Juvenile rheumatoid arthritis (JRA) is one of the most common chronic diseases of childhood, and is characterized by chronic joint inflammation. Three major subtypes of the condition are recognized based on the extent of joint involvement; pauciarticular/oligoarticular onset type (with four or lesser number of joints involved), polyarticular type (with more than four joints involved), and systemic onset type (with fever, rash, and systemic arthritis).
The condition manifests itself between the ages of 6-months and 16-years. Initial symptoms of the condition include joint pain, swelling, reddened, or warm joints. Affected children usually have generalized growth abnormality that can be abrogated by growth hormone supplementation. Clinically, the child may present with a limp and joint swellings. X-ray may reveal soft tissue swelling.
Treatment of JRA involves a combination of medication, physical therapy, and exercise. Inflammation and pain can be managed with the use of Non-Steroidal Anti Inflammatory Drugs (NSAIDs), and other medications. A regular exercise program is very important, as strengthening the muscles is a vital part of providing support and protection to the joints.
The condition is rarely fatal. Only in 4% of the systemic cases, do affected children die of infection and amyloidosis. In most of those affected with the pauciarticular type, the condition resolves itself, and children regain normal function. In about 15% of these children, however, the condition may worsen, while, 10% may have eye diseases progressing to blindness. Children affected with the systemic form, also, for the most part, tend to have a resolution of their clinical features. The worst prognosis is for those whose disease has onset before 5-years of age. A worldwide prevalence of 1-2 per 1,000 children has been estimated for JRA. Females show a more pronounced frequency for the pauciarticular and polyarticular types.