Juvenile Rheumatoid Arthritis (JRA) and Rheumatoid Arthritis
What is Juvenile Rheumatoid Arthritis?
According the Mayo Clinic, chronic arthritis is classified as Juvenile Rheumatoid Arthritis (JRA) when the rheumatoid patient is under the age of 16. JRA is actually a group of autoimmune diseases grouped under one umbrella. The pattern in which symptoms appear during the first six months following onset is used to determine the subtype of JRA. JRA is also referred to by the term Juvenile Idiopathic Arthritis (JIA), noted below.
Five classifications of Juvenile Rheumatoid Arthritis
- Systemic JRA: Was formerly referred to as Still’s disease. Systemic disease can affect organs, may include fever and rash with early symptoms.
- Polyarthritis: Polyarticular JRA affects five or more joints during the first six months. It is more likely to affect neck, jaw, and small joints and more likely to affect girls.
- Oligoarthritis: This is the most common, estimated to be at least half of JRA. It is also the group with the least severe symptoms of all JRA patients. It is also called pauciarticular JRA, referring to fewer than five joints being affected during the onset period. Pauciarticular JRA is more likely to affect eyes and most likely to be outgrown as the patient reaches adulthood.
- Psoriatic JRA: Similar to adult Psoriatic Arthritis (PA), this occurs with a psoriasis rash and possible nail pitting as unique symptoms.
- Enthesitis-related arthritis (ERA): ERA is more likely to affect the spine and hips. Like the adult spondarthropathy / spondylarthropathies such as Ankylosing Spondylitis, this subtype of JRA affects the entheses (insertion points of tendons, muscles, or ligaments) and is much more likely to be present in boys. Some say permanent joint damage is much less common, but there are also difficulties in measuring damage, according to Pediatric Rheumatology.
Comparing Juvenile Rheumatoid Arthritis to Rheumatoid Arthritis
In many ways, these various classifications of Juvenile Rheumatoid Arthritis seem to mirror adult versions of autoimmune arthritis diseases. The polyarticular JRA type is most similar to adult Rheumatoid Arthritis. The patient is more likely to have a positive Rheumatoid factor (Rf) and to be eventually reclassified as having adult Rheumatoid Arthritis.
How JRA is like RA:
- Extremely heterogeneous disease
- Treated with NSAIDs, DMARDs, and Biologics
- Genetic-related causes
- Possible environmental trigger
- Possibility of joint damage
How JRA is different from RA:
- Many with JRA do outgrow the disease
- JRA is much rarer than RA
- JRA may interfere with bone growth
- JRA is less likely to have positive Rheumatoid factor
Note: Differences in terminology exist with regard to JRA. “Juvenile chronic arthritis” has been the historical term in Europe. The newest term, “Juvenile idiopathic arthritis” (JIA), is now used as an umbrella term to refer to all types of Juvenile Rheumatoid Arthritis, while distinguishing between the several subtypes. Patients whose JRA is reclassified as RA upon reaching adulthood may or may not be given an additional diagnosis. It is sometimes said that such patients may have had child-onset Rheumatoid Arthritis.
Recommended reading related to today’s topic:
- Ankylosing Spondylitis post on RA Warrior
- How Does Reactive Arthritis Compare with Rheumatoid Arthritis?
- Psoriatic Arthritis and Rheumatoid Arthritis
- To learn more about JRA, see the Pediatric Rheumatology website.
- For research, I also consulted Cleveland Clinic articles on JRA.
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Very interesting post and one I have had questions about. I asked my rheumatologist if a person could have JRA that went away for years and came back as an adult. He said it was too long too explain but that the short answer was yes.
I think I had it just in my knees. I had pain, severe swelling and walked on crutches when flared. I just read in this article that it can affect bone growth and my right and left femurs had a one in length difference that caused secondary scoliosis. My right femur was shortened at age 28 due to the back pain. It was a successful procedure and the scoliosis and it’s pain are gone.
My daughter was diagnosed with JRA in 1999 and she is now 12 years old and still dealing with this horrible dieses. I am curious Kelly if you have found any statistic about kids growing out of JRA? I have read over and over “many grow out of JRA”, but my experience is that there are few out there to affirm this. We are very active in the community with other kids who have JRA and so far, sadly, the report is VERY low of kids who don’t have ongoing issues into their adult lives.
My daughters JRA is Polyarticular and yes, very similar to the adult version of RA. I hold hope (and pray daily) that she does grow out of this, but even should that be the case she has growth issues and bone deformity that she will carry with her the rest of her life.
I appreciate you brining attention to JRA.
Hi Theresa,
I have found the same as you with this as with many other RA issues. What is in all of the books does not match up with the thousands of RA’ers with whom I’ve had contact. I can just hear a scientist or doctor in my head saying, “But Theresa, you only interact with those whose cases are severe so your experience does not prove anything…” or something like that. I do not have as much experience w/ JRA as you do, but from what I’ve read, she may be more llikely to continue to have RA issues because of the genetic history ( you having RA too) and the version which she has now. Is she Rf positive?
