What is Oligoarticular Juvenile Rheumatoid Arthritis?

Juvenile Rheumatoid Arthritis (JRA) is the most common type of arthritis in children. There are several different forms of JRA. Each depends on the number of joints involved and whether there are other symptoms such as fever and rash. Oligoarticular JRA affects four or fewer joints. The most commonly affected joints are the knees, ankles, wrists, and, in some cases, fingers and toes.

Who it affects

It is estimated that 70,000 to 300,000 children have some form of chronic arthritis. Oligoarticular JRA is the most common type, making up about 60% of all childhood arthritis cases.

The causes

The cause of oligoarticular JRA is unknown. Some types of arthritis run in families but that does not seem to be the case for oligoarticular JRA.

Complications

If found and treated early, children with oligoarticular JRA usually do well. In some children, one leg grows longer than the other so a shoe lift may be needed for the shorter side. In rare cases, surgery may be needed to slow the growth of the longer limb.  

The most serious complication is uveitis. This is an inflammation of the eye that, if left untreated, can lead to blindness. It is seen most often in girls whose arthritis started between the ages of 2 and 5. Up to 20% of children with this type of JRA have uveitis.  

Diagnosis

There is no blood test that can diagnose JRA.   Even though 75 to 85% of children with oligoarticular JRA have a positive ANA (anti-nuclear antibody) blood test, many healthy children, who do not have JRA, can have a positive ANA test.

A diagnosis is made if the following are true: 

1.  The arthritis started before age 16.

2. There must be arthritis in at least one joint but in no more than 4 joints. Arthritis is defined as swelling in a joint and two or more of the following: limitation of range of motion, pain with motion, and increased warmth of the joint.

3.  The arthritis has lasted at least six weeks.

4.  Other causes of arthritis have not been found, such as infection.

History

Children with JRA are usually stiff in the morning or after periods of rest, such as after a nap or long car rides. Parents may notice that their child walks with a limp that improves over the course of the day. The affected joints may be swollen and warm.

Treatment

Children with this type of arthritis are usually treated with anti-inflammatory medicines such as naproxen or ibuprofen. If they do not work, injection of corticosteroid into the joint may help. Sometimes stronger medicines may be needed such as methotrexate and etanercept. Physical and occupational therapy may help improve the range of motion and strength of the affected joint(s).

Uveitis is usually treated with steroid-containing eye drops. If this is not effective, then other medicines, such as prednisone, methotrexate and infliximab may be used.

Outcome

Most children with oligoarticular JRA do well.  A recent study found that more than 90% had excellent outcomes in terms of their arthritis.

Useful resources

Rheumatology Resources, American Academy of Pediatrics

Arthritis in Children, Teens and Young Adults, Arthritis Foundation

National Institute of Arthritis and Musculoskeletal and Skin Diseases
(National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse)

Arthritis in Children, American College of Rheumatology

Condition Kit on Oligoarticular JRA

Produced by the United States Bones and Joint Decade, NFP

May 2007

United States Bone and Joint Decade

The mission of the United States Bone and Joint Decade (USBJD) organization is "to provide national leadership and coordination of activities in the United States in the worldwide movement to improve patient care, to promote research and to advance understanding and treatment of musculoskeletal conditions during the International Bone and Joint Decade." The worldwide Bone and Joint Decade is an international collaborative movement sanctioned by the United Nations/World Health Organization.

This initiative was developed in response to the staggering statistic that musculoskeletal disease currently affects more than one billion individuals worldwide. In the United States, bone and joint disorders affect one in three Americans, remain the No. 1 reason people visit the doctor, and cost an estimated $300 billion per year. The Decade's aim is to reduce the burden of musculoskeletal disease, and to improve the quality of life for those who are challenged by a musculoskeletal condition by promoting greater awareness, educating the public about prevention, and increasing research to improve diagnosis and treatment.

President Bush proclaimed the Bone and Joint Decade in the United States. All 50 U.S. states have endorsed the Decade. Around 100 U.S. patient, healthcare professional, and public organizations support the Decade, as well as all 125 medical schools and many colleges of medicine.

To learn more about the Decade, visit www.usbjd.org

United States Bone and Joint Decade, NFP

6300 N. River Road

Rosemont, IL 60018

Phone: 847-384-4010

Fax: 847-823-0536

usbjd@usbjd.org

5/14/07