Pediatric Occupational Therapy For Juvenile Rheumatoid Arthritis
Does your child complain of painful, swollen joints?
Do they have difficulty with tasks like walking or reaching for objects?
If you answered yes to these questions, your child may be struggling with juvenile rheumatoid arthritis.
With a diagnostic rate of approximately one in 1000, juvenile rheumatoid arthritis is the most common form of arthritis seen in children under 16 years of age.
Untreated, juvenile rheumatoid arthritis can lead to serious, lifelong complications, such as:
- Loss of red blood cells
- Long term recurring pain
- Vision changes
- Swelling around the heart
Fortunately, pediatric occupational therapy services include numerous treatment options for children struggling with juvenile rheumatoid arthritis.
Keep reading to learn more, or contact our Washington DC pediatric therapy clinic to book an appointment.
How Can Pediatric Occupational Therapy For Juvenile Rheumatoid Arthritis Help
If your childs pediatrician diagnoses them with juvenile rheumatoid arthritis, it is important to begin treatment immediately to prevent the condition from worsening.
An occupational therapist is an excellent addition to your childs arthritis treatment team.
Treatment for juvenile rheumatoid arthritis typically involves:
- Improving function in everyday roles and responsibilities
- Preventing joint damage
Your childs occupational therapist can help achieve these treatment goals in several ways.
For instance, your childs occupational therapist can provide advice on how to adapt your childs home and school environment to support their needs.
Similarly, they can also provide advice on how to adapt your childs activities to help them better achieve their goals.
In some cases of juvenile rheumatoid arthritis, the use of an assisted device, such as a brace or splint, may be beneficial.
Assisted devices can help your child remain independent while experiencing symptom flare ups.
They can help your child independently accomplish their activities of daily living, such as brushing their teeth, eating, and writing in school.
If your child requires the use of an assisted device, an occupational therapist can visit your childs home and school to help determine which assisted devices your child would benefit from most.
Additionally, it is important for children with juvenile rheumatoid arthritis to remain active.
What Is The Prognosis For Children Who Have Juvenile Idiopathic Arthritis
JIA affects each child differently. For some, only one or two joints are affected and the disease is easy to control. For others, JIA may involve many joints and the symptoms may be more severe and may last longer.
With early detection and treatment, including physical and occupational therapy, it is possible to achieve good control of the arthritis, prevent joint damage, and allow normal or near-normal function for most children who have JIA.
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Symptoms Of Juvenile Idiopathic Arthritis
Symptoms of JIA vary depending on the type, but all forms share persistent joint pain, swelling, warmth, and stiffness that are typically worse in the morning and after a nap or prolonged sitting. The pain may limit movement of the affected joint, although many children, especially younger ones, will not complain of pain. One of the earliest signs may be limping in the morning due to disease in one or both legs.
The symptoms of JIA may go through cycles, flaring for a few weeks or months followed by periods when they go into remission. Some children have just one or two flares and never have symptoms again, while others have many flares or symptoms that never fully go away.
Besides joint problems, the inflammation associated with JIA can cause other symptoms, such as:
If left untreated, uveitis can lead to eye problems such as cataracts, glaucoma, and vision loss, so it is important for children with JIA to have frequent eye exams.
- Skin changes. Depending on the type of JIA a child has, he or she may develop skin changes. Children with:
- Systemic JIA who have fevers can get a light red or pink rash that comes and goes.
- Psoriatic JIA can develop scaly red patches of skin. Psoriatic JIA can also cause pitted nails and dactylitis .
- Polyarticular JIA with rheumatoid factor can get small bumps or nodules on parts of the body that receive pressure, such as from sitting.
