Juvenile Rheumatoid Arthritis and Ankylosing Spondylitis
Juvenile Rheumatoid Arthritis (JRA)
(Juvenile Rue-ma-toyed Arthritis)
Ankylosing Spondylitis (AS)
When most people hear the word Arthritis they think of elderly folks - Grandma and Grandpa. Although many adults and older people will develop arthritis, it is not very common in children.
Juvenile Arthritis (JA) is a term used to categorize the different types of arthritis affecting children. The most common type of JA is Juvenile Rheumatoid Arthritis (JRA). The type of JRA that affects the spine is called Ankylosing Spondylitis (AS). JRA is diagnosed in children less than 16 years of age whose arthritis has persisted for longer than six weeks.
What causes JRA or AS?
The exact cause or causes are not understood. Sometimes it is triggered by a bacterial infection or an autoimmune problem. An autoimmune disorder can cause the body to rebel against itself.
How does the disease start?
In the beginning, the joints in the spine become swollen (inflamed) and painful. Later new bone is formed between the vertebrae and the joints. This abnormal process begins to glue parts of the spine together, limiting movement. The discs between the vertebrae may become thick and hard, causing inflammation. Sometimes the new bone causes nerve problems.
What does AS feel like?
Low back pain may travel down the back into the butt and thighs. The hips and back may feel stiff, tender, and painful. If the chest (thoracic spine) is affected, AS can make it difficult to take a deep breath. The legs can become weak and numb if certain nerves are pinched or trapped.
How does the doctor know if someone has AS?
The doctor reviews the patient's general health and family medical history. AS can run in families. That is why it is important for the doctor to know if any family member had the disease.
During the physical examination, the patient will be asked to move their body in different ways so the doctor can see how flexible the spine is. A blood sample is taken to look for an antigen called HLA-BA27. An antigen is a protein that helps the body to make antibodies to fight infection. Not everyone with this antigen has JRA or AS.
The doctor also checks the patient's nervous system. This is not painful. X-rays are taken to reveal changes in the spine's bones. A CT Scan or MRI may be ordered to see the spine in greater detail.
Is surgery always needed?
Fortunately, surgery is seldom needed. The doctor treats the patient's symptoms using certain medications, physical therapy, exercise, and sometimes bracing.
Surgery is used to correct spinal deformity, make the spine stable, and/or relieve a nerve problem. There are several types of procedures the doctor can use, depending on what needs to be fixed.
Although AS cannot be cured, most people with AS are only mildly affected. Even though the patient may have pain and stiffness, it seldom prevents the person from leading a normal and productive life.