Juvenile Arthritis and Other Rheumatic Diseases
What are juvenile arthritis and other rheumatic diseases?
Arthritis is an inflammation of the joints that causes pain and swelling. Juvenile
arthritis is the term used for arthritis in children. The most common form of juvenile
arthritis is juvenile idiopathic arthritis (JIA), also called juvenile rheumatoid
Arthritis is a group of more than 100 diseases. It’s only one category of rheumatic
diseases. Rheumatic diseases can cause pain, stiffness, and swelling in the joints,
and bones. Rheumatic diseases can also affect other areas of the body, including organs.
Some rheumatic diseases affect connective tissues. These types of tissues include
muscles, tendons, and ligaments. The diseases are known as connective tissue diseases.
Other types of diseases are caused by the body's immune system attacking its own healthy
cells and tissues. These are known as autoimmune disorders.
What causes juvenile arthritis and other rheumatic diseases?
Experts don’t know what causes juvenile arthritis and most types of rheumatic diseases.
In many cases, the cause may vary depending on the type of disease. Certain factors
that may play a part in one or more types of these diseases include:
- The immune system
- Genes and family history
- Nervous system problems
- Metabolic problems
- Excessive wear and tear and stress on the body
- Environmental triggers
- The effect of some hormones on the body
Who is at risk for juvenile arthritis and other rheumatic diseases?
Juvenile arthritis and rheumatic diseases can affect children of any age and any ethnic
background. But some types are more common in some children, such as:
- Juvenile rheumatoid arthritis (JRA). This condition more often affects children younger than age 15.
- Systemic lupus erythematosus (lupus). This occurs more often in girls.
- Ankylosing spondylitis (AS). This bone disease is more common in boys.
What are the symptoms of juvenile arthritis and other rheumatic diseases?
Each type of rheumatic diseases has its own set of symptoms. And symptoms can occur
a bit differently in each child. But the most common symptoms in all the diseases
- Joint pain
- Swelling in 1 or more joints
- Joint stiffness that lasts for at least 1 hour in the early morning
- Chronic pain or tenderness in the joints
- Warmth and redness in the joint area
- Limited movement in the affected joints
- Extreme tiredness (fatigue)
- Fevers that don't go away, or that come back
These symptoms may seem like other health conditions. Make sure your child sees his
or her healthcare provider for a diagnosis.
How are juvenile arthritis and other rheumatic diseases diagnosed?
The process starts with a medical history and a physical exam. Tests may also be done.
These include blood tests such as:
- Antinuclear antibody (ANA) test. This checks the levels of antibodies in the blood.
- Complete blood count (CBC). This is done to see if white blood cell, red blood cell, and platelet levels are
- Creatinine. This checks for kidney disease.
- Sedimentation rate. This can detect inflammation.
- Hematocrit. This test measure the number of red blood cells.
- Rheumatoid factor test. This test checks to see if rheumatoid factor is present in the blood.
- White blood cell count. This can determine the level of white blood cells in the blood.
- Uric acid. This can help diagnosis gout.
Other tests may be done, such as:
- Joint aspiration (arthrocentesis). A small sample of the synovial fluid is taken from a joint. It's tested to see if
crystals, bacteria, or viruses are present.
- X-rays or other imaging tests. These are done look at the extent of damage to a joint.
- Urine test. This is done to check for protein and various kinds of blood cells.
- HLA tissue typing. This is done to look for genetic markers of ankylosing spondylitis.
- Skin biopsy. Tiny pieces of tissue are taken to check under a microscope. This helps to diagnose
a type of arthritis that involves the skin, such as lupus or psoriatic arthritis.
- Muscle biopsy. Tiny pieces of tissue are taken to check under a microscope. This helps to diagnose
conditions that affect muscles. These include polymyositis or vasculitis.
How are juvenile arthritis and other rheumatic diseases treated?
