Children with Juvenile Rheumatoid Arthritis (JRA) in the Classroom

Juvenile rheumatoid arthritis (also known as JRA, childhood arthritis, or juvenile idiopathic arthritis) is a type of arthritis that affects children age 16 or younger. There are several different types of JRA, and they all involve varying degrees of joint inflammation and swelling, stiffness, and reduced motion. JRA can affect any joint, and is more prevalent in girls than boys; in some cases it can affect internal organs as well (especially the eye).

It is not known what causes JRA, but scientists do know it is an autoimmune disorder, which occurs when the immune system attacks the body's own tissues. JRA targets the lining of the joint, known as the synovial membrane, causing inflammation or synovitis, which may cause joint damage. Although JRA is not considered hereditary, some children have a genetic predisposition to JRA, which is ultimately triggered by some infectious or feverous event. Diet and emotional environment are not considered to be factors in the onset of JRA. JRA affects approximately 1 in 1000 children, and is characterized by the following symptoms:

  • limping
  • stiffness when awakening
  • reluctance to use an arm or leg
  • reduced activity level
  • persistent fever
  • joint swelling

Since there is no simple test for JRA, it is diagnosed via examination and the ruling out of other diseases (e.g., Lyme disease or lupus). The first line of treatment involves non-steroidal anti-inflammatory drugs (NSAIDs), as appropriate for the child’s age, which may cause intestinal distress. Stronger drugs, including steroids, may also be prescribed.
Physical and occupational therapy can reduce pain, improve function and motion, and increase strength and endurance.

Juvenile arthritis can affect the student's mobility, strength and endurance, and students may come to school with varying degrees of pain and stiffness. Teachers should keep an eye out for body language, such as facial expressions or rubbing of joints, that may indicate a child is in pain or fatigued. When the student experiences a flare, modifications may need to be made (for example, allowing snacks when the child is taking extra medication). Teachers should also be sensitive to a child’s emotional state during a flare, as studies reveal “increased anxiety-and, surprisingly, not depressed mood-was significantly associated with increased fatigue and pain frequency and intensity.”

Since arthritis can go from symptom-free periods to flares of swelling and pain very quickly, it can cause irregular absences. When the student is not experiencing a flare, he or she can be encouraged to be active and allowed to self-limit activities for joint protection. In general, it is best to foster communication with the child and the family, and to treat the child as much like his or her peers as possible.

Pain of Juvenile Arthritis May Reduce School and Social Activity. National Institute of Arthritis and Musculoskeletal and Skin Diseases. August, 2003. See

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Added by Bob Jarvis.