Juvenile Chronic Arthritis

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Juvenile Rheumatoid Arthritis is the commonest rheumatological disease which occurs in children and one of the commonest child chronic diseases. It covers a number of individual disorders which all have chronic joint inflammation in common. The causes of these conditions are not apparent and the underlying genetic reasons are complicated in that different types of arthritis cannot easily be distinguished. Juvenile idiopathic arthritis is gradually becoming more widely used, indicating the unknown reasons for this condition.

The classification can be approached by describing three main subtypes, systemic onset disease where the problems are widespread, polyarticular arthritis where many joints are affected and pauciarticular where only a few joints are involved. The typical disease course is chronic with remission periods inbetween periods of flare ups, the medical treatment being typically aimed at causing remission and maintaining it over time. The biological treatment agents more recently developed have given a greatly increased effectiveness of treatments for arthritic diseases.

How and why juvenile rheumatoid arthritis develops is not well understood, with an autoimmune attack against the tissues of the joints perhaps precipitated by infection or trauma. The lining of the joint, the synovial membranes, becomes larger and becomes chronically inflamed, with this occurring in individuals with some susceptibility of genetic origin. How the disease presents in the person and how it comes on is under the control of a number of genes. The incidence of these arthritic conditions is variable due to variations in influences from the environment, differences in the populations involved and in how susceptible individuals are.

Around half of all sufferers from juvenile chronic arthritis have the oligoarticular or pauciarticular type where a small number of joints are affected, around a third have the polyarticular type with many joints affected and the remainder have the more systemic type. People suffering from juvenile chronic arthritis may develop other autoimmune disorders. Psychological side-effects are common due to the pain and functional problems which occur with this disease, causing depression, anxiety and behaviour problems. The few joint and many joint forms of the disease occur more commonly in girls at a ratio of 3 to 4.5 to one with the systemic type occurring equally in boys and girls.

The polyarticular or many affected joint form of arthritis has two peaks of incidence, one covering one to four years of age and another covering six to twelve years. The fewer joint type, the oligoarticular form, tends to occur in children who are two to four years old. The systemic type has no particular age of incidence. The disease pattern over the first six months determines which pattern the individual patient fits into. If four or fewer joints are affected during this period then the diagnosis is the oligoarticular or fewer joint group. More than five joints are symptomatic during the first six months this indicates the polyarticular or many joint diagnosis. Arthritis, rashes and a fever are the typical onset symptoms of the systemic form.

If a diagnosis of juvenile arthritis of some form is to be made then the patient should have arthritis of some of their joints for at least six weeks. Stiffness in the morning or after periods when the joint has been kept still is a typical complaint. The start of the disease can be very sudden and dramatic or may come on slowly over some time, with common symptoms including stiffness of the joints as mentioned, joint pain in the day, periods of absence from school and a limping gait. Some patients also suffer from inflammatory disease of the bowel. A child may not always report actual pain in a joint but instead they may just allow the joint to go unused and develop atrophy or a joint contracture.

The type of juvenile chronic arthritis which has a system wide onset has typical symptoms of a fever which spikes regularly once or twice a day with the temperature going back towards normal in between the spikes. This is helpful diagnostically as infections do not behave in this way. A skin rash which lasts a few hours only may appear on the trunk and the limbs, the child may not be well and the larger joints may exhibit pain.

Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for Physiotherapist London visit his website.


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