Also, keep in mind: the treatments we are using now to fight the disease (aggressive use of DMARDs) are still new enough that we cannot prove exactly how the outcome is affected. I read some articles which claim that the early aggressive treatment of JRA would definitely help her outcome. We just can’t prove that yet. But we hope so. Also, you are getting her the best in therapy or surgery or anything that will help her, so your care for her is her best hope for now. And, of course, we can pray for her – and all kids with JRA.
OMG! This is so much closer to what is happening to me. I have had numerous issues in my childhood with what they termed tendinitis and bursitis and I have a knee deformity, One leg is somewhat shorter than the other and when I was younger I had more trouble with my knees, and my tailbone. I would stiffen up where I couldn’t straighten out for weeks. I would also have a lot of trouble with a stiff neck, and remember that my mom would put a hot compress on me to help relieve the pain and stiffness. I had forgotten about a lot of that stuff till just now when I read about the JRA. I believe I may fit into the category •Enthesitis-related arthritis (ERA)- It gives me hope that I may finally get a doctor to figure out a diagnosis!
Good luck getting your mystery solved Michelle!
I think whatever treatments you need would probably be the same. Many RA’ers have written to me privately or in their Onset Stories of various RA / JRA symptoms beginning during childhood. Some said their docs actually say that they should have been JRA diagnosed.
My sister was diagnosed with JRA when she was 6 and I was in utero. Hers was severe, no remissions and continues into adult RA until finally Enbrel slowed it down a bit. When I started having symptoms six years ago, I knew what I had. And made an appointment with a rheumy bypassing my primary care doc. It still took me five years to accept the diagnosis. I was the strong one, her protector when we were kids – how could I have her disease? Thanks for the further information on JRA. It is helpful to me.
Anj,
What a wonderful sister you are. I have daughters like that – always finding ways to protect me, trying to prevent my injury.
This acceptance issue is something I’ve been hearing a lot about. I’m wondering, do you think there is anything that could be done to help w/that?
Your story is kinda sad – I’m sure you get tired of hearing this, but at least there is medicine now. Best of all to you both. :heart:
hey Kelly – Sometimes I think the acceptance is so hard because we are trying to accept the unknown. It is a diagnosis we get but not an outcome. In a very small way, it feels like accepting the Saturday between Good Friday and Easter. Accepting the unknown is always more difficult I think.
And yes, i am so grateful for the medicine
I’m not in contact day to day with another person who has a chronic condition like I have (at least not to my knowledge), so I don’t know what it’s like dealing with a person with an autoimmune disease like Rheumatoid Arthritis. My only point of view is from the side of the sufferer (the sufferer with RA), living with people who don’t have RA.
Most people are either one way or the other; treating me like a child who can’t cross the street without holding hands or not realizing how much pain and fatigue I feel during a major flare-up. There doesn’t seem to be too much of a happy medium, and trying to explain how you feel over and over gets old after a while.
I’m sure that every Rheumatoid Arthritis sufferer feels the same at one point or another. When people first learn that I have RA I’m treated with kid gloves, like I’m going to break into pieces if I do anything more strenuous than sitting down
Being able to be independent is certainly important to me, but I’m also not a martyr. When the pain, aches and fatigue are too much for me handle without a grimace, I am usually able to put my stubbornness aside and ask for help, and most of the time help is given.
My RA is like having a dog chewing on every joint-hands, feet, knees, shoulders and elbows, hips, and lower back.
I’ve discovered that I can handle more than I thought, it’s made me a stronger person, and I’m much more empathetic to other people’s pain.
I know that in my heart, I will make this diease my own, I will walk and carry RA within my life and do the best I can, one day at a time……. hugs to all- we will battle this together and we will WIN!!!!
It is possible to have JRA as a child and have it return years later. I had JRA from 7 to 13. My parents and the rheumatologists at Childrens Hospital in Philadelphia treated my RA in what I would consider an aggressive manner. My understanding is they the experimental use of Methotrexate at that time put my RA in “remission” until about 24.
Bone length and joint alignemt was a major concern of theirs at the time I can remember. One of my legs is longer then the other and for a few years I had leg and hand braces I wore to bed each night.
I hope my experience is helpful and am happy to finally find a site collecting RA info as my doctor is suggesting the step from Metho to a biological which I don’t have any experience with.
Gary,
Thanks for your interesting story. There is some info on Biologics here on this post. It may also help to use the Tags List at the top of the page, under Enbrel, Humira, and Rituxan. Good luck to you.
Hi, I just wanted to share a little about my experience with systemic jra. I was diagnosed at age 14 but showed signs before that, they went misdiagnosed.. By the time I was diagnosed I had been hospitalized for weeks with blood transfusions.. I did get put on mtx and pred and I stayed with that for 2 years that wasn’t really helping and I couldn’t stand the meds so I changed my diet and did the herbal things.. I had symptoms still but they were much better than with the drugs.. I am 24 now and currently in the worse flare up since I was in the hospital. I think it’s partly due to my diet recently I haven’t been strict at all and I feel I’m paying for it now .. I’m in the process of getting a new diagnosis or something because I haven’t seen a Rheumatologist in 8 years.. I wish there was more information out there on adults diagnosed with jra
perfect and point on the line.
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