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 The leading web portal for pharmacy resources, news, education and careers March 21, 2018
Pharmacy Choice - Juvenile Arthritis Disease State Management - March 21, 2018

Juvenile Arthritis Disease State Management

Arthritis is a group of disorders that result in damage to the joints of the body. Children are susceptible to develop any of the form of arthritis that adults may suffer from later in life. However, juvenile arthritis is very different in the symptoms, diagnosis, onset, and duration that a patient may suffer from the disease. Juvenile Arthritis (JA) typically begins prior to the age of 16 and affects close to 300,000 children. JA has been found to be more prevalent in the Native American population. The most common symptoms are joint swelling, pain, and stiffness that may be exacerbated in the morning after awaking or a nap. Other significant symptoms include: limping, fever, rash, weight loss, fatigue, blurred vision, and eye redness or pain.

Unlike Rheumatoid Arthritis, which can be diagnosed with high confidence utilizing blood tests that test for the presence of the antibody known as Rheumatoid Factor, the presence of this antibody is usually negative in patients that suffer from JA. Unfortunately, JA cannot be diagnosed utilizing a single test. The main process for confirming JA in a patient is to complete a full health history to ensure the symptoms are not resulting from trauma, injury, or infection. Additional tools utilized to diagnose may include a physical exam, x-ray, and lab testing. The three most common types of juvenile rheumatoid arthritis are:
  1. Systemic onset juvenile arthritis which can affect the entire body. Although this is the least common type of JA, it can also be the most debilitating.
  2. Pauciarticular, also known as Oligoarthritis, will typically affect five or less joints. The joints most commonly affected are the knee, ankle, elbows, spine, and wrist. Pauciarticular can also affect the eye, most often the iris, and has a higher incidence in females. This is known as uveitis, iridocyclitis, or iritis.
  3. Polyarthritis, also known as Polyarticular arthritis, affects five or more joints and has a higher incidence in females. The joints most affected are the fingers, small joints in the hands, knees, hips, ankles, neck, and jaw.
Depending on the type of JA that a child is diagnosed with, there are a variety of different treatment options intended to allow physical activity, reduce joint swelling, maintain movement in affected joints, and relieve/decrease pain. NSAIDS, including ibuprofen and naproxen, are first line agents used to decrease inflammation and relieve pain. Oral corticosteroids are also utilized to reduce inflammation, but their use should be monitored to ensure unwanted side effects such as weight gain, stunted growth, weakening bones, and increased susceptibility to infections do not occur in treated patients. In the event that patients do not respond to first line treatments, other options such as Biologic Response Modifiers and disease modifying agents like methotrexate, azulfidine, and plaquenil can be prescribed.
Links - Juvenile Arthritis
Arthritis Foundation - JA Alliance. The JA Alliance (Juvenile Arthritis Alliance) is a virtual community connected through the Arthritis Foundation Web site.

American College of Rheumatology is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with arthritis and rheumatic and musculoskeletal diseases.


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