Juvenile Rheumatoid Arthritis
There are several different types of this children’s arthritis. Some types affect mostly girls under 5, and another affects boys. The type that causes fever affects boys and girls under five.
About 1 in 1000 children in the UK are affected, but rarely in black populations.
Some of the changes are very similar to rheumatoid arthritis. However, there are differences in effect, because of growth. The inflammation can increase growth in the short-term, but chronic disease may result in small bones and short stature.
In all types, the most frequently affected joint is the knee, in two thirds of cases. Other commonly affected joints are the ankle, wrist, hip and neck.
In younger children the first thing noticed is often a reluctance to weight-bear, or limp. Morning stiffness may be noted by the parents. Whilst the arthritis is active, the child may feel unwell and have a low-grade fever.
The “systemic” type usually starts with a high (~40°C) relapsing fever, once or twice a day, often in the evening. The child may be irritable and refuse food. Frequently a rash appears with the temperature.
The diagnosis is principally made with history and examination, and with exclusion of other serious illnesses.
Management for all types combines early treatment with an active exercise programme. This requires a multi-disciplinary team, including the parents and child.
Treatment is does not usually involve surgery. Most children are prescribed anti-inflammatories (NSAIDs), such as Ibuprofen or Diclofenac, but not aspirin. In moderate or severe cases Disease Modifying Drugs (DMARDs) are also used, e.g. methotrexate and sulphasalazine. Anti-TNF drugs are increasingly used in children. Steroid injections into joints can be very helpful.
Many types settle well over a few years, with no long-term disability.
Surgery may be needed as an adult; joint replacement is increasingly performed in early adulthood as implants have become more reliable. For the types of operations that are performed, please see the “Rheumatoid Arthritis” pages.