What is Juvenile Rheumatoid Arthritis?
Juvenile Rheumatoid Arthritis is an arthritic joint disease in patients under the age of sixteen. This type of arthritis is associated with iritis (uveitis) or inflammation inside the eye involving the uveal tissue in the eye. Another common name for it is idiopathic juvenile arthritis.
Types of Juvenile Rheumatoid Arthritis
Pauciarticular Juvenile Rheumatoid Arthritis
This is characterized by involvement of four joints or less with the wrists and knees being affected most commonly. This form has the highest association of iritis or uveitis.
Polyarticular Juvenile Rheumatoid Arthritis
This is characterized by involvement of many joints with five or more joints affected. It may affect small and large joints. This form has an intermediate association with iritis or uveitis.
Systemic Juvenile Rheumatoid Arthritis
This characterized by systemic involvement with joint inflammation, pain, rash, and fever. This form has the least association with iritis or uveitis.
What Causes Juvenile Rheumatoid Arthritis?
The exact cause is not known but it is felt to be an autoimmune disease.
Symptoms of Juvenile Rheumatoid Arthritis
Inflamed joints with swelling and/or redness
Fever, rash, swollen lymph nodes, and weak appearing
Light sensitivity (photophobia)
Many children can have no ocular symptoms but still have active iritis or uveitis.
Younger patients tend to have a higher incidence of iritis or uveitis.
Examination for Juvenile Rheumatoid Arthritis
A dilated complete eye exam is required in children with JRA. The vision can be affected
secondary to the inflammation in the eye. The classic findings are the presence of cells and
proteins in the anterior chamber (the space between the cornea and iris) of the eye. In
approximately seventy five percent of patients, the iritis will be present bilaterally. The
posterior portion of the eye needs to be evaluated to make sure there is no inflammation in
that portion of the eye.
Keratic Deposits Due to Iritis
Lab Tests That May Be Done for Juvenile Rheumatoid Arthritis
HLA antigen- HLA 27
ANA- antinuclear antibody test
Rheumatoid factor- RF antibody test
Sed rate- test for inflammation in the body
Treatment for Uveitis Secondary to Juvenile Rheumatoid Arthritis
Topical corticosteroids are used to treat the iritis or uveitis.
Topical non-steroidal anti-inflammatory medications may be used as well.
Systemic corticosteroids may be necessary if the patient does not respond to topical treatment.
Ocular Management of Patients with Juvenile Rheumatoid Arthritis
Medical treatment as needed for any ocular inflammation. Proper follow up depends on the
risk factors of the patient and may vary from every three months to a year except during any
active treatment phase. Ten to fifteen percent of children lose their vision secondary to the