Juvenile Rheumatoid Arthritis(JRA)

Juvenile rheumatoid arthritis (JRA) — which causes joint inflammation for at least six weeks in children 16 years old or younger — is the most common type of childhood arthritis. In most cases, symptoms of juvenile rheumatoid arthritis may fade after several months or years.

Juvenile rheumatoid arthritis can be complicated. There are several types of juvenile rheumatoid arthritis, classified based on the joints affected, symptoms and test results.

Treatment of juvenile rheumatoid arthritis focuses on preserving physical activity to maintain full joint movement and strength, preventing damage and controlling pain.

Symptoms

If you're a parent or caretaker, watch for signs and symptoms of juvenile rheumatoid arthritis, particularly in young children.

Symptoms depend upon the category of JRA, and the main categories of JRA are:

•Pauciarticular JRA. This affects four or fewer joints — typically larger joints, such as the knees. This is the most common form of JRA.

•Polyarticular JRA. This affects five or more joints — typically small joints, such as those in the hands and feet. Polyarticular JRA often affects the same joint on both sides of a child's body.

•Systemic JRA. Also known as Still's disease, systemic JRA affects many areas of the body, including joints and internal organs. This is the least common form of JRA.
Signs and symptoms of juvenile rheumatoid arthritis may include:

•Joint swelling, with pain and stiffness. This may be more pronounced in the morning or after a nap. Commonly it affects the knees and the joints in the hands and feet. Children may complain of pain, or you might notice them limping.

•Fever and rash. These can be associated with many medical conditions, but if they're persistent, they may signal systemic JRA. Fever and rash caused by systemic JRA may appear and disappear quickly.

•Swelling of lymph nodes. This sign may occur in children with systemic JRA.

•Eye inflammation. This problem, which occurs mostly in children with pauciarticular JRA, initially produces no signs or symptoms in most of those affected. Routine eye examinations are recommended because eye inflammation may result in blindness.
Like other forms of arthritis, JRA is characterized by times when symptoms are present (flares) and times when symptoms disappear (remissions).


What Causes JRA?

It's not known exactly what causes JRA in kids. Research indicates that it is an autoimmune disease. In autoimmune diseases, white blood cells lose the ability to tell the difference between the body's own healthy cells and harmful invaders like bacteria and viruses. The immune system, which is supposed to protect the body from these harmful invaders, instead releases chemicals that can damage healthy tissues and cause inflammation and pain.
To effectively manage and minimize the effects of arthritis, an early and accurate diagnosis is essential. By understanding the symptoms and characteristics of each type of JRA, you can help your child maintain an active, productive lifestyle.


Types of Juvenile Rheumatoid Arthritis

Typically, juvenile rheumatoid arthritis appears between the ages of 6 months and 16 years. The first signs often are joint pain or swelling and reddened or warm joints. Many rheumatologists (doctors specializing in joint disorders) find that the greater the number of joints affected, the more severe the disease and the less likely that the symptoms will eventually go into total remission.

The three major types of juvenile rheumatoid arthritis are:

1. Oligoarticular JRA, which affects four or fewer joints. Symptoms include pain, stiffness, or swelling in the joints. The knee and wrist joints are the most commonly affected. An inflammation of the iris (the colored area of the eye) may occur with or without active joint symptoms. This inflammation, called iridocyclitis, iritis, or uveitis, can be detected early by an ophthalmologist.

2. Polyarticular arthritis, which affects more girls than boys. Symptoms include swelling or pain in five or more joints. The small joints of the hands are affected as well as the weight-bearing joints such as the knees, hips, ankles, feet, and neck. In addition, a low-grade fever may appear, as well as bumps or nodules on the body on areas subjected to pressure from sitting or leaning.

3. Systemic JRA, which affects the whole body. Symptoms include high fevers that often increase in the evenings and then may suddenly drop to normal. During the onset of fever, the child may feel very ill, appear pale, or develop a rash. The rash may suddenly disappear and then quickly appear again. The spleen and lymph nodes may also become enlarged. Eventually many of the body's joints are affected by swelling, pain, and stiffness.
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