Health Topics > Juvenile Rheumatoid Arthritis

Contributed by John T. Lynn M.D., Rheumatologist
Arthritis Affiliates, P.C.

During flare-ups of arthritis, a child might experience pain, swelling and stiffness of the joints. Vigorous exercise should be avoided during flare-ups.

This child might need to rest, apply ice packs to any joints that are swollen, do gentle stretching, and take anti-inflammatory medicines and/or analgesics. As the flare-up subsides, the child will be able to ease into more vigorous exercise. Exercise during a flare-up of inflammation can make the joint pain, swelling and stiffness worse.

Types of Juvenile Arthritis:

1. Juvenile Rheumatoid Arthritis: This occurs in three forms.

a) Pauciarticular JRA: This is the most common form of juvenile rheumatoid arthritis. Inflammation occurs in four or fewer joints. Often the knees are involved. Usually the inflammation does not cause any permanent damage to the joints. Often the inflammation improves or resolves by the time the child becomes an adult. Except during flare-ups of pain, swelling and stiffness, a child with pauciarticular JRA is able to participate in most physical activities. The treatment consists of anti-inflammatory medicines, analgesics as needed, and occasionally medicines that change the immune system to lessen the inflammation. Children with the pauciarticular form of JRA should see an ophthalmologist to look for a rare form of eye inflammation (uveitis) which can be associated.

b) Polyarticular JRA: In this form of JRA many joints are inflamed much like adult rheumatoid arthritis. The neck and temporomandibular joint can be affected and deformities of the joints can occur. The growth of bone can be affected. Treatment is usually more aggressive and includes anti-inflammatory medicines, physical therapy, and Methotrexate. Children with polyarticular JRA should avoid vigorous exercise and contact sports.

c) Systemic JRA (Still’s Disease): This is the least common form of juvenile rheumatoid arthritis and causes inflammation of the whole body, including the skin, lymph nodes, internal organs, and joints. During the acute phase, high fevers are common. With treatment with corticosteroids (prednisone) and Methotrexate the disease often goes into remission, but the inflammation can continue in many joints.

2. Systemic Lupus Erythematosus: This is a disease of the immune system. The immune system attacks the skin, the joints, and in some cases the internal organs and blood cells. Most cases of lupus are easily controlled with anti-inflammatory medicines, anti-malarial medicines (Plaquenil), or Methotrexate. Patients with more aggressive disease require corticosteroids (prednisone) and chemotherapy medicines to change the immune system so that it does not attack the body. The disease is well-known for causing tiredness which can be a limiting factor in how much a child exercises. Ultraviolet light exposure can cause a flare-up of lupus, so sun avoidance and sun screens are recommended.

3. Ankylosing Spondylitis: This is a disease that causes inflammation of the spine and often the large joints of the body. The eyes can be affected (uveitis). The most common symptom is stiffness of the low back or the entire spine. Treatment is with anti-inflammatory medicine. Activity and exercise can make the child feel looser, but contact sports should be avoided.

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