JRA What exactly is JRA? Juvenile Rheumatoid Arthritis (JRA), or sometimes called juvenile chronic arthritis, is a disease that affects children causing joint inflammation which makes the joints stiff and painful. This Disease affects about one in one thousand children ages sixteen and younger. Doctors have also found that the more joints affected the more serious the disease and symptoms are less likely to go into full remission. There are three types of JRA and each type is based on the number of joints affected in the first six months of the active onset. The first type, which is the most common, affecting 60% of children that have JRA is Pauciarticular JRA. This form of the disease affects one to four joints in the child and is also known as.
Joints most commonly affected are the knee and wrist joints. Also an inflammation of the Iris may be present with or without joint inflammation. The second type, Polyarticular JRA, affects 30% of children with JRA, more so in girls than boys, and affects five or more joints. The small joints of the hands are affected as well as the major weight-bearing joints such as the knees, hips, ankles, feet, and neck. In addition to the joint inflammation a low grade fever may be present along with bumps or nodules on the body from on areas that are subject to pressure from leaning or sitting. The third type affecting 10% of children with JRA is Systematic JRA, which affects the whole body.
Rashes may appear and disappear, the lymph nodes and spleen may swell, accompanied by a high fever and eventually leading to swelling of the joints causing stiffness and pain. Causes What causes JRA is not well understood to the medical world. Though most experts now believe that it is a combination of number of factors such as: an overactive immune system that inappropriately attacks joint tissues as if they were a foreign substance; viral or bacterial infections are suspected to trigger the autoimmune process; and then there are the genetic factors, children whose families have a history of other autoimmune diseases are reported to have a higher occurrences of JRA, because recent studies show that it is a possibility that these families carry genes that are much more susceptible to autoimmune diseases. What exactly happens with JRA? The course that this disease takes is highly unpredictable in the first few years. This disease can be mild with few symptoms or it can be serious affecting the child’s life on a daily basis. Symptoms can worsen and disappear without clear reason.
Sometimes a pattern for the acute and remission phases can be established, but not always. Children will experience a combination of symptoms during the acute phase of the disease such as the joint pain, joint inflammation, and stiffness of the joints. Many also experience sleep disturbances and have difficulty falling asleep. Out of all the children with JRA, 70% to 90% recover without any serious disabilities.
Long term affects might include joint stiffness into adulthood, pain that sometimes requires medication to provide relief, and some limits to physical activity due to ongoing arthritis. However even though there is a very goof long term outlook for children with JRA it greatly depends on which type they have. If the child has Systematic JRA or Polyarticular JRA he or she is at a higher risk for more serious long term problems. Is massage beneficial to children with JRA? Treatment plans for children with JRA aim at reducing the pain and swelling and trying to keep any long term damage from happening. Also most treatment plans for JRA patients involve several medications-some being injections of corticosteroids, exercise, and physical therapy programs.
There is certainly room for massage in the treatment plan for JRA. Controlling stress levels is very important for children suffering from chronic ailments such as JRA, because as the stress hormone increases symptoms will increase as well. Massage has been proven to help reduce the stress hormone and help boost the immune system which leads to less pain for the child. Some of the biggest risk factors of JRA is the disfiguration of the joints and contractures from immobilization. Range of motion exercises are extremely important to maintain joint range and muscle strength. Goals & Treatment Plan The main goal as a massage therapist is to help reduce the pain experienced by the child and also to help the child maintain range of motion in the affected joints to help prevent long term damage.
Along with the range of motion and pain reduction a common goal of the sessions will be to help promote the child’s sense of well being in a nurturing environment where child and parent will feel comfortable. The treatment plan for a JRA client will consist of one to two months of once a week visits which will consist mostly of heat therapy and range of motion. If client is in the acute phase (hot swelling, fever or rash) then client will be asked to reschedule. Before the child comes in for their initial visit the therapist will request a meeting with the parents to obtain very specific details about their child’s JRA such as what type, what medications, other treatments attempted, and what they are hoping their child will get out of these sessions. In turn the therapist will explain their plan of treatment and what it will consist of.
At the first session the therapist will get to know the client. The therapist will sit down first with child and parents and discuss how the child feels overall and will rate pain on a scale of one to ten for each joint affected. Once the therapist has a general idea of the client from a verbal aspect they will then move on to a general relaxation massage to obtain a starting assessment of the client such as tension holding areas and current range of joints affected. Following sessions will start with heat therapy to loosen stiff joints before starting to work on them. The therapist will then warm muscles up with effleurage and to the clients tolerance then take each joint through several range of motion exercises and stretching. Client and parents will be shown how to continue stretching and range of motion exercises at home for in between sessions.
The sessions can be as focused as the client feels necessary. Days where the client is feeling well a general relaxation massage would be a good option, providing that they are keeping up with their at home exercises. Then there are the days that the client is just having a bad day on the pain scale so a passive massage or energy work would be beneficial. By the end of the sixth session the therapist and parents will sit down and discuss further treatment options for the client depending on how well client is improving. If client is improving greatly then sessions will be cut back to once or twice a month depending on the client or if there is improvement but it is progressing very slowly, then therapist might suggest another few weeks of once a week visits.