Rheumatoid arthritis is an autoimmune inflammatory disease that usually affects adults later in life, however there are many children aged 16 and under living with juvenile rheumatoid arthritis (JRA). JRA affects children’s bones, which begin to deteriorate with swelling around the joints from an early age. Girls are more likely than boys to be afflicted by JRA. It primarily develops in children between the ages of 2-4, but is also common during the pre-teen and teen years. The exact cause of JRA is unknown, but it may be related to genetics and environmental factors.
Early, Cold-Like Symptoms
Many of the initial symptoms of JRA mimic a cold or flu. Your seemingly normal child may come home from daycare or school with a fever and extreme fatigue, which you assume is just a bug they picked up from their classmates. Or they may complain of being stiff and sore around their joints, which seems to resemble “growing pains.” These are all normal illnesses and growth stages for young children, however they can sometimes indicate JRA. A combination of symptoms that recur on a consistent basis may be an early sign of the disease. These symptoms include fever, swelling, joint pain, stiffness, chronic fatigue or lethargy, which require immediate medical attention. Diagnosing JRA early and then determining the right treatment plan to address these symptoms is vitally important.
Common JRA Symptom: Stiffness And Swelling
Children with JRA often have stiff joints, making it difficult to move positions or even make small movements like holding utensils. It is usually at its worst upon waking up and gets better throughout the day as the child moves. Upon waking up, the child’s limbs can be limp or will stay in the same position. Another common symptom is swelling or redness around the child’s stiff joints, which is a sign of inflammation. If a child’s joints feel warm to the touch or they complain of hot, searing pain, this is a sign of JRA. Swelling can last for several days or it may come and go, primarily affecting a child’s hands, knees and feet. Children might limp if the swelling and stiffness is in their knees and legs.
Common JRA Symptom: Pain
It is common for children to complain of pain in their joints and muscles after a long day of physical activity, however a child with JRA may complain of muscle pain first thing in the morning or after waking up from a nap. Their knees, hands, feet, neck and jaw joints may be particularly painful, but their pain may lessen the more they move their body. A doctor may recommend acetaminophen or ibuprofen to bring down the pain. The difference between pain caused by injuries or other illnesses and JRA is that arthritis-related pain develops slowly and can affect joints all over the body, rather than one single area. Additionally, pain due to injury will eventually heal, whereas JRA symptoms will persist if untreated.
Common JRA Symptom: Eye Problems
Eye infections are relatively common in childhood as many bacterial infections can easily be passed by classmates at school. In JRA, serious complications can arise in children’s eyes as a result of inflammation, causing blindness if untreated. Often, inflammation in the eye starts off as redness, eye pain or blurred vision, which can progress into something more serious. JRA related eye complications include iritis, which is inflammation around the iris and uveitis, the middle layer of the eye. It is important for children to see a pediatric opthamologist at the first sign of experiencing inflammation around the eyes. These eye specialists will work alongside the child’s rheumatologist to create a thorough treatment plan to prevent further damage.
Common JRA Symptom: Fever
A fever may come alongside joint and muscle pain, but it is different from a fever associated with non-JRA related illnesses. A fever associated with JRA typically does not happen alongside the symptoms of respiratory or stomach infections such as nausea, vomiting, diarrhea or breathing difficulties. The unexplained fever can come on at the same time every day, but then disappear just as quickly as it came on. Whenever the body is hit with fever, it is signaling that the body is fighting illness or inflammation. Fevers in children with JRA usually indicate swelling in the tissues around the brain, which causes body temperatures to rise. It is important to see the doctor when kids are experiencing these unexplained fevers, especially alongside joint and muscle pains.
Additional JRA Symptoms
Sometimes in very young children, especially those who cannot verbalize where they may be in pain, it is important to look for other symptoms of JRA, such as losing a developmental milestone like walking. They may have been walking well, then suddenly start limping and need to be carried. JRA can also cause skin rashes, which are different from rashes resulting from allergies or eczema. If a faint but pink rash develops across knuckles, cheeks or the arms and legs, this may be a sign of JRA. These rashes can last from a few days to several weeks. Another sign of rheumatoid arthritis in children is a loss of appetite, which results in weight loss, in addition to fatigue and lethargy.
It is important to see a doctor when any one of these symptoms persist in a child. A doctor will check a child’s medical history, along with giving a physical exam and ordering blood and imaging tests, such as x-rays. JRA has a lot of the same symptoms as other illnesses, thus it is important to rule out other causes of sickness. If ignored, JRA can cause life threatening health problems for children. Early diagnosis is the key to treating JRA as it will give the child the time to undergo the necessary treatment to live symptom-free and avoid any growth abnormalities. Once a child is diagnosed with rheumatoid arthritis, it is important that they are seen by a pediatric rheumatologist who specializes in treating the illness.
Treatment For JRA
When children get diagnosed early, they also get treated sooner and early treatment results in better outcomes. Many of the same drugs that adults with rheumatoid arthritis use are the same ones used to treat children, with methotrexate and biologics being the most commonly used drugs. These medications can keep children’s JRA from deteriorating to the point that they require a wheelchair, which was what typically happened in the past. Today, physical therapy and occupational therapy are also part of treatment plans to keep kids' muscles and joints strong. Splinting can also be an effective tool for children to help them function better. Many of the treatments can ease symptoms enough to allow children to have a normal life, where they can attend school and play with their friends.