Usually, arthritis is a disease that affects the elderly and middle-aged people. Juvenile rheumatoid arthritis includes several types of arthritis, including spondyloarthropathy and reactive arthritis, which affect children and adolescents. In this article, we consider the forms of juvenile rheumatoid arthritis.
What affects juvenile rheumatoid arthritis
Juvenile rheumatoid arthritis (JuRA), also known as juvenile idiopathic arthritis, has some distinctive features that include:
- The disease affects the patient early – usually in childhood or adolescence.
- The disease is more common among women.
Jura usually affects children under the age of 16, and the prevalence of this disease is 0.01% among the general population.
Forms of Juvenile Rheumatoid Arthritis
There are three different forms of JRA that include:
Four or fewer joints are involved in this type of JuRA, and this type accounts for almost half of all cases of JuRA.
Patients are usually very young girls aged 1 to 4 years or older than boys. However, both boys and adult girls can suffer.
Children with the condition may develop associated visual impairment, including chronic uveitis, which affects the anterior chamber of the eyes. This can cause permanent eye damage. Uveitis ultimately affects up to 20% of children with this disease. There may be minimal symptoms with a paucarticular Jura.
The polyarticular beginning of Jura.
In this type of Jura, five or more joints are involved. This occurs in almost 40% of all children with juvenile juvenile disease. In addition to articular involvement, there are symptoms such as irritability, fatigue, anemia, loss of appetite, growth retardation, etc.
This condition affects girls more often than boys. There is a later onset and likelihood of a positive outcome with a rheumatoid factor.
The systemic beginning of Jura.
This is less common from various forms of juvenile rheumatoid arthritis, observed in 10% of the Jurassic population. Initially, symptoms appear, such as once a day or twice a day fever, as well as a characteristic pale pink rash, usually found above the torso, shoulders, and hips. Fever is usually small in the morning and should be present for a minimum of two weeks for diagnosis.
Children with the disease may have other systemic symptoms that affect other vital organs, including hepatosplenomegaly (enlarged liver and spleen), lymphadenopathy (swollen lymph nodes), and pericarditis (fluid buildup inside the membranes around the heart). This condition affects both boys and girls in a similar way, and the peak detection age is usually one to six years.
Diagnosis of Jura
The diagnosis is based on a medical history and a family history of similar conditions, as well as a patient examination. Because falls and injuries are common among children, initial pain and stiffness may be overlooked.
Joint pain alone, in the absence of swelling, stiffness, soreness, etc., is never enough to establish a diagnosis of JRA. Symptoms should be present for at least six consecutive weeks for a more confirmatory diagnosis.
Jura is diagnosed on a more confirmed basis when other conditions that may cause joint symptoms, including fibromyalgia, joint infection (septic arthritis) or leukemia, etc., are excluded.
Antinuclear Antibody Test (ANA) may be relevant when clinical data strongly indicate Jura. ANA is positive in 60% -80% of patients with JuRA, especially in the pauciarticular JuRA.
Rheumatoid factor is positive only in 15-20% of children with juvenile disease. This is more common in children with later polyarthritis or polyarticular JuRA.
In about half of patients with juvenile rheumatoid arthritis, the disease persists in adulthood. In more than a third of patients, the disease leads to severe disability approximately ten years after diagnosis. Blindness due to uveitis occurs in approximately 15 of 305 cases.
Treatment of Jura
There are two main goals of treatment:
- To alleviate the symptoms of the disease.
- To prevent disease progression and joint damage.
Non-steroidal anti-inflammatory drugs (NSAIDs) are drugs that are widely used to control the symptoms of juvenile anemia. They suppress both pain and inflammation. However, the dose required for the anti-inflammatory effect is twice the dose required to combat pain.
For many years, NSAIDs have been replaced by other more effective means to reduce joint inflammation. This is due to their adverse side effect profiles. NSAIDs are known to cause stomach ulcers, gastrointestinal complications, kidney damage, and heart disease. However, these agents may be administered in the short term.
Prevention of the progression of joint damage.
Disease-modifying anti-rheumatic drugs are widely used to prevent the progression of joint damage. These agents have a diverse mechanism of action, and they act by decreasing joint swelling and pain, reducing markers of acute inflammation in the blood and stopping progressive joint damage.
These include methotrexate, sulfasalazine, leflunomide, hydroxychloroquine, gold salts, and cyclosporine. However, they are also associated with varying degrees of side effects.
In cases of severe polyarticular JuRA, oral corticosteroids are sometimes used, waiting for anti-rheumatic drugs to take effect. In systemic jura, oral steroids are often used to control other symptoms. In all three types of juvenile corticosteroids, corticosteroids can be used as injections injected directly into the joint space.
A newer approach is the use of biological agents. TNF inhibitors were the first licensed biological agents, including etanercept, infliximab. This was followed by monoclonal antibodies such as abatacept, rituximab and tocilizumab.
Supportive care includes exercises, joint protection, psychological support for the patient and family to help deal with related symptoms and disabilities.
Physiotherapy is an important part of the treatment of debilitating arthritis. This helps maintain optimal flexibility and bond strength. Assistive devices such as a cane, walker, long shoes, etc., can help.