Juvenile idiopathic arthritis symptoms

Initial symptoms (including relapses in the course) are often fatigue, tearfulness, and in performance. The main symptoms of arthritis (pain, swelling, heat and movement restrictions) can not be compared to adults. Younger children often express the pain directly. They change their behavior.

The affected joints are held in a deformity, usually in flexion. This inactivity in one axis misalignment if left untreated can lead to permanent contractures (tendon shortening with remaining movement restrictions), and muscle wasting. Furthermore, there may be asymmetric growth of joints and adjacent bone.

Basically, each joint may be involved. On affected joints pressure can often cause pain. Joint pain is typically more in the morning and after prolonged inactivity and is enhanced by movement of the inflamed joint.

Classification and symptoms and medical histories of the various subgroups

Most of the more advanced, older classifications of the International League of Associations for Rheumatology (ILAR) and the WHO from 1998 summarized the different course types in homogeneous subgroups on scientific issues (risk factors, co morbidities, complications, prognosis and therapy). In clinical practice, this classification was not always enforced, but its usefulness is continuously evaluated scientifically and a revised version is expected shortly.

It is categorized after six months disease duration. In the period from six weeks to six months after the onset of the arthritis, it remains unclassified. For the classification of the disease, manifestation is up to the sixth month after the onset of the disease, although the long-term course then presents a different attack pattern. A distinction is based on symptoms and laboratory findings from the following subgroups:

Systemic juvenile arthritis (senior synonym: Still’s disease)
Polyarthritis, rheumatoid factor positive
Polyarthritis, rheumatoid factor negative
Oligoarthritis
Persistent (i.e. 1-4 joints in the long term> 6 months)
Extended (i.e. > 4 joints in the long term> 6 months)
Arthritis by enthesitis
Psoriatic arthritis
Other arthritis
Do not meet the above criteria
Meet the criteria of several categories

Epidemiology

Approximately 10-20% of the profiles of juvenile idiopathic arthritis are associated with the systemic form. The disease manifests itself mainly between the second and eighth year of life, boys and girls are affected in about equal frequency.

Symptoms at the start

The disease usually begins acutely with high fever, which preferentially occurs in the early morning and evening hours. In between the body temperature drops below 37°C. Preferably, the trunk, upper arms and thighs experience a volatile, salmon-colored skin rash, which is provoked by heat and is often accompanied by itching.

Joint pain affecting the cervical spine is typical initially with pain in the head rotation. Inflammation of the large joints, less commonly the small joints, can, in half of the patients, take weeks or months in coming. If within six months, there is no arthritis, we first go with fever of an unknown cause.

Other symptoms may result from pain when taking deep breaths with polyserositis (pleurisy), cardiac symptoms (pericarditis), and abdominal pain (peritonitis). Sonography can be detected in body cavities for discrete fluid collections.

Generalized swelling of lymph nodes and the liver are typical. Laboratory tests often show maximum inflammation (ESR, C-reactive protein, leukocytosis, ferritin), thrombocytosis > 500/nl, pronounced hypochromic anemia, increased fibrinogen, complement factors (C3, C4), possibly GOT and LDH. There is a lack of other autoimmune disease’s typical autoantibodies (ANA, ds-DNA-AK, ENA, ANCA) and hemolysis (Coombs test negative). There are often numerous, carefully excluded differential diagnoses, before one can speak of systemic arthritis.