Juvenile Rheumatoid Arthritis.

Sakharova Inna. Ye., MD,

Univ. assistant
Juvenile
Rheumatoid
Arthritis (JRA) is
classified as a
connective tissue
disease. It is a
chronic systemic
inflammatory
disorder that
damages the joints
of the body.
 Clinical features of JRA:
• Joint pain, stiffness, and swelling:
These are the most common
symptoms of JRA, but many
children do not recognize, or do
not report, pain. Stiffness and
swelling are likely to be more
severe in the morning.
• Loss of joint function: Pain,
swelling, and stiffness may impair
joint function and reduce range of
motion. Some children are able to
compensate in other ways and
display little, if any, disability.
Severe limitations in motion lead
to weakness and decreased
physical function and sometimes
to invalidization.
 Clinical features of JRA:

• Limp: A limp may

indicate a particularly
severe case of JRA,
although it also may be
due to other problems
that have nothing to do
with arthritis, such as an
injury. In JRA, a limp
often signals knee
involvement.
 Clinical features of JRA:
• Eye irritation, pain, and
redness: These symptoms
are signs of eye
inflammation. The eyes
may be sensitive to light. In
many cases, however, eye
inflammation has no
symptoms. If the
inflammation is very severe
and not reversed, it can
cause loss of vision. The
most common types of eye
inflammation in JRA are
uveitis and iritis. The
names refer to the part of
the eye that is inflamed.
• Recurrent fevers:
Fever is high and
comes and goes with
no apparent cause.
Fever may “spike”
(go high) as often as
several times in one
day.

• Rash: A light rash

may come and go
without explanation.
• Myalgia (muscle aches):
This is similar to that
achy feeling that comes
with the flu. It usually
affects muscles
throughout the whole
body, not just one part.
 Clinical features of JRA:
• Lymph node swelling. Swollen lymph nodes are noticed
most often in the neck and under the jaw, above the
clavicle, in the armpits, or in the inguinal region.
• Weight loss. This is common in children with JRA. It
may be due to the child’s simply not feeling like eating.
• Growth problems: Children
with JRA often grow more
slowly than average. Growth
may be unusually fast or slow
in an affected joint, causing
one arm or leg to be longer
than the other. General
growth abnormalities may be
related to having a chronic
inflammatory condition such
as JRA or to the treatment,
especially glucocorticoids
 Diagnostic criteria of JRA:
Clinical signs:
1. Arthritis more than 3 months (in Europe),
more than 6 weeks (in USA).
2. Next joint arthritis in 3 months and more after
the first joint affection
3. Symmetrical affection of small joints
4. Effusion in joint cavity (under the capsule)
5. Joint contracture.
 Diagnostic criteria of JRA:

6. Tendosynovitis or bursitis.
7. Muscular atrophy.
8. Morning stiffness of joints.
X-ray signs:
1. Osteoporosis.
2. Articular cavities narrowing
3. Bone growth disturbances
Symmetrical affection of small
joints
Joint contracture
Joint contracture
Bursitis
Muscular atrophy
Osteoporosis
Osteoporosis
Articular cavities narrowing
Bone growth disturbances
 The main JRA subsets:
Subset # of Gend Age ANA RF Out-
joints er come
Pauciartic 1-4 F 2 yrs ++ - Good
ular 50 %
Polyarticu 5 F 3-9 + - Poor
lar RF- yrs 25 %
Polyarticu 5 F Teens + + Very
lar RF+ poor
Systemic Any Either 0-16 - - Very
poor
 Laboratory tests in JRA

• ANA (antinuclear antibody)

• RF (Rheumatoid factor )
• CRP (C-reactive protein)
• ESR (erythrocyte sedimentation rate)
• CCP (Cyclic Citrullinated Peptide Antibody)
test
 Nonsteroidal anti-inflammatory
drugs (NSAIDs)

Medications Doses Side effects

(mg/kg)
Aspirin 50-120 Stomack pain, vomiting,
gastrointestinal
Ibuprofen 10-30 bleedings, headache,
blood in the urine, fluid
retention, thinning and
Tolmentin 10-15
scarring of the skin
(especially with
Naproxen 5-20 naproxen), stomach
ulcer (aspirin).
 Slow-acting anti-rheumatic drugs
(SAARDs)
Medications Doses Side effects
(mg/kg)
Hydroxychlo- 5-7 Upset stomach, skin
roquine rash and a eye
(Plaquenil) damage. A child who
takes this drug should
Sulfasalazine have his/her eyes
(Azulfadine) examined at least
every six months by
an ophthalmologist
 Gold compaunds

Medications Doses(weekly, Side effects

depending from
body weight )
Auranofin, 20 kg – 10 mg Skin rash,
Ridaura, 30 kg – 20 mg mouth sores,
Myochrysine 40 kg – 30 mg kidney
Solganol problems, a low
50 kg – 40 mg blood count or
> 50 kg – 50 mg anemia
 Slow-acting anti-rheumatic drugs
(SAARDs)
Medications Week Doses Side effects
of (mg/
treatm kg)
ent
Penicillamine 0-2 25-50 Diarrhea, skin rash,
(DePen, low blood counts,
2-4 50-100
Cuprimine) nausea or vomiting,
4-6 100 stomach pain, loss
6-8 100-150 of appetite, swollen
glands, unusual
10-14 150-200
bleeding or bruising
 Immune System Medications
(Cytostatics)
Medications Doses Side effects

Methotrexate Typically 7.5 to Loss of appetite,

(Rbeumatrex) 25 mg a week nausea or
vomiting, skin
Azathioprine rash, unusual
(Imuran) bleeding or
Cyclophospha bruising,
mide tiredness or
(Cytoxan) weakness,
sterility.
 Other medications

 Biologic Agents, which blocks the protein TNF

Etanercept (Enbrel)
Infliximab (Remicade)
 Glucocorticoid Drugs (Dexamethasone,
Methylprednisolone, Cortef, Prednisolone and
Prednisone)
 Analgesics (acetaminophen [Tylenol, Panadol],
tramadol [Ultram])
 Very important parts of treatment for
juvenile arthritis:
• Therapeutic exercises
• Sports and Recreational Activities
• Splints
 Very important parts of treatment for
juvenile arthritis:

• Morning Stiffness Relief

• Diet
• Eye Care
• Dental Care
• Surgery