- Arthritis (joint inflammation) is present for atleast one and a half months before the diagnosis of disease.
- Apart from joint pain, general malaise or anaemia can also be seen.
- A general recurrent high degree fever is also seen.
- Joint pain, swelling in the joints, redness in the joint areas, or pinkish rashes in the trunk and proximal extremities may also be present.
- Initial symptoms include reduced physical activity, poor appetite and lethargy.
- Swelling of the joints like shoulder, hips and back are difficult to diagnose clinically, therefore, such cases need an MRI or ultrasound screening for detection.
- Morning stiffness is a common feature of this disease, which reduces through the day.
- Late effects include joint contracture (i.e. stiff and deformed joint) and severe damage of the joints.
- It can also be associated with inflammation of the eye. It is estimated that about one in every five female cases of juvenile rheumatoid arthritis suffers from eye inflammation.
- It can also cause chronic anterior uveitis (inflammation of the uvea, which is a pigmented layer between the retina and the outer fibrous layer). This condition needs special attention and proper treatment as it can cause permanent blindness if ignored.
- Growth disturbances are also seen in children with juvenile rheumatoid arthritis. There can be skeletal discrepancies and asymmetrical skeletal growth. Also skeletal maturation is affected.
Children suffering from juvenile rheumatoid arthritis show severe systemic effects later in life which include cataract, uveitis, which may worsen to cause permanent blindness, retarted physical growth, widespread joint contractures, osteoporosis and muscle weakness.
Various treatment options are considered which aim at reducing the inflammation, minimising the pain and restoring the normal social and physical activities of the child.
The child is given non-steroidal anti-inflammatory drugs (NSAID) to reduce the pain and inflammation in the joints. Corticosteroidal injections are given in the joint space. Methotrexate is a newly introduced drug which comes in the category of disease modifying anti-rheumatic drug (DMARD) which successfully reduces the pain and inflammation in the joints.
To restore the normal social and physical activities of the child, an occupational therapist (OT) and a physical therapist (PT) is appointed, who should take proper consultation with a rheumatologist and promote the physical activities of the child.