ARTHRITIS, JUVENILE RHEUMATOID |
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DESCRIPTION
Juvenile rheumatoid arthritis is an inflammatory disease of connective tissue--mostly joints--that affects children. The joints -- usually the knees, elbows, ankles, and neck are involved. It may also involve adjacent muscles, cartilage, and membranes lining the joints. Juvenile rheumatoid arthritis starts at 2 to 5 years and usually disappears by puberty. It is 4 times more frequent in girls.
Appropriate health care includes:
Home care after diagnosis.
Physician's monitoring of general condition and medications.
Psychotherapy or counseling to help the family cope with the child's long-term illness. Emotional support may be the most important factor in a child's treatment.
Surgery to correct deformed joints (sometimes).
SIGNS & SYMPTOMS
Pain, swelling, and stiffness in the toes, knees, ankles, elbows, shoulders, or neck joints. The pain may begin suddenly or gradually, and may involve only one or many joints. The child may refuse to walk without being able to explain why.
Daily temperature rise to about 103F (39.4C)--usually in the evening. Fever is frequently accompanied by a body rash and chills.
Poor appetite and weight loss.
Anemia.
Irritability and listlessness.
Swollen lymph glands.
Eye pain and redness.
Chest pain (if the disease is severe enough to affect the heart).
CAUSES
Probably caused by an autoimmune disorder, in which the body's immune system attacks its own normal tissues. The first symptoms are often associated with physical or emotional stress.
RISK FACTORS
Stress.
PREVENTING COMPLICATIONS OR RECURRENCECannot be prevented at present.
BASIC INFORMATION
MEDICAL TESTS
Your own observation of symptoms.
Medical history and physical exam by a doctor.
Laboratory blood studies, including autoimmune assays (ANA tests) (See Glossary).
X-rays of the involved joints. Changes may not appear on X-rays until the late stages.
POSSIBLE COMPLICATIONS
Involvement of tissues other than joints, producing uveitis (an eye inflammation), an enlarged spleen, or pericarditis (inflammation of the heart muscle).
Permanent joint deformity.
PROBABLE OUTCOME
Juvenile rheumatoid arthritis is currently considered incurable. However, in 75% to 80% of cases, the disease is in complete remission by puberty. Attacks usually last a few weeks and occur off and on throughout childhood. Symptoms can usually be controlled with treatment.
TREATMENT
HOME CARE
If the child doesn't have a firm mattress, place a 3/4-inch plywood board between the box springs and mattress to provide better support.
Request eye examinations at least twice a year to detect uveitis.
Encourage the child and the family to maintain a positive outlook.
MEDICATION
Your doctor may prescribe aspirin or other non-steroidal anti-inflammatory drugs to reduce pain and inflammation.
ACTIVITY
During an attack, keep your child in bed, except to use the bathroom, until fever and other symptoms subside. Splints may be necessary to support and protect an inflamed joint.
After an attack passes, the child can gradually resume normal activities with rest periods during the day. The child should not become overtired and should sleep at least 10 to 12 hours each night.
Your doctor will probably recommend exercises when the child is well enough to do them.
DIET & FLUIDS
No special diet.
OK TO GO TO SCHOOL?When signs of infection have decreased, appetite returns, and alertness, strength, and feeling of well-being will allow.
CALL YOUR DOCTOR IF
Your child has symptoms of juvenile rheumatoid arthritis.
The following symptoms occur during treatment: chest pain; temperature of 102F (38.9C) or higher; loss of appetite.
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
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