Juvenile Arthritis

Description

Doctors classify three types of juvenile arthritis (JA). They are based upon symptoms, the number of joints involved and presence of certain antibodies in the blood. The classifications help predict how the disease will progress. Types of JA are pauciarticular, polyarticular and systemic.

Pauciarticular (paw-see-are-tick-you-lar)

About half of affected children have the pauciarticular type of JA. Girls under age 8 are more likely to develop it. Half of this group will have monoarticular arthritis (i.e., involvement of just one joint, usually a knee or ankle). These patients usually have a very mild arthritis and remit. Patients with more than one joint often require more medications and may progress to the polyarticular type of disease.
This type of JA affects four or fewer larger joints. These include the knee, ankle or wrist. Involvement of fingers or toes is unusual.
It may also cause eye inflammation. To prevent blindness, your child may need regular exams from a doctor who specializes in eye diseases (ophthalmologist). Eye problems may continue into adulthood.

Polyarticular

About 30 percent of children with JA have the polyarticular type, which is also more common in girls than boys.
This type of JA affects five or more smaller joints (i.e., hands, feet), usually the same ones on each side of the body. It can also affect large joints.
Children with a certain antibody in their blood called IgM rheumatoid factor (RF) often have a more severe form of the disease, which doctors think is the same as adult rheumatoid arthritis.

Systemic

About 20 percent of children with JA have the systemic type.
This type of JA causes swelling, pain and limited motion in at least one joint, and rash and inflammation of internal organs (i.e., heart, liver, spleen and lymph nodes). Fever to at least 102 degrees daily for a minimum of two weeks continuously is required to make this diagnosis.
A small percentage of children with systemic JA develop arthritis in many joints and have severe arthritis that continues into adulthood.

JA affects each child differently and can last for an indefinite period of time. There may be times when symptoms get better or disappear (remissions) and other times when symptoms are worse (flare-ups). Sometimes a child may have one or two flare-ups and never have symptoms again. Other children may have frequent flare-ups and symptoms that never go away.

For an active, growing young person, the disease can impact many aspects of life such as school, friends and family relationships, dating and sports. Often the whole family must cope with special challenges the disease presents. Some basic guidelines:

Treat the child as normally as possible.
Make sure he or she gets appropriate medical care and follows the doctor's instructions. If one treatment does not seem to be working or causes unpleasant side effects, talk with the doctor about trying another.
Encourage your child to exercise when there are no symptoms, such as playing team sports and taking part in other activities that keep joints strong and flexible. Provide play time with other children to enhance social development.
Work closely with your child's school and teachers to develop suitable lesson plans and teach classmates about JA. Sometimes your child may have to miss school for prolonged periods of time and the teacher may have to send assignments home. With proper attention, most children with JA should progress normally through school.
Explain to your child that JA is nobody's fault and consider joining a support group for people with JA and their families.

June 2004