Classification Of Inflammatory Arthritis In Children And Adults
The classification of inflammatory arthritis occurring in children and adults provide us some clues about the nature of these diseases. The American College of Rheumatology classification criteria uses the term ‘juvenile rheumatoid arthritis’ , which includes JRA of pauciarticular, polyarticular and systemic onset . The European classification uses the term ‘juvenile chronic arthritis’ , which includes polyarticular arthritis, pauciarticular arthritis, systemic arthritis, juvenile ankylosing spondylitis, psoriatic arthritis and arthritis associated with inflammatory bowel disease. The more recent International League Against Rheumatism classification of ‘juvenile idiopathic arthritis’ has seven subsets, including the spondyloarthropathies . The very fact that there are different classification criteria, and each classification scheme has several subtypes, suggests that juvenile arthritis is not a single entity with uniform clinical, laboratory and immunogenetic features. The revised American Rheumatism Association criteria for RA, proposed in 1987, state that patients fulfilling any four of seven criteria fulfill the requirement for RA . The terms ‘classic’ RA and ‘probable’ RA were removed. Thus, RA in adults appears to be a single disease with different manifestations, while patients with one subtype of JRA clearly differ from patients with the other subtypes.
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Does Juvenile Arthritis Lead To Rheumatoid Arthritis
Most adults with rheumatoid arthritis test positive for the presence of rheumatoid factor , whereas some test negative.
Usually, children with juvenile arthritis outgrow their disease. However, some kids with positive RF will develop arthritis during their adulthood. Children with positive RF have the second most common type of JApolyarticular JA. Polyarticular JA is closely related to adult RA.
A blood test to confirm the presence of RF is necessary to identify if the child has an early-onset adult RA. However, an early-onset adult RA occurs rarely in about five percent of all JA diagnoses.
How Is Pauciarticular Juvenile Rheumatoid Arthritis Diagnosed
Theres no single test for PJRA right now. Instead, doctors will look at your childs symptoms and medical history. Tests will be done to rule out other conditions.
Your childs doctor might refer to a specialist called a pediatric rheumatologist to confirm a diagnosis of PJRA. As a rule, PJRA can only be diagnosed in children who are under 16 years old, and who have been experiencing symptoms for at least 6 weeks.
The following tests may be done to confirm or rule out other conditions:
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What Causes Juvenile Rheumatoid Arthritis
Like adult rheumatoid arthritis, JRA is an autoimmune disease, which means the body’s immune system attacks its own healthy cells and tissues.
JRA is considered to be a multifactorial condition. Multifactorial inheritance means that many factors are involved in causing a health problem. The factors are usually both genetic and environmental, where a combination of genes from both parents, in addition to unknown environmental factors, produce the trait or condition. Often one gender is affected more frequently than the other in multifactorial traits. Multifactorial traits do recur in families because they are partly caused by genes.
A group of genes on chromosome 6 codes for the HLA antigens play a major role in susceptibility and resistance to disease. Specific HLA antigens influence the development of many common disorders. Some of these disorders, like JRA, are autoimmune related and inherited in a multifactorial manner. When a child has the specific HLA antigen type associated with the disease, he/she is thought to have an increased chance to develop the disorder.
The HLA antigen associated with JRA is called DR4. Children with the DR4 HLA antigen are thought to have an increased chance to develop JRA however, it is important to understand that a child without this antigen may also develop JRA. This means HLA antigen testing is not diagnostic or accurate for prediction of the condition. Females are affected with JRA more often than males.
Are There Support Groups For Individuals With Jia
The Arthritis Foundation is a leading non-profit organization that is dedicated to addressing the needs of adults and children living with arthritis in the United States. There are more than one hundred local offices throughout the U.S. Many local and national events are organized to educate and connect patients and families. To learn more visit
Some information specific to children can be found at
Last reviewed by a Cleveland Clinic medical professional on 02/01/2019.
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Juvenile Arthritis: What It Is And Treatment Options
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Juvenile Arthritis: What It Is And Treatment Options
When it comes to arthritis, we automatically think of the elderly. Yes, they are the common sufferers of this debilitating condition. But, did you know that there are over one hundred different types of arthritis? There are. One of those is juvenile arthritis.
