Juvenile Arthritis (cont.)
Pauciarticular juvenile rheumatoid arthritis
Pauciarticular juvenile rheumatoid arthritis (JRA) is defined by the involvement of less than four joints after six months of illness. This form often begins in young girls as a swollen knee or ankle that appears without injury or explanation. Usually it is
"painless," but someone may notice that the knee looks swollen or the child is walking awkwardly. Since arthritis causes morning stiffness, parents are slow to get concerned about this because
"she always looks okay once she gets going." This arthritis is often very mild and treated just with mild nonsteroidal antiinflammatory drugs, but it can cause two important problems. A serious problem that many children with pauciarticular juvenile rheumatoid arthritis (JRA) develop is inflammation of the eye (iridocyclitis). The inflammation is not painful, but if not detected and treated, it may lead to scarring of the lens and permanent visual damage (even blindness). At the beginning,
this inflammation cannot be seen except by an ophthalmologist using a special
instrument called a "slit lamp." Because the eye disease is more common in children with a positive test for antinuclear antibodies (ANA), these children require eye examinations every three months by an eye specialist. All other children with juvenile rheumatoid arthritis (JRA) need eye examinations every six months. No one has been able to completely explain the association of eye disease and arthritis or why it is more frequent in children with ANA. But we do know it happens, and it's important to make sure every child's eyes get checked.
The second important problem with pauciarticular juvenile rheumatoid
arthritis (JRA) is that it may
cause the bones in the legs to grow at different rates with the
result that one leg is longer than the other. When this happens,
children are forced to walk with a limp. This damages the knee and
the hip leading to premature arthritis, from "wearing out" the joints
by the time the child is an adult, and should be prevented.
Fortunately, this can be recognized early. When the knee or another joint is inflamed by the arthritis, its blood supply increases. Then, just like a plant that receives more water than the plants around it, it grows faster and larger. Doctors are always trying to stop the inflammation to prevent this problem. Most often the therapy is successful and the child does
not develop a significant leg-length discrepancy. If he or she does,
we can do two things. First we can put a lift in the shoe on the
short side to correct the effect of the different leg lengths. This
doesn't do anything for the knee, but it prevents excessive wear on
the hip and allows the child to walk more normally. The next step is
to monitor growth. When the child is getting closer to fully grown, an
orthopedist can look at x-rays of the legs and try to guess when the
bones are going to stop growing. If the leg with arthritis is 3 cm
longer than the other leg, they will look at the x-rays and try to
guess when there is 3 cm of leg growth left. Then you stop the growth
on the leg that is too long and allow the short leg to catch up. This
can be done with a very simple operation.
Next: Polyarticular juvenile rheumatoid arthritis »
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