Abby has Juvenile Rheumatoid Arthritis (JRA) affecting primarily her left ankle.
What is JRA you may ask? JRA is the most common form of arthritis in children. It may be a mild condition that causes few problems over time, but it can be much more persistent and cause joint and tissue damage in other children. JRA can produce serious complications in more severe cases.
Arthritis is best described by four major changes in the joints that may develop. The most common features of JRA are: joint inflammation, joint contracture (stiff, bent joint), joint damage and/or alteration or change in growth. Other symptoms include joint stiffness following rest or decreased activity level (also referred to morning stiffness or gelling), and weakness in muscles and other soft tissues around involved joints.
Abby experiences all of these symptoms. Her ankle swells and gets warm to the touch from the inflamation at times. Due to the ankle pain, she also walks with the foot turned out and her ankle rolled inward. She wears inserts in her shoes to correct this. Her left leg is also longer than her right by a an inch or two.
The signs and symptoms of JRA vary from child to child, and even from day to day in the same child! This is an important fact for parents, caretakers and teachers (especially gym teachers) to keep in mind when working with children who have JRA.
There is no single test to diagnose JRA. The diagnosis is made when there has been persistent arthritis in one or more joints for at least 6 weeks after other possible illnesses have been ruled out. Sometimes, a variety of tests may be necessary to come to a firm diagnosis. Once your child's physician suspects or makes this diagnosis, your child may be referred to a pediatric rheumatologist. This is a physician who specializes in the diagnosis and treatment of children with arthritis and arthritis-related conditions.The type of arthritis is usually determined based on the symptoms a child has had during the first 6 months of the illness.
Abby has been diagnosed with Pauciarticular Arthritis. This type of JRA affects only a few joints, fewer than 5. The large joints, such as the shoulder, elbow, hip, and knee, are most likely to be affected, for Abby it is her left ankle.
There are two different types of pauciarticular JRA: one type usually affects little girls under age 7 and is associated with the development of eye inflammation (chronic iridocyclitis or uveitis) in about 1/3 of these children. These children should be tested for antinuclear antibodies (ANA). This tells the rheumatologist and the ophthalmologist (eye doctor) whether the child has a higher risk of developing uveitis (when the ANA is positive the risk is higher). Unfortunately, this eye condition is silent so only proper monitoring by an eye doctor who is familiar with this complication of JRA may find the changes in the eyes.
Abby is "ANA Wekly Positive" which means that she must see an opthalmologist every three months to make sure that no eye inflammation is occurring. So far, her opthalmologist has not seen any inflammation.
Treatment usually involves a combination of physical therapy, medication, exercise, healthy eating habits, eye care, etc. Abby's treatment currently involves medication, physical therapy, and eye care. Abbyschedule is a s follows:
- Physical Therapy - one day a week for 30 minutes.
- Methotrexate - 7.5mg once a week.
- Prevacid - in the mornings daily.
- Zantac - in the evenings daily.
- Celebrex - twice daily.
- And of course lots of love from mom, dad, and Ethan.