What to know about juvenile idiopathic arthritis

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According to the Centers for Disease Control and Prevention (CDC), JIA is the most common type of arthritis in children. It is a chronic disease that affects joint tissues and may last from several months to a person’s lifetime.

Rheumatoid arthritis is an autoimmune disease. It occurs when the body’s immune system attacks the tissue lining the joints and the fluid inside them. This causes the tissue to become thicker and produce excess fluid, resulting in pain, inflammation, and stiff joints.

JIA can spread to the surrounding tissues, which may damage the bones and cartilage. Parts of the body that may become inflamed include the eyes, especially in the case of uveitis. Without prompt treatment, JIA can also cause disabilities in childhood.

There are various symptoms of JIA, depending on the type.

The most common include:

• pain or stiffness in joints
• swollen or red joints
• tiredness
• blurry eyes
• rash
• loss of appetite
• fever

There are seven subtypes of JIA, which researchers have separated according to their symptoms and the particular joints they affect. According to health experts, the core types include:

• Polyarticular JIA: This type damages five or more joints within the first 6 months. Rheumatoid factor (RF) blood tests show the type, whether the results indicate RF-positive or RF-negative. Experts sometimes call the two types seropositive polyarticular JIA and seronegative polyarticular JIA.
• Oligoarticular JIA: Researchers state that oligoarticular JIA affects one to four joints within 6 months. This type of JIA falls under the category of “persistent” if it does not affect more joints. If it does, then it falls under the category of “extended.”
• Systemic onset JIA: This is the least common type. Normally, it affects one or more joints and comes with extreme fever and skin rash. It may also affect the internal organs, causing swelling of the spleen, lymph nodes, heart, liver. About 1 in 10 children with JIA experience this type.
• Enthesitis-related JIA: Aside from arthritis, a child may also have enthesitis, a swelling of the tissue where the bone meets a tendon or ligament. It usually affects the knees, feet, and hips.
• Psoriatic arthritis: As its name suggests, this is a combination of arthritis and psoriasis, a skin disorder. Research shows that psoriatic arthritis affects 24 in 10,000 people. The diagnostic criteria for this condition are that a child has arthritis along with a psoriatic rash or two of the following:
  • dactylitis, swelling in the fingers or toes
  • having a first-degree relative with psoriasis
  • onycholysis, or pits in the fingernails
• Undifferentiated arthritis: Doctors use this classification for children with JIA who do not fit into any of the above types or meet the criteria for more than one JIA type.

Diagnosing JIA can be difficult, as there is no specific test for the condition.

A doctor will check a child’s complete medical history and perform a medical examination. They will also check the child’s joints for any sign of arthritis.

Other tests that healthcare professionals use to help diagnose JIA may include:

• imaging techniques, such as X-rays, ultrasound, or MRIs, to check joint health
• blood or urine tests to determine the type of arthritis
• tests to show the level of inflammation, which can help rule out other conditions
• eye exams in certain cases

JIA treatments aim to reduce pain and inflammation while increasing strength and preventing further joint damage. Treatment options include medications, exercise, and occupational therapy.

Medications

Medications for treating JIA include:

• Disease-modifying anti-rheumatic drugs (DMARDs): DMARDs change the way that arthritis functions in the body by suppressing attacks on the joints. Methotrexate is a common DMARD that treats JIA. Other types include sulfasalazine and leflunomide.
• Corticosteroids: Doctors can administer corticosteroids in different forms such as injections, topical ointments, or pills. However, oral corticosteroids may cause adverse effects, such as weakened bones, especially after prolonged use. This is why doctors usually try to limit their long-term use because it can alter a child’s development.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Although these medicines primarily provide pain relief, NSAIDs do not stop the JIA from progressing. Some require a prescription, while others are available over the counter. NSAIDs are also available in topical form — common examples include ibuprofen and naproxen. Some people may experience nausea and stomach upset from NSAIDs, so they should eat before taking them.
• Biological modifying agents, or biologic DMARDs: These directly target proteins in the immune system that cause inflammation. Doctors may administer biological modifying agents as a subcutaneous injection or intravenously to treat severe arthritis in children. People should be careful when taking biological agents, as they may weaken the immune system and promote the rate of infections. Some examples ofbiologic DMARDs include:
  • infliximab
  • adalimumab
  • etanercept
  • abatacept
  • anakinra
  • rilonacept
  • tocilizumab

Exercise and occupational therapy

Exercise and physical and occupational therapy can reduce pain, improve movement and muscle tone, and help children with JIA to be as mobile and independent as possible.

An occupational therapist can help a child with JIA by:

• suggesting exercises to strengthen or stretch specific muscles
• teaching relaxation techniques to help a child sleep and increase their energy levels
• suggesting different ways of performing everyday activities such as using an adapted writing grip to reduce strain on the thumb when writing
• fitting or making splints to help stabilize joints or stretch out tissues that have tightened or softened
• advising the child on pain management

According to research, without treatment, JIA can lead to:

• irreversible joint damage
• the slow growth of a child’s bones
• long lasting arthritis and disability
• difficulty seeing, which has links to uveitis, a form of eye inflammation

Different children can present different symptoms of JIA.

While some JIA types may affect one or two joints in some, making it easier to manage, other subtypes affect multiple joints, resulting in long lasting symptoms and greater difficulty in treating or managing the condition.

Children with JIA can control their condition with an early diagnosis and a treatment plan that may involve physical therapy, which helps prevent joint damage and promotes function.

JIA refers to a group of conditions that affect a child’s joints.

Depending on which type of JIA a child has, the condition can last any amount of time. In some cases, it may last a lifetime.

Treatments for JIA include different types of medication, such as DMARDs, corticosteroids, and NSAIDs. Strengthening exercises and occupational therapy could also help.