Anatomy of Joints:

Joints or articulations are the areas where two bones connect. Joints can be mobile or immobile. But, most of your joints are movable. Joints consist of the following:

• Cartilage: The cartilage is a type of tissue that covers the bone surface at the joint. It protects the joint by reducing the friction.
• Synovial Membrane: The Synovial Membrane lines your joint and secures it into a joint capsule. It helps by secreting the synovial fluid that lubricates the joint allowing free movement.
• Ligaments: The ligaments are tough, elastic bands that surround the joint. It provides support and limits the movement of the joint.
• Tendons: The tendons present on each side of the joint attach to the adjoining muscles and control the movement of the joint.

Causes of JRA:

The actual cause of JRA is unclear. While the research says that it might be an Autoimmune Disorder. In Autoimmune Disease, the Immune System is unable to differentiate between the healthy and pathogenic cells. So, the Immune System attacks the healthy cells.

In Juvenile Rheumatoid Arthritis, the Immune System releases chemicals that affect the healthy tissues in your body leading to inflammation and pain in the joints. The incidence of JRA is increased by certain gene mutations which make you more susceptible to environmental factors such as viruses.

Types of JRA:

There are three types of JRA that include:

• Pauciarticular JRA: Pauciarticular Arthritis affects five or fewer smaller joints of wrists and knees. If this type of JRA occurs in children over the age of 7, then it is most likely to spread the disease to other joints.
• Polyarticular JRA: The Polyarticular JRA affects five or more joints irrespective of the size of the joints.
• Systemic Onset JRA: Systemic Onset JRA is a rare type of JRA. It affects only about 10 per cent of people with Arthritis. It involves a sudden Onset of high fever with persistent rashes.

Symptoms:

The symptoms of JRA include:

• Persistent and severe joint pain
• High recurrent fever
• Swollen, red, or warm joints
• Stiffness in the joints
• Rashes appear with fever
• Low back pain
• Limited movement of the joints
• Limping

Complications:

If Juvenile Arthritis is left untreated, it may lead to severe complications. These include the following:

• Eye inflammation (Uveitis)
• Anemia
• Stunted growth
• Joint destruction
• Asymmetrical limbs
• Swelling around the Heart
• Long-term recurring pain

Diagnosis:

Your doctor diagnoses JRA in your child by taking a medical history and performing a physical examination. Your doctor may also suggest certain diagnostic tests which include:

• Erythrocyte Sedimentation Rate (ESR): An elevated ESR indicates inflammation. This test is performed to rule out other conditions and assess the degree of inflammation.
• C-reactive Protein (CRP) Test: In the body, the C-reactive protein is released by the Liver in response to inflammation. Therefore CRP test is ordered to assess the inflammation.
• Rheumatoid Factor: The Rheumatoid factor is the antibody which is usually present in children with Rheumatoid Arthritis.
• Anti-nuclear Antibody: Anti-nuclear antibody is produced by the Immune System in children with Autoimmune Disorder.
• X-rays and Magnetic Resonance Imaging (MRI): The X-rays and MRI scans are suggested to rule out other conditions such as infections and fractures.

Treatment:

Your doctor may recommend certain medications to relieve pain and progression of the disease. Juvenile Rheumatoid Arthritis treatment includes:

Nonsteroidal Anti-inflammatory Drugs (NSAIDs): The NSAIDs such as ibuprofen and naproxen are prescribed to reduce pain, inflammation, and swelling.

Disease-Modifying Antirheumatic Drugs (DMARDs): If the NSAIDs fail to relieve the symptoms, then your doctor may recommend DMARDs such as methotrexate and sulfasalazine. These drugs are used to decrease the progression of the disease.

Tumour Necrosis Factor (TNF) Blocker: TNF blockers such as etanercept and adalimumab are given to reduce pain, swelling, and morning stiffness.

Corticosteroids: The corticosteroids such as prednisolone control the progression of the symptoms and prevent serious complications. However, corticosteroids may increase the risk of infections and interfere with normal growth. So, these drugs should be used for a short duration.

Your doctor may also recommend physical therapy and occupational therapy for your child. In severe conditions, surgery may be required for the treatment of Juvenile Arthritis, to improve the movement at the joints.

Self-management

Performing physical activities and eating healthy foods may benefit the children with JRA. The doctor may recommend certain tips to manage JRA that include the following:

• Exercising regularly: Performing physical activity thrice weekly may strengthen your muscles and improve joint flexibility. Low-impact exercises such as walking and swimming may be beneficial.
• Applying cold or heat: Doing a hot water bath or applying heat or cold to the affected joints may relieve morning stiffness.
• Eating healthy food: In children with Juvenile Rheumatoid, weight changes are common. Therefore, a healthy diet may help to maintain normal body weight.

Causes:
Rheumatic Fever is an infection caused by group A Streptococcus or Streptococcus pyogenes. The exact association between group A Streptococcus and Rheumatic Fever is still unclear. However, experts believe that the bacterium attacks the Immune System. In response to Streptococcus infection, the body produces antibodies that fight against the Bacteria. Sometimes, these antibodies affect the tissues of your joints or the heart leading to Rheumatic Fever.
 

Complications:
If the condition is left untreated, it can lead to long-term complications.
Rheumatic Fever affects your heart and causes permanent damage that leads to Rheumatic Heart Disease, Valve Stenosis, Valve Regurgitation, and damage to the Heart Muscle.
 

