Still's disease
Key points
- Juvenile Rheumatoid Arthritis is a chronic, inflammatory disease resulting in joint pain and inflammation.
- Juvenile Rheumatoid Arthritis (JRA) is a chronic inflammatory arthritis in children.
- The physical examination shows swollen, warm, and tender joints that hurt to move.
- Long periods of spontaneous remission are typical.
Alternative names
Juvenile chronic polyarthritis; JRA; Juvenile rheumatoid arthritis
Definition
Juvenile Rheumatoid Arthritis is a chronic, inflammatory disease resulting in joint pain and inflammation. It may result in joint damage. It usually occurs before age 16.
Causes, incidence, and risk factors
Juvenile Rheumatoid Arthritis (JRA) is a chronic inflammatory arthritis in children. It occurs in between 50-100 per 100,000 children in the United States. JRA is a general term for the most common types of arthritis in children. It is divided in to several categories:
1. Systemic JRA: This form, which occurs in about 10% of cases, involves joint pain and swelling as well as fevers and rash. It is similar to Adult Still's Disease. The cause of this form of JRA is unknown.
2. Polyarticular JRA: This form occurs in about 40% of cases and involves multiple joints that are painful and swollen. The cause of this form of JRA is unknown. Some children may have a positive Rheumatoid Factor and evolve into Rheumatoid Arthritis.
3. Pauciarticular JRA: This form occurs in about 50% of cases and involves only a few joints. Some of these children, in particular boys, will be HLA-B27 positive. Families with HLA-B27 are at increased risk for this arthritis.
Symptoms
Arthritis symptoms:
- joint stiffness on arising in the morning
- limited range of motion
- slow rate of growth or uneven arm or leg growth
- hot, swollen, painful joints
- a child my stop using an affected limb
- back pain
Systemic JRA symptoms:
- Fever, usually high fevers every day
- Rash that comes and goes with the fever
- Swollen lymph nodes (glands)
JRA can also cause eye inflammation. These symptoms include:
- red eyes
- eye pain
- photophobia (increased pain when looking at a light)
- visual changes
Signs and tests
The physical examination shows swollen, warm, and tender joints that hurt to move. The child may have a rash. Other signs include an enlarged liver, enlarged spleen, or swollen lymph nodes.
Written and revised by
Gerald Hurowitz, M.D.
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