What is juvenile idiopathic arthritis?
Juvenile Idiopathic Arthritis (JIA), also known as juvenile Rheumatoid Arthritis, is the most common form of arthritis among children.
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Arthritis can be a chronic condition that is long-lasting and is characterised by:
- Stiffness
- Swelling
- Pain in the joints
A total of 300,000 children in America have some form of arthritis. Some children only have arthritis for a few months while others may have arthritis that lasts for years. Rare cases can make the condition last a lifetime.
It is not known what causes JIA. Researchers believe that JIA is primarily caused by an autoimmune disorder. The immune system mistakenly attacks innocent cells in people with autoimmune disorders as if they are dangerous invaders.
JIA is usually mild. However, severe cases can lead to joint damage or chronic pain. It is important to recognize the symptoms of JIA so that you can get treatment before the condition worsens.
The treatment usually includes:
- Inflammation reduction
- How to manage pain
- Increasing function
- preventing joint damage
- This will help your child live an active and productive life.
What are the signs and symptoms of juvenile idiopathic arthritis?
JIA is most commonly manifested by the following symptoms:
- joint pain
- Stiffness
- Reduced range of motion
- Warm and swelling joints
- Limping
- Redness in the affected region
- swollen lymph nodes
- Recurrent fevers
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JIA can affect one or more joints. The condition can cause rash, fever, swelling, and even paralysis. This subtype of JIA is known as systemic JIA (SJIA), which affects approximately 10% of JIA-afflicted children.
What are the different types of juvenile idiopathic arthritis?
There are six types:
Systemic JIA. This type of JIA can affect the whole body, including the skin and joints.
Oligoarticular JIA. This JIA affects fewer than five joints. About half of all arthritis patients are affected by this type.
Polyarticular JIA. This type of JIA can affect five or more joints. It is possible that the protein known as rheumatoid factors may be present.
Juvenile psoriatic arthritis. This form of JIA affects joints and is associated with psoriasis. It’s also known as juvenile psoriatic.
Enthesitis-related JIA. This JIA involves bone meeting tendons and ligaments.
Undifferentiated arthritis. This type of JIA can be caused by symptoms that span multiple subtypes, or may not fit into any other subtype.
The more severely the disease affects the joints, the greater the likelihood of it happening.
How can juvenile idiopathic arthritis be diagnosed?
C-reactive protein test. This test measures C-reactive proteins (CRP) levels in blood. CRP is a substance that the liver makes in response to inflammation. A second test to detect inflammation is the sedimentation rate, or erythrocytes sediment rate (ESR).
Test for rheumatoid factors. This test looks for the presence of rheumatoid factors, which is an antibody that the immune system produces. This antibody is often a sign of rheumatoid disease.
Antinuclear antibody. Antinuclear antibodies are an antibody to nucleic acids (DNA andRNA). They’re primarily found in the cell nucleus. People with an autoimmune disorder often create it. A blood test for antinuclear antibodies can determine if the protein is in the blood.
HLA-B27 test. This test detects a genetic marker associated with enthesitis related JIA.
MRI or X-ray scan. These imaging tests can also be used to rule other conditions such as fractures or infections that could be causing joint inflammation and pain. Imaging can also show specific signs and findings for subsets of inflammatory joint arthritis.
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How can juvenile idiopathic arthritis be treated?
JIA can be managed and reduced with a variety of treatments. Most healthcare providers recommend a combination treatment to reduce pain and swelling, as well as to preserve movement and strength.
Medical treatment
In conjunction with other treatments, nonsteroidal anti-inflammatory drug (NSAIDs) such as ibuprofen or aleve (Advil), are used often to reduce inflammation and swelling. Aspirin use in children is not recommended due to potential side effects.
Sometimes, stronger medications are prescribed such as biologics and disease-modifying antirheumatic drug (DMARDs).
DMARDs are used to alter the course of the disease. In this instance, they suppress the immune system to stop it attacking the joints.
Using DMARDs instead of NSAIDs is recommended. Before using biologics, your child’s healthcare provider might recommend that DMARDs be used with or without NSAIDs.
Here are some examples of DMARDs used to treat JIA:
- methotrexate
- sulfasalazine
- leflunomide
Methotrexate is recommended as a DMARD over any other drugs.
Biologics target specific proteins or molecules that are involved with the disease process. