Childhood Arthritis - Types, Causes and Other Information

Childhood arthritis has virtually reached epidemic proportions, with nearly 300,000 children in the United States alone having some form of arthritis.

Arthritis can be short-term - lasting for just a few weeks or months, then going away permanently - or it can be chronic and last for months or years. In rare cases, it can last a lifetime.

Much disagreement exists among experts about the definitions of child arthritis. At least three clinical classifications exist - juvenile rheumatoid arthritis (JRA), juvenile chronic arthritis (JCA), and juvenile idiopathic arthritis (JIA).

All three schemes do not include many of the conditions considered as arthritis and other rheumatic conditions in adults. However, all schemes define childhood arthritis as occurring in people younger than 16 years.

Juvenile Rheumatoid Arthritis - Most Common Type of Childhood Arthritis

Juvenile rheumatoid arthritis (JRA), the most common form of childhood arthritis to occur in children, affects approximately 50,000 children in the United States. JRA causes chronic swelling, pain, tenderness and inflammation of at least one joint for longer than six weeks, with no apparent extenuating cause such as joint damage or injury, altered growth or joint contracture.

JRA affects approximately three times as many girls as boys, and can last for years, in some cases becoming progressively worse. It affects mainly the joints of the arms and legs, especially the fingers and wrists. As defined by the American College of Rheumatology, it is an active, inflammatory, peripheral and symmetrical form of arthritis, meaning that generally, both hands, or both legs, are affected. Three main types of JRA have been identified - pauciarticular (also called oligoarticular), polyarticular and systemic.

Types of Juvenile Rheumatoid Arthritis (JRA)

Oligoarticular JRA affects four or fewer joints. Symptoms include swelling, pain, or stiffness in the joints, affecting especially the knee and wrist joints. An inflammation of the iris may also occur with or without active joint symptoms, which sets this type apart from others. This inflammation, called iridocyclitis, iritis, or uveitis, can be detected early by an ophthalmologist, and often leads to a definitive diagnosis.

Polyarticular arthritis’ symptoms include swelling or pain in five or more joints. The small joints of the hands become affected as well as the weight-bearing joints such as the knees, hips, ankles, feet, and neck. For this type of childhood arthritis, a low-grade fever may be present, as well as raised nodules or bumps on the body on areas exposed to pressure from sitting.

Systemic JRA affects the entire body. Symptoms include high fevers that often increase in the evenings and then may suddenly drop to normal. Children with this type of childhood arthritis must often be hospitalized when flare ups occur. During the onset of fever, the child may feel very ill, appear pale, or develop a rash. The rash may suddenly disappear and then quickly appear again. Eventually, many or most of the body's joints are affected by swelling, pain, and stiffness.

Causes of Juvenile Rheumatoid Arthritis

Many theories have been put forth regarding the causes of JRA, but no definitive answers have been agreed upon. Some genetic predisposition appears to be involved in a majority of cases. The immune and defense systems also appear to be malfunctioning in some capacity, classifying the condition as a kind of autoimmune disorder.

In autoimmune diseases, white blood cells lose the ability to distinguish between the body's own healthy cells and harmful invaders like bacteria and viruses. The immune system, rather than protecting the body from these antigens, instead releases chemicals that can damage healthy tissues and cause inflammation and pain, in effect turning on itself.

Some anecdotal evidence also suggests that high stress can trigger the onset of the condition - situations like divorce or death in the family. Some children develop the condition after severe injury, though it is likely that the injury itself did not cause JRA, but rather triggered the latent tendency toward it. Generally, JRA appears anywhere between 6 month and 16 years. Many rheumatologists have noted that the greater the number of joints affected, the less likely that the symptoms of childhood arthritis will one day go into remission.

In addition to swollen and painful joints, children with systemic JRA also develop distinctive rashes, fevers, pericarditis (fluid around the heart), and enlargement of the lymph nodes, liver and spleen. Serious anemia may also result as the kidneys release blood cells into the urine.

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