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Juvenile rheumatoid arthritis


Disease: Juvenile rheumatoid arthritis Juvenile rheumatoid arthritis
Category: Bones, joints, muscles diseases
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Disease Definition:

Juvenile rheumatoid arthritis is the most common type of arthritis in children under the age of 16. This condition is also called juvenile idiopathic arthritis.


Persistent joint pain, swelling and stiffness are caused by juvenile rheumatoid arthritis. Even though some children may experience symptoms for the rest of their lives, but other may only experience them for a few months. Juvenile rheumatoid arthritis has several types, which are classified according to the number of joints that are affected, the signs and symptoms and the results of blood tests.


Serious complications, such as eye inflammation and growth problems could be caused by some types of juvenile rheumatoid arthritis. Preventing joint damage, controlling pain and improving function are what treatment for this condition will aim at.

Work Group:

Prepared by: Scientific Section

Symptoms, Causes


Some of the most common signs and symptoms of juvenile rheumatoid arthritis may include:


  • Pain: Especially first thing in the morning or after a nap, parents may notice that their child limps, however, he/she may not complain of joint pain.
  • Swelling: Even though small joints of the hands and feet could also be affected, but this sign is mostly seen in the knees.
  • Stiffness: The child may appear to be more clumsy than usual.


Juvenile rheumatoid arthritis has three main types:


During the first six months of the disease, this type affects fewer than five joints. This is the same type that causes eye inflammation, which in some rare cases could lead to blindness.


During the first six months of the disease, this type affects five or more joints. Usually, the signs and symptoms are confined to the joints.


This type causes swollen lymph nodes, rashes and fever, which could come and go quickly. This type, which used to be called Still's disease, could also cause inflammation of internal organs.


Juvenile rheumatoid arthritis is marked by times when symptoms flare up and times when symptoms disappear, just like other forms of arthritis.


In case a child has joint pain, stiffness or swelling for more than a few weeks, particularly if these are accompanied by fever, the child should be taken to see a doctor. 


This disease is believed to be an autoimmune disorder. An autoimmune disorder occurs when the body's immune system attacks its own cells and tissues. Heredity and environment seem to play a role in this, but its exact cause is still not known. A person could be more prone to environmental factors, such as viruses, which could trigger the disease, due to certain gene mutations.



Juvenile rheumatoid arthritis could cause several serious complications. However the risk of these complications could be greatly reduced if parents keep a careful watch on their child's condition and seek appropriate medical attention. Some of those complications may include:

Eye problems:

Eye inflammation could result from certain types of juvenile rheumatoid arthritis. This condition could result in cataracts, glaucoma and even blindness if it's left untreated. It's very important for children with juvenile rheumatoid arthritis to be examined regularly by an ophthalmologist, because eye inflammation usually occurs without any symptoms.

Growth interference:

The development of a child's bones and growth could be inhibited by juvenile rheumatoid arthritis. Growth could also be inhibited by some medications that are used to treat juvenile rheumatoid arthritis, such as corticosteroids.


Helping the child maintain a normal level of physical and social activity is what treatment for juvenile rheumatoid arthritis will aim at. A combination of strategies could be used to prevent complications, relieve pain and swelling, and maintain full movement and strength.



Pain relievers could be the only needed medication for some children. However, others may need medications to limit the progression of the disease. Some of the medications that are typically used include:


These medications should be used under a doctor's supervision because children could develop side effects, such as bleeding and liver and stomach problems. Pain and swelling could be reduced by naproxen or ibuprofen.


When NSAIDs fail to relieve symptoms of joint pain and swelling, disease-modifying antirheumatic drugs (DMARDs) are used. Some of the commonly used DMARDs for children include sulfasalazine and methotrexate. Nausea and liver problems could be some of their side effects. These medications are used to slow the progression of juvenile rheumatoid arthritis and could be used in combination with NSAIDs.

TNF blockers:

Pain, morning stiffness and swollen joints could be treated with tumor necrosis factor (TNF) blockers. However, the risk of infections, especially in the lungs, and even cancers, such as lymphoma, are increased by these medications. Some examples are infliximab and etanercept.


Children with more severe juvenile rheumatoid arthritis could use these medications. These medications could be used to prevent complications such as pericarditis, which is the inflammation of the sac around the heart, or they could be used to control symptoms until a DMARD takes effect. One type of corticosteroids that could be administered by mouth or by injection is prednisone. However, corticosteroids should be used for the shortest possible duration because they could increase susceptibility to infection and interfere with normal growth. It's very important to follow a doctor's instructions on usage because ceasing long-term use of corticosteroids suddenly could be quite dangerous.



To help keep the joints of the child flexible and maintain range of motion and muscle tone, the child may be recommended working with a physical therapist. Regarding the best exercise and protective equipment for the child, the physical therapist or occupational therapist could make additional recommendations. Additionally, to help protect the child's joints and keep them in a good functional position, he/she may also be recommended using special supports or splints.



In some rare cases of juvenile rheumatoid arthritis, to improve the position of a joint, surgery may be needed.



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Dr. Samer Al-Jneidy

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Dr. Faisal Dibsi

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