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Juvenile Chronic Arthritis
One of the most frequent chronic diseases of children and the most common rheumatological condition in this group is juvenile rheumatoid arthritis. This is not one disorder but a group of interrelated disorders which all exhibit inflammatory changes in the joints. The triggering factors for these diseases have not been uncovered and it has proven hard to delineate one particular type of condition from another due to the complex genetic factors. While it is often called JRA, there is a move to standardise the naming of these diseases into juvenile idiopathic arthritis.
Juvenile idiopathic arthritis can be classified into three main types, one which affects a few joints (pauciarticular arthritis), one which affects many joints (polyarticular arthritis) and a more overall disease which is termed systemic juvenile arthritis. The disease is chronic, persisting over a long period with flare ups and then periods of remission, with treatments aimed at inducing remissions for as long as possible without toxic effects from medication. More recent biological treatment agents have greatly increased the treatment efficacy against many arthritic diseases.
The triggering factors for juvenile rheumatoid arthritis have not been clearly identified, with a possible trigger of trauma or infection developing an autoimmune attack against joint tissues. The synovial lining of the joint increases in bulk and develops chronic inflammation, with perhaps some genetic vulnerability contributing to this process. A group of genes are understood to be involved in the pattern of disease presentation and the nature of its onset. There are many factors which influence the incidence of these types of arthritic diseases, such as how susceptible individuals are and the population types involved.
The oligoarticular type of juvenile chronic arthritis, in which a small number of joints are inflamed, is the commonest disease type, consisting of about half of all patients. Thirty percent have a large number of joint affected, the polyarticular type, and the rest have the systemic form. Sufferers from chronic juvenile arthritis may at some type suffer also from another autoimmune disorders. The severe pain and disability due to the arthritis causes significant psychological distress, behavioural problems, anxiety and depression. The polyarticular and oligoarticular forms occur more often in girls than boys with a frequency of three to four and a half to one. The systemic form occurs equally.
In terms of age, the few joint (oligoarticular) type occurs most commonly in children of two to four years in age, while the many joint (polyarticular) peaks at one to four years and also at six to twelve years. The systemic type can occur right through the childhood years. The division of juvenile chronic arthritis that a child belongs in is determined by the pattern of onset of the disease over the first six months. If four joints or fewer are involved then the child is classified into the oligoarticular chronic arthritis group. If a child has more than five joints affected in the six month period then they are recognised as being in the polyarticular type. The type which presents with a systemic onset comes on with the arthritis, fever and rashes.
An arthritis must occur for six weeks in a joint to be able to make the diagnosis of juvenile arthritis of the various types. Morning stiffness is a common phenomenon and relates to the fact that the joints stiffen and become more painful after being still for any length of time. The onset of the disease can be slow and gradual or very sudden, with stiffness after resting, joint pain during the day, absences from school and a limp in walking. Inflammatory bowel disease may be associated with these conditions in some cases. Children may not complain particularly about joint pain but rather they may allow a joint to become unused or limp, leading to disuse of the joint or joint contractures.
In the systemic form of juvenile arthritis the child suffers from fevers which spike once or twice a day at around the same time, the temperature typically returning back to normal each time. This pattern is different from infections so helps to distinguish what the patient is suffering from. These patients usually show a short lasting rash over the trunk and limbs, joint pain often in the bigger joints and appear to be unwell.
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapist, back pain, orthopaedic conditions, neck pain, injury management and Local London Physiotherapists. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
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Filed under back pain by on Mar 28th, 2010. 
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