destruction and deformity of the joints. It can go into remission and relapses and can last for years. It is a common rheumatic disease that can also affect multiple other organs of the body.

What causes JRA?
           The cause of RA is still unknown. Infectious germs such as viruses, bacteria and fungi have been suspected. It is postulated that the tendency to develop RA may be genetically inherited.

How does Juvenile Rheumatoid Arthritis present?
           Juvenile Rheumatoid Arthritis may have a waxing and waning course. Remissions may occur spontaneously (rare) or with treatment and can last for weeks, months or years.
           When the disease is active, the symptoms include fatigue, lack of appetite, low-grade fever muscle and joint aches and stiffness. Stiffness is most common in the morning or after long periods of inactivity. With arthritis, the joints become red, swollen, painful and tender. Multiple joints are usually involved. The small joints of both hands, wrists are commonly involved. Small task such as cutting vegetables, kneading flour beco me difficult. Chronic arthritis leads to damage to joint cartilage and bone leading to loss of cartilage and erosion and joint deformity and destruction.

How is Juvenile Rheumatoid Arthritis diagnosed?
           The diagnosis is based on the pattern of symptoms, the distribution of joints involved and blood and X-ray findings.
           Abnormal blood antibodies such as rheumatoid factor (RA factor) and antinuclear antibody (ANA) are frequently found in patients with JRA.
           Joint X-Rays may show bony erosion, decreased joint space (indicating damage to the cartilage) and finally fusion.
          Sometimes aspiration of fluid from the joint may be required to study it under the microscope to differentiate it from other causes of arthritis such as infection and gout. This procedure may also be helpful in relieving joint swelling and pain.
           ESR (erythrocyte sedimentation rate) is a blood test to monitor patients during the disease course. It is high when the disease is active and lowers down when the disease goes into remission.

What is the treatment for Juvenile Rheumatoid Arthritis?
           There is no curative treatment available. The goal of therapy is to reduce the arthritis, maximize joint function and prevent joint destruction and deformity. Therapy consists of a combination of medications, physiotherapy and patient education. Therapy is customized according to disease activity, types of joints involved, general health and age of the patient.

Medications – consists of anti-inflammatory drugs (NSAIDS) such as aspirin, ibuprofen and even corticosteroids to decrease pain and inflammation.
           Other drugs such as methotrexate, chloroquine and gold salts are used to induce remission and prevent progressive joint destruction.
           The drug used for a patient depends on severity of the disease and is individualized.
           The most common side effects of the NSAIDS (non-steroidal anti-inflammatory drugs) are gastr it is and stomach ulcers. Hence, they are usually taken with food. Corticosteroids are useful to short periods during severe disease activity when the disease is not responding to NNSAIDS. They are given as tablets or injected directly into joints. They are very potent in reducing inflammation and restoring joint mobility and function. However, they have several side effects and hence are given under a doctor’s guidance and regular monitoring.
           Calcium and Vitamin D supplements may be required to prevent thinning of bones due to osteoporosis.

Physiotherapy – Proper exercise is important to maintain joint mobility. It involves passive movement of the joint during acute disease state and active mobilization of the joint when the disease is recovering to maximize joint mobility. Immobilizing the joint with splints may be required to prevent deformities during active stage due to overuse of the joint.

Surgery – is recommended to repair damaged joints. Total joint replacement may be required in painful joints with limited movement and deformity.

What are the long-term consequences of JRA?
           JRA is a chronic disease characterized by periods of flares and remission. With combined exercise, joint protection and medications - the residual damage and deformity of the joint is minimized.

What is the likely future therapy?
           Newer therapy such as monoclonal antibody therapy is being developed where these monoclonal antibodies are directed against a special factor causing disease called the tumor necrosis factor (TNF-alpha). Also studies involving various types of collagen are in progress.

Last created on 31-05-2004
Last updated on 18-11-2006