Juvenile rheumatoid arthritis, be alert to these signs!

Juvenile rheumatoid arthritis is defined in medicine as a common connective tissue disease in children. Clinically, the main feature of the disease is chronic arthritis. If not treated in time, it is likely to affect multiple systems of the body, such as the skin, muscles, liver, etc. What are the clinical signs of juvenile rheumatoid arthritis?

Age of onset

It can occur at any age, with two peaks of onset at 2-3 years old and 9-12 years old. It can be divided into three types according to the onset form, clinical course and prognosis.

Whole body type

It can occur at any age, but is more common in children, regardless of gender. It accounts for about 20% of JRA. This type of disease is characterized by a fever with daily fluctuations between 36°C and 40°C. The child looks seriously ill when he has a fever, but can play as usual after the fever subsides. The fever lasts for weeks to months.

About 95% of children develop a rash, which is a reddish spot or annular erythema. It can appear anywhere on the body and may itch. The rash appears when the fever is high and disappears after the fever subsides, leaving no trace. Local heating or trauma may induce the rash.

In the acute phase, joint pain or transient clinical manifestations of arthritis are often ignored due to systemic symptoms. Joint symptoms may only become the main complaint after months or years of illness. About 25% of children eventually develop chronic polyarthritis.

About 85% of cases are caused by enlargement of the liver, spleen and lymph nodes. Occasionally, there are central nervous system symptoms, manifested as seizures, abnormal behavior and abnormal electroencephalograms. Long-term disease with repeated attacks can cause delayed development. The interval between relapses of systemic JRA is difficult to predict, and most cases will not relapse after puberty.

Polyarthritis

5 or more joints are affected, more common in women, and the large joints such as ankles, knees, wrists and elbows are affected first, often symmetrically. The joints are swollen, painful, but not red. The characteristic is that the joints are not stiff when getting up in the morning (morning stiffness). As the disease progresses, the small joints are gradually affected: when the peduncle joints are affected, typical fusiform swelling is present. When the temporomandibular joints are affected, it is manifested as difficulty opening the mouth. Young children may complain of ear pain. For patients with a long course of disease, it may affect local development and cause micrognathia. It may affect the laryngeal arytenoids (annular cartilage - arytenoid cartilage) and cause hoarseness, phonation and difficulty eating. Involvement of the cervical spine may cause neck pain and restricted movement. Involvement of the hip joints may cause osteonecrosis and permanent lameness. In the late stage of the disease, the affected joints eventually become ankylosing and deformed, the area around the joints and heat atrophy, and motor function is impaired.

This type may have systemic symptoms, but they are not as severe as the systemic type, such as low-grade fever, general malaise, slow growth, and mild anemia. Physical examination may reveal mild enlargement of the liver, spleen, and lymph nodes.