As previously stated, there are over one hundred different types of arthritis. There are different reasons for pain and that pain is felt in different areas of the body, but there is pain. With arthritis, it is always there. With juvenile arthritis, children experience this pain. Unfortunately, children are unable to manage and deal with pain as well as mature adults.
In terms of juvenile arthritis alone, there are three types. All are associated with rheumatoid arthritis. What are they?
Pauciarticular is the most commonly diagnosed in children. Luckily, it is the mildest. Pain is often experienced in the ankles, knees, fingers, elbows, and hips however, any joint can hurt.
Systemic is another type of juvenile arthritis, but it is rarely diagnosed. It is much less common. Unfortunately, complications are common. Pain is severe and often unbearable. Every joint in the body is susceptible to pain. It can also spread to other body organs.
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Whats The Outlook For People With Pauciarticular Juvenile Rheumatoid Arthritis
The outlook for PJRA can vary. Some children will recover completely within a few months. Other children might have symptoms for years, or symptoms that get worse as they age. Worsening symptoms can lead to complications with bone growth, eye health, and even organ function.
But treatment can help children with PJRA manage their symptoms and prevent complications. Your childs pediatric rheumatologist can develop a treatment plan focused on managing pain and improving your childs ability to perform daily activities. Many children with PJRA are able to manage their symptoms, attend schools, and do other activities.
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How Is Juvenile Arthritis Diagnosed
Because a child may have no symptoms of juvenile arthritis, and because some of the symptoms can be associated with other diseases, a diagnosis may be difficult. Because there is no actual test for juvenile arthritis, the diagnosis is made by excluding other conditions that may cause similar symptoms, such as bone disorders or breaks, fibromyalgia, infection, Lyme disease, lupus, or cancer.
The doctor is likely to begin by taking a complete medical history and performing a complete medical exam. Additional testing might be useful in determining what type of arthritis the child has. Some of the other tests that might be ordered include:
- Complete blood count
- Lab tests on blood or urine
- Imaging tests, such as magnetic resonance imaging scans
- Blood culture to check for bacteria, which could indicate an infection in the bloodstream
- Tests for viruses
- Tests for Lyme disease
- Bone marrow exam, which is used to check for leukemia
- Erythrocyte sedimentation rate to see how quickly the red blood cells fall to the bottom of a test tube
- Test for rheumatoid factor, an antibody that may be found in people with arthritis
- Antinuclear antibody test to show evidence of autoimmunity
- Bone scan to detect changes in bones and joints
- Joint fluid sampling and synovial tissue sampling, which might be performed by an orthopedic surgeon
What Is The Treatment For Juvenile Arthritis
Treatment for juvenile arthritis generally includes both exercise and medications. The treatment plans are also based on the type of juvenile arthritis. For instance, children who have polyarticular juvenile arthritis and who have a positive result on the rheumatoid factor test have the potential for more joint damage and may need more aggressive treatment.
In general, though, treatment for juvenile arthritis has several main goals:
- To relieve pain
- To increase joint mobility and strength
- To prevent joint damage and complications
The following types of drugs may be used to treat juvenile arthritis:
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Family History Of Autoimmune Disorders
Patients with RA frequently have a positive family history of RA. In fact, several extended families with RA have been reported and there are many affected sibling pairs with RA. The availability of such affected sibling pairs has been conducive to the performance of at least three genome-wide scans of linkage in RA . Although there are studies that report an increased prevalence of inflammatory arthritis among relatives of patients with JRA , a family history of inflammatory arthritis is less common in children, and extended multiplex pedigrees are extremely rare in JRA. Only about 300 affected sibling pairs with JRA are estimated to be in the USA , and about 180 of them have been entered into a Registry at Cincinnati Children’s Hospital Medical Center .
