Juvenile Rhuematoid Arthritis: What is it, and how is it different from RA?

I've had JRA since I was 3 years old... pictured left is me not long after I was diagnosed.  If you look, you can see my left knee is much larger than the right.  There are many people out there who do not realize that arthritis can affect kids also. There is also a bit of a difference between RA and JRA, not major, but there still is one.  In this blog I am going to discuss what JRA is, the differences between RA and JRA, and a little bit about my journey as a kid. 

First, Juvenile Rheumatoid Arthritis (JRA) is arthritis that causes joint inflammation and stiffness for more than 6 weeks in a child of 16 years of age or less. Inflammation causes redness, swelling, warmth, and soreness in the joints, although many children with JRA do not complain of joint pain. Any joint can be affected, and inflammation may limit the mobility of affected joints.




Doctors classify JRA into three categories, Pauarticular, Polyarticular, and Systematic. 
Pauarticular is when four or fewer joints are affected, and is the most common type of JRA in children, it affects about half of all JRA kids.   Paucarticular disease typically affects large joints, such as the knees. Girls under age 8 are most likely to develop this type of JRA.  Many children with Pauarticular outgrow this by adulthood. 
Polyarticular (which is what I was diagnosed with) affects 30% of all children with JRA. In polyarticular disease, five or more joints are affected. The small joints, such as those in the hands and feet, are most commonly involved, but the disease may also affect large joints. Polyarticular JRA often is symmetrical; that is, it affects the same joint on both sides of the body.
Some children with polyarticular disease have a special kind of antibody in their blood called IgM rheumatoid factor (RF). These children often have a more severe form of the disease, which doctors consider to be the same as adult rheumatoid arthritis.
Systematic is when there is joint swelling, along with a fever and a light pink rash, and may also affect internal organs such as the heart, liver, spleen, and lymph nodes. Doctors sometimes call it Still's disease.  The systemic form affects 20% of all children with JRA. A small percentage of these children develop arthritis in many joints and can have severe arthritis that continues into adulthood.

Some children have special proteins in the blood called antinuclear antibodies (ANAs). Eye disease affects about 20 to 30% of children with pauciarticular JRA. Up to 80% of those with eye disease also test positive for ANA, and the disease tends to develop at a particularly early age in these children. Regular examinations by an ophthalmologist (a doctor who specializes in eye diseases) are necessary to prevent serious eye problems such as iritis (inflammation of the iris) or uveitis (inflammation of the inner eye, or uvea).  I was diagnosed with uveitis the same day I was diagnosed with my JRA.  As you can see in the picture to the right, my left eye almost closed. 

 I was actually misdiagnosed at first, and put in a cast for months (see photo above).  When it came time to come out of the cast, I cried for three days straight because my knee was locked in place and I could not walk.  It was a long journey of lots of physical therapy, and using a walker, but I was able to pull through.   The JRA started in my left knee, but by the time I was 8, it has spread to every joint in my body.  My rheumatologist said that there was a slight possibility I could outgrow the disease by the time I was 18.  Unfortunately I didn't, and still have it to this day. 

What is the difference between JRA and RA?
The main difference between juvenile and adult rheumatoid arthritis is that many people with JRA outgrow the illness, while adults usually have lifelong symptoms. Studies estimate that by adulthood, JRA symptoms disappear in more than half of all affected children. Additionally, unlike rheumatoid arthritis in an adult, JRA may affect bone development as well as the child's growth.  For example, I'm only 5 feet tall and a lot of my bones are very small and not adult size.  My jaw is very small, I have to use a child's toothbrush and have had teeth removed because there was no room.  My face itself is very small, I have to wear children's glasses and hats.  This is all because my bone growth was stunted because of my JRA. 

Another difference between JRA and RA is the percentage of people who are positive for RF (the rheumatoid factor in our genetic make-up). About 70 to 80 percent of all adults with rheumatoid arthritis are positive for RF, but fewer than half of all children with rheumatoid arthritis are RF positive. Presence of RF indicates an increased chance that JRA will continue into adulthood.

RA and JRA are treated similarly, and both have no known cause or cure.  My hope is to find a cure for this disease so children and adults aren't affected like this.  In the meantime, research doctors are continuing to try to improve existing treatments and find new medicines that will work better with fewer side effects.  Let's hope this will happen, and starting spreading awareness for this.