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.

Three main divisions of juvenile rheumatoid arthritis can be described, that affecting many joints which is called polyarticular, that involving few joints and termed pauciarticular and a more body wide disease onset known as systemic arthritis. The arthritis is a chronic disease which flares up at times and then goes into remissions, with targeting of the medical treatment towards the induction and maintenance of a remission. Recent advances in the development of drugs have produced the biological agents which are much more effective for arthritic diseases.

How and why juvenile rheumatoid arthritis develops is not well understood, with an autoimmune attack against the tissues of the joints perhaps precipitated by infection or trauma. The lining of the joint, the synovial membranes, becomes larger and becomes chronically inflamed, with this occurring in individuals with some susceptibility of genetic origin. How the disease presents in the person and how it comes on is under the control of a number of genes. The incidence of these arthritic conditions is variable due to variations in influences from the environment, differences in the populations involved and in how susceptible individuals are.

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 is the Superintendent of Physiotherapists at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for Physiotherapist London visit his website.

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