Relatives of patients with RA have an increased prevalence of other autoimmune disorders besides inflammatory arthritis . Thomas et al. described a significantly higher prevalence of insulin-dependent diabetes mellitus and autoimmune thyroiditis among first- and second-degree relatives of patients with RA than in patients with degenerative arthritis . Similarly, Lin et al. found that 7.8% and 2.8% of first-degree relatives of RA probands had autoimmune thyroid disease and IDDM, respectively, versus prevalences of 1% and 0.35% in the general population .
How Will Jia Affect Me
Many children who have JIA won’t have any symptoms when they’re adults, but its not possible to accurately predict this. In most cases, childhood arthritis has a good outcome. You should look forward to a future thats no different from those of your friends and classmates.
In at least 30% of cases, however, arthritis can remain active into adult life. Some young adults with JIA have joint damage that limits their daily activities to some extent and a few may need joint replacements. Other problems can sometimes occur. Some people are physically smaller than average or have osteoporosis as a result of their arthritis and/or treatment with steroids.
A successful outcome in JIA requires many things, including:
- a positive approach
- an experienced team working alongside your GP
- a caring, helpful environment with support from family, friends and teachers.
You also need to know how to get help that you can understand, know who to approach and be confident enough to ask for support and advice.
You can read more about JIA and how it will affect you in our Young people section of the website.
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What Are The Symptoms Of Juvenile Idiopathic Arthritis
Symptoms may appear during episodes . Or they may be ongoing . Each childs symptoms can vary. Symptoms may include:
- Swollen, stiff, and painful joints in the knees, hands, feet, ankles, shoulders, elbows, or other joints, often in the morning or after a nap
- Eye inflammation
- High fever and rash
- Swollen lymph nodes
These symptoms can seem like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.
Overview Of Juvenile Idiopathic Arthritis
Like adults, children can develop arthritis. The most common type of chronic, or long-lasting, arthritis that affects children is called juvenile idiopathic arthritis . JIA broadly refers to several different chronic disorders involving inflammation of joints , which can cause joint pain, swelling, warmth, stiffness, and loss of motion. The various forms of JIA have different features, such as the pattern of joints involved and inflammation of other parts of the body besides the joints. JIA may last a limited time, such as a few months or years, but in some cases it is a lifelong disease that requires treatment into adulthood.
JIA is idiopathic, meaning that its origins are not understood. While the exact causes of JIA are unknown, it begins when the immune system becomes overactive and creates inflammation.
With treatment, most children achieve periods of wellness , and sometimes the disease goes away permanently with no further need for medications. It is important to see a doctor early if your child has swollen or stiff joints because delaying therapy can lead to joint damage, a lesser response to treatment, and other problems.
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Diagnosis Of Juvenile Idiopathic Arthritis
Juvenile idiopathic arthritis is diagnosed using a number of tests including:
- medical history
- physical examination
- blood tests however, most children diagnosed with juvenile idiopathic arthritis do not have rheumatoid factor in their blood, so blood tests do not eliminate juvenile idiopathic arthritis
- x-rays and scans
- eye examination.
How Is Juvenile Idiopathic Arthritis Diagnosed
Diagnosing JIA may be difficult. There is no single test to confirm the disease. Your childs healthcare provider will take your childs health history and do a physical exam. Your child’s provider will ask about your child’s symptoms, and any recent illness. JIA is based on symptoms of inflammation that have occurred for 6 weeks or more.
Tests may also be done. These include blood tests such as:
Your child may also have imaging tests. These can show how much damage the bones have. The tests may include:
- X-rays. This test uses a small amount of radiation to make images of organs, bones, and other tissues.
- CT scan. This uses a series of X-rays and a computer to make detailed images of bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays.
- MRI. This test uses large magnets and a computer to make detailed pictures of organs and structures in the body.
- Bone scan. This uses a small amount of radiation to highlight the bones in a scanner.
Other tests may include:
- Urine tests. These look for blood or protein in the urine. This can mean the kidneys are not working normally.
- Joint aspiration . A small sample of the synovial fluid is taken from a joint. It’s tested to see if crystals, bacteria, or viruses are present.
- Full eye exam done by an ophthalmologist
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