What is Juvenile Rheumatoid (Idiopathic) Arthritis?

Growing up, I thought I knew what arthritis was. It was what caused witches’ fingers to be knobby and twisted, it was what caused hunchbacks, misshapen body parts, and it is a sign of being old. Arthritis was a problem that my grandparents and people of their age dealt with. 

Exhibit A: When I was younger I took the evil witch from Snow White as the epitome of arthritis: shriveled, bent over, knobby twisted fingers, and a misshapen nose (even though I now know that the nose has nothing to do with arthritis!)

But when I was diagnosed with arthritis at 14 years old, I experienced a new first-hand understanding that arthritis is not simply as it is portrayed by popular media. 

 Firstly, there are many kinds of arthritis, more than 100 different types! While all forms of arthritis generally cause joint swellage and cartilage erosion, their causes are different. Osteoarthritis is the most common form, and probably where the stereotype of arthritis is an old people disease arose. Osteoarthritis is when the age, obesity, or injury causes cartilage to break down in 1-2 certain joints in the body. The resulting bone-on-bone interactions in the joints cause pain and deformities. 

The other most common type of arthritis is rheumatoid arthritis. This is an autoimmune disorder where the body attacks healthy joint tissues, causing stiffness, pain, and eventually joint degeneration. Sometimes, you also experience fevers, rashes, eye inflammation, and even organ inflammation. If you are diagnosed at or before the age of 16, you are considered to have juvenile rheumatoid arthritis (JRA). Actually, these days the new official name is juvenile idiopathic arthritis (JIA). This simply means that the cause of inflammation is unknown. Additionally, within rheumatoid arthritis and juvenile rheumatoid arthritis, the amount of joints and which joints affected again dictate a different subset of disease. I specifically have polyarticular JIA, which means multiple joints are affected in my body. Other subsets include oligoarticular JIA and systemic-onset JIA. 

Within each disorder there are also varying levels of diease severity, and I consider myself lucky because my arthritis is not severe to the point where my joints are in constant pain. I do feel stiffness—exacerbated by cold and mornings— and aches, but I don’t have to take steroids or painkillers.

However, I am on medication for my arthritis, and the medication I use is called methotrexate. It is the most common drug used to treat rheumatoid arthritis, and is a folate inhibitator. It works by inhibiting the body’s production of folate, a necessary vitamen in cell production. This prevents my immune system from creating inflammatory macrophages that attack my joints, effectively controlling my arthritis. 

But with autoimmune diseases, there is no cure. We have yet to understand the human immune system, and the medication I take is simply to control my symptoms. It is not the most effective medication because there is no way to pinpoint folate inhibition for just inflammatory macrophages. Therefore, all the cells in my body are affected and have more difficulty reproducing. 

Cell production is necessary to life, so I take folic acid supplements in addition to methotrexate to help my cells reproduce. Despite taking supplements, I still have to get bloodwork done every two months to monitor my organ function; methotrexate is known to cause complications in organs such as the liver and kidney.

I’ve been on methotrexate for around 6 months now, and thankfully my organs are functioning as normal. Considering the time I’ve been on medication, I’m still a novice when compared to those who have been taking it for years. But I feel like such a jaded patient whenever I take methotrexate because I use an injectable kind.

<— This is what it looks like.

It involves needles and syringes and I hate hate hate needles and syringes. 

I knew I wanted to inject my own medication because no one was getting near me with a needle except for myself, but my mental block was huge. The first 4 times I injected medication I took 30+ minutes per try because I would hold the syringe and just keep making the motions but never actually injecting it. I thought I would never get over my fear, but this was a weekly ritual, and eventually I just began stabbing it into the side of my leg without a second thought. Sometimes I still get disgusted when I really think about the needle and yellow liquid (methotrexate is a bright, pee yellow) going into my flesh, but that’s just life I guess.