Treatment will depend on your child's symptoms, age, and general health. It will also
depend on what type of disease your child has, and how severe the condition is. A
treatment plan is tailored to your child with his or her healthcare team. The healthcare
team will include your child's primary healthcare provider. It will also include a
rheumatologist, orthopedist, physical therapist, and other healthcare providers.
There is no cure for most juvenile arthritis and other rheumatic diseases. The goal
of treatment is often to limit pain and inflammation, and help ensure joint function.
Certain organs, such as the eyes and heart, are also checked often for problems. Treatment
plans often use both short-term and long-term methods.
Short-term treatments include:
- Medicines. Short-term relief for pain and inflammation may include pain relievers such as acetaminophen,
ibuprofen, or other nonsteroidal anti-inflammatory medicines. Talk with your child's
healthcare provider before giving any of these medicines to your child.
- Heat and cold. Pain may be eased by using moist heat (warm bath or shower) or dry heat (heating
pad) on the joint. Pain and swelling may be eased with cold (ice pack wrapped in a
clean, thin towel) on the joint.
- Joint immobilization. Using a splint or brace can help a joint rest and protect it from further injury.
- Massage. Lightly massaging painful muscles may increase blood flow and bring warmth to the
Long-term treatments include:
- Disease-modifying antirheumatic drugs (DMARDs). These medicines may slow down the disease and treat any immune system problems linked
to the disease. Examples of these medicines include methotrexate, penicillamine, and
- Corticosteroids. These medicines, such as prednisone, reduce inflammation and swelling. They can be
taken by mouth or as an injection.
- Biologics. These are medicines to help stop the inflammation process in the body. These include
etanercept, golimumab, infliximab, and others.
- Weight loss. Extra weight puts more stress on joints such as the hips and knees.
- Exercise. Certain exercises may help reduce joint pain and stiffness. These include swimming,
walking, low-impact aerobic exercise, and range-of-motion exercises. Stretching may
also help keep the joints flexible.
- Use of assistive devices. Canes, crutches, and walkers can help to keep stress off certain joints and to improve
- Surgery. In severe cases of disease, surgery may be needed to fix or replace a joint. There
are 2 main types of surgery: repair and replacement. Surgery to repair a damaged joint
may include removing debris in the joint, fusing bones, or correcting a bone deformity.
If a joint is too damaged for repair, it may need to be replaced with an artificial
What are the complications of juvenile arthritis and other rheumatic diseases?
If only a few joints are affected, arthritis may cause little or no joint damage.
Some children may have chronic pain and disability. Other complications include slowed
growth, anemia, and problems with the eyes or heart.
Helping your child live with juvenile arthritis and other rheumatic diseases
Help your child manage his or her symptoms by sticking to the treatment plan. Encourage
exercise and physical therapy. Find ways to make it fun. Work with your child’s school
to make sure your child has help as needed. Work with other caregivers to help your
child take part as much possible in school, social, and physical activities. Your
child may also qualify for special help under Section 504 of the Rehabilitation Act
of 1973. You can also help your child find a support group to be around with other
children with similar health conditions.
When should I call my child’s healthcare provider?
If your child’s symptoms get worse or he or she has new symptoms, let the healthcare
Key points about juvenile arthritis and other rheumatic diseases
- Arthritis is an inflammation of the joints that causes pain and swelling. Juvenile
arthritis is the term used for arthritis in children.
- Arthritis is one type of rheumatic disease. Arthritis affects joints, muscles, tendons,
ligaments, and bones. Rheumatic diseases can affect other body parts. These include
organs such as the heart and eyes.
- Common symptoms include joint pain, swelling, stiffness, and warmth.
- Experts don’t know what causes juvenile arthritis and most types of rheumatic diseases.
- Treatment options include medicines, heat and cold, massage, exercise, physical therapy,
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child.
Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose
for that visit.
- Know how you can contact your child’s provider after office hours. This is important
if your child becomes ill and you have questions or need advice.