Damage to the heart valves or other heart tissues may lead to certain heart problems later in life, such as Atrial Fibrillation and Heart Failure.

Risk factors:

The risk of developing Rheumatic Fever increases with the following factors:

• Family history of Rheumatic Fever
• Increased susceptibility to Streptococcus Infection
• Environmental factors such as poor sanitation and overcrowding

Diagnosis:

Your doctor confirms the diagnosis based on the physical examination, medical history, and certain tests. Physical examination involves checking your joints for inflammation, identifying the nodules under the Skin or Skin rash, and checking for Fever. Other diagnostic tests would include:

• Blood test: Your blood sample is drawn and examined for the presence of antibodies to the Streptococcus Bacterium.
• Electrocardiogram (ECG): It records the electrical signals of the heart. The test identifies the inflammation of the heart and the functioning of the Heart.
• Echocardiography: The test provides detailed images of the Heart. It is used to determine any damage to the Heart valves in the early stages.

Treatment:

The primary goals of the treatment involve relieving the symptoms, destroying the group A Streptococcal Bacteria, and preventing the recurrence of the Disease. Your doctor might recommend the following treatment options:

Antibiotics: Your doctor may prescribe Penicillin antibiotics to eradicate the Bacteria. After completion of Penicillin therapy, your doctor might order another course of antibiotics to prevent the recurrence of the infection.

Anti-inflammatory Therapy: Your doctor might order pain relievers such as aspirin or naproxen. These drugs reduce the inflammation, fever, and pain. In severe conditions, corticosteroids such as prednisone may be prescribed.

Anticonvulsant drugs: If there are severe jerky and involuntary body movements, your doctor might recommend Anticonvulsant drugs such as Valproic acid or Carbamazepine.

Symptoms:

The Onset of symptoms usually occurs after two to four weeks of infection. The signs and symptoms vary individually and would include the following:

• Fever
• Painful joints (such as ankles, knees, elbows or wrists; less often in shoulders, hips, hands and feet)
• Pain in one joint that radiates to another joint
• Red, warm or swollen joints
• Formation of small, painless nodules beneath the skin
• Chest pain
• Fatigue
• Flat or slightly raised, painless rash
• Difficulty swallowing
• Thick, bloody discharge from the nose
• Sore throat
• High body temperature (>101°F)
• Uncontrollable and jerky muscle movements (most often in the hands, feet, and face)
• Headache
• Nausea and vomiting
• Shortness of breath

Causes:
The lining which surrounds your joints is called Synovium. When your Immune System attacks the Synovium, then RA occurs.
Due to this, the Synovium thickens and results in inflammation. This eventually destroys your cartilage and bone within the joint.
The joint loses its shape and alignment because the tendons and ligaments that hold the joint get stretched or weakened.
A genetic component may also contribute to RA but other than that the actual process where RA starts is unclear. Certain viral or bacterial infections may also trigger RA.
 

Treatment:
The primary goals of the treatment are to improve your quality of life by reducing the severity of pain and by stopping further damage to the joints. Your doctor would recommend a combination of treatment methods for best results.
 

Drugs:
Your doctor will prescribe analgesics to manage the pain and reduce the inflammation near the joints.
(NSAIDS) Nonsteroidal Anti-inflammatory Drugs are prescribed to reduce your joint pain and inflammation.
Your doctor will prescribe certain creams namely menthol or capsaicin that help in blocking the transmission of pain signals from your joint.
Your doctor may prescribe Disease-modifying Anti-rheumatic Drugs (DMARDs) or Corticosteroids that help in suppressing your Immune System.
 

Symptoms:
Due to RA, the range of motion of the affected joint decreases. The joints would be painful, stiff and swollen. In severe cases, you may experience redness of the skin around the joint.
You may not feel like eating as you may lose your appetite. Your day may be tiresome and lethargic. You may experience fever, and you may also get anaemic.
 

Diagnosis:
Diagnosis of RA starts with your doctor performing a physical examination. During the examination, your doctor will check for fluid around the joints (pit oedema), warmth or redness near the joints, and the range of motion near the joints.
To determine what kind of Arthritis you have, your doctor may extract and analyze the levels of inflammation in your joint fluids and blood.
To look at the bones and cartilage, your doctor may order imaging tests such as X-rays, MRI, and CT scans. By this, your doctor can also rule out other possible causes such as bone spurs.
 

Surgery:
If there is no benefit from the medications, your doctor would recommend a surgical replacement of your knee.

In the case of severe Arthritis in your fingers or wrists, your doctor may perform a joint fusion. In this procedure, the ends of your bones are locked together until they heal and become one.

Physical Therapy (Physiotherapy)

Physical Therapy is recommended to strengthen the muscles and to increase your range of motion near the joint.

Complications:

If you have RA you may develop certain complications such as:

• Lymphoma (cancer of the Immune System)
• Lung Disease
• Osteoporosis (bone thinning disease)
• Rheumatoid Nodules
• Dry Mouth and Eyes
• Carpal Tunnel Syndrome
• Abnormal Body Composition

Risk factors:

The most common factors that increase your risk of developing RA are:

• Gender: Being a woman keeps you at an increased risk for developing RA
• Age: RA most commonly develops at the age of 40 to 60 years
• Obesity: Being overweight makes you develop RA due to the increased pressure on the limbs
• Smoking: Cigarette smoke increases your risk of developing RA and also increases the severity of RA