Diagnosis

Diagnosis of juvenile rheumatoid arthritis can be difficult because joint pain can be caused by many different types of problems. No single test can confirm a diagnosis, but tests can help rule out some other conditions that produce similar signs and symptoms.

Blood tests

Some of the most common blood tests for suspected cases of juvenile rheumatoid arthritis include:

  • Erythrocyte sedimentation rate (ESR). Sedimentation rate is the speed at which your red blood cells settle to the bottom of a tube of blood. An elevated rate can indicate inflammation.

    Measuring the ESR may be used to rule out other conditions, to help classify the type of juvenile rheumatoid arthritis and to determine the degree of inflammation.

  • C-reactive protein. This blood test also measures levels of general inflammation in the body but on a different scale than the ESR.
  • Anti-nuclear antibody. Anti-nuclear antibodies are proteins commonly produced by the immune systems of people with certain autoimmune diseases, including arthritis.
  • Rheumatoid factor. This antibody is commonly found in the blood of children who have rheumatoid arthritis.
  • Cyclic citrullinated peptide (CCP). Like the rheumatoid factor, the CCP is another antibody that may be found in the blood of children with rheumatoid arthritis.

In many children with juvenile rheumatoid arthritis, no significant abnormality will be found in these blood tests.

Imaging scans

X-rays or magnetic resonance imaging (MRI) may be taken to exclude other conditions, such as:

  • Fractures
  • Tumors
  • Infection
  • Congenital defects

Imaging may also be used from time to time after the diagnosis to monitor bone development and to detect joint damage.

Treatment

Treatment for juvenile rheumatoid arthritis focuses on helping your child maintain a normal level of physical and social activity. To accomplish this, doctors may use a combination of strategies to relieve pain and swelling, maintain full movement and strength, and prevent complications.

Medications

For some children, pain relievers may be the only medication needed. Other children may need help from medications designed to limit the progression of the disease.

Typical medications used for juvenile rheumatoid arthritis include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve), reduce pain and swelling. Stronger NSAIDs are available by prescription. Side effects include stomach upset and liver problems.
  • Disease-modifying antirheumatic drugs (DMARDs). Doctors use these medications when NSAIDs alone fail to relieve symptoms of joint pain and swelling.

    They may be taken in combination with NSAIDs and are used to slow the progress of juvenile rheumatoid arthritis. Commonly used DMARDs for children include methotrexate (Trexall) and leflunomide (Arava).

    Side effects may include nausea and liver problems.

  • Biologic agents. Also known as biologic response modifiers, this newer class of drugs includes tumor necrosis factor (TNF) blockers, such as etanercept (Enbrel) and adalimumab (Humira). These medications can help reduce pain, morning stiffness and swollen joints.

    But these types of drugs increase the risk of infections. There may also be a mild increase in the chance of getting some cancers, such as lymphoma.

    Other biologic agents work to suppress the immune system, including abatacept (Orencia), rituximab (Rituxin), anakinra (Kineret) and tocilizumab (Actemra).

  • Corticosteroids. Medications such as prednisone may be used to control symptoms until a DMARD takes effect or to prevent complications, such as inflammation of the sac around the heart (pericarditis).

    Corticosteroids may be administered by mouth or by injection directly into a joint. But these drugs can interfere with normal growth and increase susceptibility to infection, so they generally should be used for the shortest possible duration.

Therapies

Your doctor may recommend that your child work with a physical therapist to help keep joints flexible and maintain range of motion and muscle tone.

A physical therapist or an occupational therapist may make additional recommendations regarding the best exercise and protective equipment for your child.

A therapist may also recommend that your child make use of joint supports or splints to help protect joints and keep them in a good functional position.

Surgery

In very severe cases of juvenile rheumatoid arthritis, surgery may be needed to improve the position of a joint.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Caregivers can help children learn self-care techniques that help limit the effects of juvenile rheumatoid arthritis. Techniques include:

  • Getting regular exercise. Exercise is important because it promotes both muscle strength and joint flexibility. Swimming is an excellent choice because it places minimal stress on joints.
  • Applying cold or heat. Stiffness affects many children with juvenile rheumatoid arthritis, particularly in the morning. Although some children respond well to cold packs, most children prefer a hot pack or a hot bath or shower.
  • Eating well. Some children with arthritis have poor appetites. Others may gain excess weight due to medications or physical inactivity. A healthy diet can help maintain an appropriate body weight.

    Adequate calcium in the diet is important because children with juvenile rheumatoid arthritis are at risk of developing weak bones (osteoporosis) due to the disease, the use of corticosteroids, and decreased physical activity and weight bearing.

Coping and support

Family members can play critical roles in helping a child cope with juvenile rheumatoid arthritis. As a parent, you may want to try the following:

  • Treat your child, as much as possible, like other children in your family.
  • Allow your child to express anger about having juvenile rheumatoid arthritis. Explain that the disease isn't caused by anything he or she did.
  • Encourage your child to participate in physical activities, keeping in mind the recommendations of your child's doctor and physical therapist.
  • Discuss your child's condition and the issues surrounding it with teachers and administrators at his or her school.

Preparing for your appointment

If your pediatrician or family doctor suspects that your child has juvenile rheumatoid arthritis, he or she may refer you to a doctor who specializes in arthritis (rheumatologist) to confirm the diagnosis and explore treatment.

What you can do

Before the appointment, you might want to write a list that includes:

  • Detailed descriptions of your child's symptoms
  • Information about medical problems your child has had in the past
  • Information about the medical problems that tend to run in your family
  • All the medications and dietary supplements your child takes
  • Questions you want to ask the doctor

What to expect from your doctor

Your doctor may ask some of the following questions:

  • Which joints appear to be affected?
  • When did the symptoms begin? Do they seem to come and go?
  • Does anything make the symptoms better or worse?
  • Is the joint stiffness worse after a period of rest?
Oct. 17, 2014
References
  1. Marzan KAB, et al. Early juvenile idiopathic arthritis. Rheumatic Disease Clinics of North America. 2012;38:355.
  2. Questions and answers about juvenile arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Juv_Arthritis/. Accessed Sept. 3, 2014.
  3. Juvenile arthritis. Arthritis Foundation. http://www.arthritis.org/conditions-treatments/disease-center/juvenile--arthritis/. Accessed Sept. 2, 2014.
  4. Arthritis in children. American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/juvenilearthritis.asp. Accessed Sept. 2, 2014.
  5. Sullivan KE. Inflammation in juvenile idiopathic arthritis. Pediatric Clinics of North America. 2005;52:335.
  6. Ferri FF. Ferri's Clinical Advisor 2015: 5 Books in 1. Philadelphia, Pa.: Mosby Elsevier; 2015. https://www.clinicalkey.com. Accessed Sept. 3, 2014.
  7. Firestein GS, et al. Kelley's Textbook of Rheumatology. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2013. https://www.clinicalkey.com. Accessed Sept. 3, 2014.

Juvenile rheumatoid arthritis