Tuesday, November 11, 2008

Some facts on JRA

Why is Prompt, Aggressive Treatment of

Juvenile Idiopathic Arthritis Necessary?

In the last decade important changes have

occurred regarding treatment of juvenile arthritis that

can prevent long-term disabilities. Published studies


The majority of children with juvenile idiopathic

arthritis will continue to have active disease as

they enter adulthood. (this is discouraging!!!)

Persistent synovitis leads to joint deformity and

destruction and often occurs less than 2 years

following onset of disease.

Disruption of proper joint function predisposes

children and young adults to premature

osteoarthritis and a potential of lifetime disability.

Chronic disability from juvenile arthritis can stunt

the physical and psychological growth of a child,

and may disrupt family dynamics due to ongoing

psychological and economic stresses

What is Remission?

The first phase of remission is the achievement


inactive disease

which is defined as: no joints

with active arthritis; no fever, serositis, splenomegaly,

or generalized lymphadenopathy attributable to JIA; no

active uveitis; normal ESR or CRP; and a physician’s

global assessment of disease activity indicating no

disease activity.

Clinical remission on medication


defined as inactive disease on medication for a full six

months, and

clinical remission off medication


achieved when there is inactive disease off of medications

for a full 12 months. Although many children can

achieve clinical remission on medications, most will

have a flare of their arthritis within three years of

discontinuing medications. (Jacob was just past the 3 year point off meds!)

Can I just stress EARLY DIAGNOSIS IS THE KEY!!! After Jacob was in clinical remission for a few years I didn't give the arthritis another thought. I thought he had outgrown the disease. When his knee flared up this January it was a complete shock and by the extent of the overgrown synovium it had been coming on for a while. When he was seen by his rheumatologist in January it was on an 18mo. follow-up.