Arthritis - juvenile

What is juvenile idiopathic arthritis?#

Juvenile idiopathic arthritis (JIA) is a group of conditions that cause joint pain and swelling in children and teenagers under the age of 16. The word “idiopathic” means “of unknown cause”. Many people assume that arthritis only affects older people, but it can affect the young too. Around one in 800 children has a form of juvenile idiopathic arthritis.

Other names for the condition include juvenile arthritis, juvenile rheumatoid arthritis, juvenile chronic arthritis, and Still’s disease.

What causes JIA?#

The exact cause of JIA is not known, but it occurs as a result of a malfunctioning immune system. The immune system is meant to identify foreign invaders, such as bacteria and viruses, and attack them to keep the body healthy. In JIA, the immune system mistakenly attacks healthy tissue in and around the joints, causing ongoing inflammation and pain.

Symptoms#

The symptoms a child experiences depend on the type of arthritis they have. They can include:

• pain, swelling and stiffness in one or more joints
• skin over the affected joints that may feel warm or look red
• fever
• a rash
• feeling generally unwell
• eye inflammation (uveitis)
• mental and physical tiredness, or fatigue

Types of juvenile idiopathic arthritis#

There are several types of JIA, and the symptoms and effects of each are different.

Oligoarticular JIA affects only a few joints. (“Oligo” and “pauci” both mean “not many” or “few”, so it is also called pauciarticular JIA.) It usually starts between the ages of 2 and 4, is more common in girls, and most often affects larger joints such as the knees, ankles, wrists or elbows. There is a risk of an eye condition called uveitis, which is inflammation of the inner eye. There are two forms:

• persistent oligoarticular arthritis – no more than 4 joints are inflamed 6 months after diagnosis
• extended oligoarticular arthritis – 5 or more joints are inflamed more than 6 months after diagnosis

Polyarticular JIA affects 5 or more joints (“poly” means many). It usually starts between the ages of 1 and 12, is more common in girls, and affects both small and large joints. It may cause tiredness and a feeling of being generally unwell. There are two forms, based on whether rheumatoid factor (RF) is found in the blood: rheumatoid factor positive and rheumatoid factor negative.

Systemic JIA can affect many areas of the body, not just the joints. It is the least common type and affects boys and girls equally. It often causes fever, tiredness and a skin rash, and can involve other systems such as the skin or internal organs.

Enthesitis-related JIA involves inflammation of the entheses, the places where tendons attach to bone. It tends to target the large joints of the legs, the spine and the entheses, is more common in boys, and usually develops in late childhood or adolescence. It can be associated with a red, painful eye (acute uveitis).

Psoriatic JIA involves inflammatory arthritis of the joints together with the skin condition psoriasis. It usually affects the fingers, wrists and toes, but may affect other joints too. The psoriasis and the arthritis may not develop at the same time. It is more common in girls and develops in preschool children or at around 10 years of age. There may be a family history of psoriasis, and there may be pitting (small dents) in the fingernails or toenails.

Undifferentiated JIA is when the condition does not fit any of the other types.

Diagnosis#

JIA is diagnosed using a number of tests, which may include:

• a review of medical history
• a physical examination
• blood tests
• x-rays and scans
• an eye examination

Treatment#

There is no cure for JIA, but treatment can help manage the symptoms. Working closely with your healthcare team leads to the best outcomes. The team may include doctors, nurses, physiotherapists, occupational therapists, dietitians, podiatrists, psychologists and social workers.

Because there are different types of JIA with different effects, treatment needs to be tailored to each child, depending on the symptoms they are experiencing.

Medication#

Most children with JIA will need some form of medication at some time. There are many medications that work in different ways. Doctors usually start with the simplest medications at the smallest doses and increase to more complex medications or larger doses depending on how the child responds. Common types include:

• Pain-relievers (analgesics) – for temporary pain relief
• Creams and ointments – rubbed into the skin over a painful joint for temporary relief
• Eye drops – to treat eye inflammation
• Non-steroidal anti-inflammatory drugs (NSAIDs) – to control inflammation and relieve pain
• Corticosteroids – to quickly control or reduce inflammation, taken as tablets or given by injection into a joint, muscle or other soft tissue
• Disease-modifying anti-rheumatic medications (DMARDs) – work on controlling the immune system; they help relieve pain and inflammation and can reduce or prevent joint damage
• Biologics and biosimilar medicines (bDMARDs) – a type of disease-modifying drug that targets the specific cells and proteins causing inflammation and damage, rather than suppressing the whole immune system

Self-management#

There are many things you and your child can do to help manage the condition. Follow the plan your health professionals have developed. That means taking medications as prescribed, doing the exercises provided by the physiotherapist or occupational therapist, and letting your doctor know about any changes in your child’s symptoms or how they are feeling.

• Stay active. Physical activity is key to maintaining muscle strength and joint flexibility and to managing pain. A physiotherapist or exercise physiologist can design an individual program.
• Learn ways to manage pain. Strategies such as heat and cold treatments, distraction, massage and medication can all help.
• Eat well. There is no diet that cures JIA, but a healthy, well-balanced diet supports good health. Keeping to a healthy weight matters too, because extra weight adds strain to the joints, especially load-bearing joints such as the hips, knees and ankles.
• Protect joints. An occupational therapist can give advice about aids, equipment and gadgets that make tasks easier.
• Stay at school. This is good for your child’s health and wellbeing. Talk with your doctor, allied health professionals and teachers about ways to help your child keep up.

Key points#

• The exact cause of JIA is unknown, but it occurs because of a malfunctioning immune system that attacks healthy tissue around the joints.
• Symptoms depend on the type of arthritis and can include joint pain, swelling and stiffness, fever, rash, tiredness and eye inflammation.
• There are several types of JIA, and treatment needs to be tailored to each child.
• There is no cure, but medication, staying active, managing pain and eating well all help manage the condition.

Where to get help#