Mark Borigini M.D.

Overcoming Pain

Juvenile Rheumatoid Arthritis And The Equal Role Of Compassion and Medicine

The role of compassion and prescriptions.

Posted May 03, 2010

Juvenile rheumatoid arthritis (JRA) is also known as juvenile idiopathic arthritis. But no matter what one might choose to call it, it is the most common type of arthritis in children under the age of 16 years, and can cause great suffering to those afflicted, and their families.

As with adult rheumatoid arthritis, the disease causes symptoms such as joint pain and swelling, accompanied by profound stiffness. JRA can cause symptoms which last for but a few months; however, in many cases it causes lifelong joint inflammation. Under this umbrella of JRA, there lie several types of JRA, classified according to the following:
1. The type and number of joints involved.
2. The signs and symptoms.
3. The result of blood tests.
In addition, certain types of JRA are more commonly associated with complications such as eye inflammation and difficulties with normal growth of the child.

We tend to forget that children are not simply "little adults", and many do not necessarily complain initially of what is often an insidious onset of pain: In many cases, a parent or a babysitter many notice that a child is limping, especially upon arising from sleep in the morning, or a daytime nap. It might also appear that a child affected with JRA is "clumsy"; whereas, the reality is that the joint stiffness makes it difficult to move as nimbly as a healthy child.

The three main types of JRA:
1. Pauciarticular JRA, where less than five joints during the first six months of the disease are affected. Eye inflammation is more common in this type, and frequently associated with a positive ANA blood test. Hip and knee joints are most commonly involved.
2. Polyarticular JRA, where five or more joints are affected during the first six months of the disease. This type is most similar to adult rheumatoid arthritis, as signs and symptoms are mostly limited to the joints; and the rheumatoid factor blood test is often positive.
3. Systemic JRA, where evidence of disease is found in many places besides the joints. Children so affected can experience swollen lymph nodes, rashes and fever, in addition to inflammation of the internal organs, particularly the liver.

JRA is an autoimmune disorder, whereby the body's immune system attacks its own tissues. It is a disease more common in girls, and more common in white children. No one knows exactly what causes JRA, but theories include that it occurs more frequently in those who have had a viral infection beforehand, and who have deficiencies of certain protective antibodies. However, no theory has been definitively proven.

Treatment for JRA focuses on maintaining as much as possible the normal activity of childhood; to this end, a combination of pain relief, anti-inflammatories, physical therapy, and compassion must be used. Medications used include ibuprofen and naproxen, methotrexate and sulfasalazine, Enbrel and Remicade, and corticosteroids such as prednisone. Regular exercise is important in order to maintain muscle strength and joint flexibility; swimming is a good choice, as it places minimal stress on the joints. Hot baths can help greatly with the stiffness of JRA. A diet rich in calcium is important, as chronic arthritis can predispose to osteoporosis, as can medication used to treat the disease (for example, prednisone), as can the decreased physical activity due to the debilitating nature of the disease.

Family members are so important in assisting a child with JRA cope with all the ramifications of that illness, whether they be physical, psychological, or social. It is imperative a child with JRA be treated, to the extent possible, the same as any other well child; the child should be encouraged to participate in life to the fullest extent possible. Parents should work with teachers to allow, for example, more time for the child with JRA to walk from classroom to classroom; an extra set of textbooks might be provided so the child does not have to carry a heavy load home every day.

Treatment with the correct medications, coupled with a loving and supportive network of family and friends, can make JRA a very treatable disease. It is a difficult thing to see a child with a chronic illness; but newer treatments coupled with psychological support can go a long way to channel compassion and chemistry into a very livable life.