Nutrition in Juvenile Rheumatoid Arthritis

Abstract

Juvenile Rheumatoid Arthritis (JRA) is one of the more common chronic diseases affecting about one child every 1000 (1). The diagnosis of JRA is established entirely on clinical grounds. Laboratory investigations are rarely pathognomonic and are used instead to assist in the differential diagnosis, detect complications and monitor disease activity. The diagnosis of JRA is based on three criteria: 1) arthritis persisting for more than three months; 2) onset of arthritis before age 16; 3) exclusion of other diseases that may cause arthritis (2). There are three main clinical patterns of the disease: pauciarticular onset which affects up to four joints, polyarticular onset affecting five or more joints, and systemic onset which has prominent extra-articular features such as fever or rash. The pauciarticular JRA carries the greatest risk for iritis. The articular prognosis for these patients is good although a third of them will go on to develop polyarthritis that is difficult to manage. Patients with polyarticular onset have a poorer articular prognosis: 30-50% develop bony erosions and active arthritis that persists into adulthood. Life threatening complications such as pericarditis and amyloidosis are associated with systemic onset JRA. About a third of systemic onset patients develop severe polyarthritis resistant to treatment, and the articular outlook for these patients is poor (3). Ten years after disease onset, 75% of systemic, 50% of polyarticular and 60% of pauciarticular patients have functional limitations (4).