Juvenile rheumatoid arthritis rash: what you need to know
Juvenile rheumatoid arthritis is an obsolete term that refers to a group of arthritic conditions that typically begin in a person’s childhood or adolescence and can continue into adulthood. Most doctors now use the term juvenile idiopathic arthritis, or JIA. Often, one of the first symptoms of JIA is a rash with or without fever.
These arthritic conditions cause inflammation of the joints and sometimes internal organs.
This article describes the rashes of JIA and describes some of the other symptoms associated with the disease. It also provides information on how doctors diagnose and treat JIA.
JIA is an umbrella term that includes six arthritis subtypes:
Children with juvenile subtypes of PsA or systemic JIA may develop a rash, in which the skin becomes inflamed, itchy, and discolored.
General symptoms of juvenile RP
Children with juvenile RP usually have joint symptoms, usually in the following joints:
- the wrists
Juvenile PsA can also cause itching and scaly rashes. This rash may develop before or after the joint symptoms.
General symptoms of systemic JIA
About 10-20% of children with JIA have systemic JIA. This subtype affects the whole body, including the joints, skin, and internal organs.
Some symptoms of systemic JIA include:
- a rash
- a high fever of 103 ° F (39.4 ° C) which usually peaks in the evening
- joint pain that is usually worse in the morning or after long periods of immobility
Below are some symptoms associated with subtypes of JIA that can cause a rash.
Juvenile PsA rash
The juvenile PsA rash usually presents as a reddish patch of skin that may appear silvery-white in some areas due to a buildup of dead skin cells. The rash is usually itchy or painful.
Although it can grow anywhere on the body, it most commonly affects the following areas:
This rash is persistent and usually does not present with a fever.
Systemic rash of JIA
The systemic rash of JIA is usually a flat, pale, non-itchy rash. It can appear on one of the following areas:
- The abdomen
Unlike the juvenile PsA rash, the systemic rash of JIA may last only a few minutes to a few hours. In addition, he usually presents with a fever.
Healthcare professionals do not know the exact cause of JIA. However, it is likely that some children have a genetic predisposition to the disease, which something in the environment then triggers. This combination of factors then triggers an overactive immune response.
Subtypes of JIA that can cause rashes occur as a result of problems with a person’s innate or adaptive immunity.
With innate immunity, babies are born with an innate immune system (IBS) which is the body’s first line of defense against pathogens.
With adaptive immunity, the adaptive immune system (AIS) develops throughout a person’s life. Its purpose is to target and destroy pathogens that manage to escape ISI.
Juvenile RP and most of the other subtypes of JIA are autoimmune diseases, which means they are caused by overactive ISA. However, some researchers believe that systemic JIA is an autoinflammatory disease, which means that it is due to the overactive IIS.
Juvenile PsA and systemic JIA both cause widespread or systemic inflammation in several body tissues, including the skin.
The two subtypes of JIA that can trigger a rash can have different effects on the body. The sections below show some examples of these effects.
A juvenile PsA rash can develop on the skin, but it can also affect the nails. This leads to nail psoriasis, in which the nails become itchy, discolored, and painful. In some cases, the nails can also come loose from the nail bed.
Juvenile PsA can also have various effects throughout the body. Examples include:
- pain and swelling in the joints, usually in the fingers and toes
- swelling of the fingers, toes, or wrists
- joint irregularities due to chronic inflammation
- eye pain
Systemic JIA can cause serious complications throughout the body. Examples include:
- Problems with bones and joints: Chronic inflammation slowly damages the joints, causing pain and loss of function. It can also interfere with growth and development, causing stunted growth and limbs of different lengths.
- Lung and heart problems: Children with systemic JIA can develop high blood pressure and lung disease. These conditions can lead to circulation and breathing problems.
- Macrophage Activation Syndrome (SAM): This is a severe inflammatory response that can overwhelm the body. Although healthcare professionals generally associate SAM with various rheumatic conditions, some experts estimate that 80% of cases are related to systemic JIA.
There is no test that can conclusively diagnose juvenile PsA or systemic JIA. Instead, doctors should make a diagnosis based on the following:
- the child’s symptoms
- the child’s medical history
- the results of a complete physical exam
- the doctor’s clinical expertise
Certain tests can help diagnose certain types of arthritis and rule out other conditions that can cause similar symptoms. Examples of these tests include blood tests and skin biopsies.
Treatment options for a JIA-related rash will depend on the underlying cause of the rash. The sections below list a few potential options.
Treatment for JIA involves treating the underlying inflammation to reduce symptoms and prevent joint damage. Treating the inflammatory response will also help improve the rashes.
A variety of medications can help manage the symptoms of JIA, including:
- Nonsteroidal anti-inflammatory drugs: It is usually a first-line treatment that doctors prescribe to control pain in mild cases.
- Oral corticosteroids: These drugs help reduce systemic inflammation in moderate to severe disease.
- IV corticosteroids: These drugs help reduce inflammation in people with serious illness and in those with complications, such as SAM.
- Disease-modifying anti-rheumatic drugs: These drugs help stop inflammatory forms of arthritis or slow their progression.
- Inflammatory cytokine blockers: These drugs calm the inflammatory response. Examples include anakinra and canakinumab.
Treatments for juvenile PsA
Doctors may recommend
- emollients to hydrate and protect the skin
- topical steroids to reduce inflammation and slow the growth of skin cells
- topical retinoids to decrease scaling and flatten thick plaques
- vitamin D analogues, which are topical medications that help slow the growth of skin cells, remove dander, and shrink thick plaques
Doctors may also recommend UV light therapy and drugs called biologics to reduce the frequency of flare-ups and the severity of symptoms.
If a child develops a rash with a high fever, their parent or guardian should see a doctor immediately.
Rashes have multiple possible causes, and some are more serious than others. For this reason, it is best to see a doctor to rule out any potentially serious causes, including JIA.
JIA refers to a group of arthritic conditions that typically begin in a person’s childhood or adolescence. There are six subtypes of JIA, two of which can cause a rash. These are juvenile PsA and systemic JIA.
The rashes associated with juvenile PsA and systemic JIA differ in appearance. In juvenile RP, the rash is usually reddish, painful, or itchy, and it tends to last a long time. In systemic JIA, the rash is usually flat, pale, and not itchy, and it tends to go away within minutes or hours. Systemic JIA rashes also tend to be accompanied by high fever.
Treatment for the rash of JIA involves targeting the underlying inflammation and using topical medications to relieve skin symptoms.
Anyone who is worried about a rash on their child should contact a doctor for advice.