Juvenile Rheumatoid Arthritis: Basics

Juvenile rheumatoid arthritis affects the quality of life of children with the disease with articular and extra-articular manifestations such as heart, lung, nerve and eye. Juvenile rheumatoid arthritis has the ability to fully recover in adulthood, but the disease affects the development of the skeletal system as well as the child's growth rate.

Juvenile rheumatoid arthritis is also known as childhood idiopathic arthritis or childhood rheumatoid arthritis. Accordingly, this is a condition of inflamed and stiff joints lasting more than 6 weeks in children younger than 16 years old. It is estimated that more than 50,000 children in the United States have the disease. The inflammatory process causes the joints to become red, hot, and painful. Any joint in the body is likely to be affected and limited in activity.
Rheumatoid arthritis in children is an autoimmune disease, which means that the body mistakenly recognizes normal cell tissues as invading pathogens that cause disease in the body. The immune system, which protects the body from harmful agents, attacks healthy tissues, leading to inflammatory reactions.

Many studies have been done, but the exact pathogenesis of juvenile rheumatoid arthritis has not been found. Many experts agree with the hypothesis that the pathogenesis occurs through two basic steps. Initially, the child's body occurs the process of forming and activating genes that increase the risk of disease. Then, other factors from the outside environment such as viruses activate and cause the disease to actually appear.
Rheumatoid arthritis in children can cause fever and anemia, affecting the heart, lungs, eyes, and nervous system. The acute phase of arthritis can last for weeks and carries a high risk of recurrence. The treatment for rheumatoid arthritis in children is similar to that in adults with the enhancement of physical therapy methods. However, many of the powerful drug classes used in adults are not needed in juvenile rheumatoid arthritis. Chronic joint destruction in rheumatoid arthritis in children is rare, and most children with the disease make a full recovery without major disability or sequelae.

Juvenile rheumatoid arthritis is divided into 3 main groups, based on the number of joints affected, symptoms and the presence of specific antibodies in the blood.
Rheumatoid arthritis
Rheumatoid arthritis in children affecting less than 4 joints is classified as oligoarthritis. It is the most common form, accounting for more than half of cases, and is associated with circulating antinuclear antibodies (ANAs). Large joints such as the knee are the group most at risk of injury. Girls under 8 years of age are more likely to develop rheumatoid arthritis in children with rheumatoid arthritis.
The most affected extra-articular organ in oligoarthritis is the eye, which accounts for about 20% to 30% of all cases. Regular visits to an eye doctor are necessary to treat serious problems such as iritis and uveitis. Many children with juvenile rheumatoid arthritis may have no signs of arthritis as they get older, but eye complications continue.
Polyarthritis
Approximately 30% of all rheumatoid arthritis cases in children are classified as polyarthritis, when more than 5 joints are affected. The small joints in the hands and feet are the most affected joints. Juvenile rheumatoid arthritis usually occurs symmetrically on both sides of the body. Children in this group of diseases have the presence of low levels of factors in the blood, in some cases presenting with symptoms similar to rheumatoid arthritis in adults. Presence of rheumatoid factor in the blood is considered a factor that increases the likelihood that the disease will continue to develop later in life.
Systemic inflammatory form
In addition to the inflammatory manifestations in the joints, systemic inflammatory rheumatoid arthritis is characterized by the appearance of symptoms in many different organs such as fever, erythema, and cardiac dysfunction , liver, spleen and lymphatic system. Childhood rheumatoid arthritis, also known as Still's disease, accounts for about 20% of all cases, in children with the absence of antinuclear antibodies and rheumatoid factor in the blood.
Juvenile rheumatoid arthritis is fully reversible while adult rheumatoid arthritis is a chronic, long-lasting disease. Many studies estimate that the symptoms of the disease will disappear in more than half of the cases.

The most common clinical symptoms are joint pain and swelling, stiffness in the morning or after a sleep. In addition, children with the disease may also have to face other symptoms such as:
High fever Loss of appetite Weight loss Anemia Anemia Red rash on arms and legs Pain that limits movement of damaged joints, although However, many young children do not complain of this symptom.
Juvenile rheumatoid arthritis affects mainly the knee joint and the joints of the hands and feet. One of the earliest signs of disease is a morning limp due to knee stiffness.
In addition to joint manifestations, children with systemic inflammatory rheumatoid arthritis also have high fever and skin rash. These two signs may appear and disappear within a short period of time. Systemic rheumatoid arthritis can cause swollen lymph nodes in the neck and other areas of the body. Damage to the heart and lungs is also possible, although very rare.
Ocular inflammation is a serious complication that often occurs in rheumatoid arthritis in children with oligoarthritis. Iritis and uveitis usually develop late after the joint manifestations.
The symptoms of rheumatoid arthritis in children either improve or disappear in the recovery phase and become more severe in the acute phase. Some children have only one or two exacerbations and the symptoms never return. Others may experience multiple exacerbations with long-lasting symptoms.

Treatment of juvenile rheumatoid arthritis requires the coordination of many different specialties, including musculoskeletal, pediatrics, rehabilitation and psychology. Experts will discuss and offer treatment strategies to reduce joint swelling, maintain joint mobility, reduce pain, and detect and treat complications. Some of the treatment methods are combined together such as:
Medical: many drugs are indicated to relieve symptoms and slow the progression of the disease. Nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen, naproxen and other prescription drugs are the first class of drugs indicated for pain and inflammation reduction. The drug has many side effects in the gastrointestinal tract and liver. Disease-retarding antirheumatic drugs (DMARDs) are indicated when NSAIDs are ineffective, but a response may take weeks or months. Corticosteroids are indicated in severe cases of juvenile rheumatoid arthritis, to prevent complications of pericarditis. Biologic agents are a new type of drug that is used when other drugs have not worked. The drug, usually administered by injection, inhibits the overactivity of the immune system through a direct effect on inflammatory proteins. Physical therapy: Children with rheumatoid arthritis should be guided in physical therapy to maintain muscle strength and support the movement of joints. Physiotherapists will design an individual exercise program suitable for each child with the disease. A number of assistive devices such as splints are also used to maintain the normal development of the child's joints and skeletal system. Alternative therapy: acupuncture is seen as a way to support children in relieving stress when living with disease. Acupuncture helps relieve pain and improve joint flexibility, limiting the use of pain relievers. Rheumatoid arthritis is a disease not only found in adults but also in children. In fact, the disease has the ability to fully recover in adulthood, but the disease affects the development of the skeletal system as well as the growth rate of the patient. Therefore, early diagnosis and diagnosis of the disease is very important.
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