the purpose of the study is to investigate the effect of Electrical Acupuncture Versus naproxen phonophoresis on Refractory pain in Juvenile Rheumatoid arthritis

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children and adolescents, affecting approximately one in 1000 children in North America. It is diagnosed in children younger than 16 years of age with arthritis in one or more joints for at least six weeks after other causes have been excluded. Arthritis in JIA is characterized by stiffness, pain and swelling of affected joints. The disease course of JIA may involve flares of increased disease activity or chronic persistent joint inflammation, even into adulthood. Various complications may arise secondary to ongoing disease activity or treatment, including joint damage and deformity, growth abnormalities and osteoporosis with fragility fractures The prevalence of refractory pain in children with arthritis is of particular concern because it often contributes to poor physical and psychosocial outcomes. Increased daily symptoms of pain predict considerable functional disability, including significantly reduced participation in school, social and physical activities, and augmented mood disturbance

Inclusion Criteria:

• • Age ranges from 14 to 16 years.

  • All children will be assigned to the study are suffering from persistent oligoarthritis.
  • All children have regional knee pain complaint more than 6 weeks.
  • Pain and stiffness especially in the morning, and a joint that feels warm to the touch
  • Low grade fever at the onset of disease

Exclusion Criteria:

• • Neurological disorders.

  • Dermatological disorders.
  • Acute trauma prior to the study.
  • Other co- morbidities like diabetes and conditions associated with inflammation such as malegnancies.
  • Analgesic drugs or NSAIDs during the treatment period.

children suffering from juvenile idiopathic arthritis/oligoarthritic (mainly the knee joint) will participate in the study.

All children will be randomly assigned into 2 groups of equal numbers A, B using sealed envelopes, 21 children for each group.

• Study group A: will receive especially electrical acupuncture on the knee joint
• Study group B: will receive naproxen phonophoresis on the knee joint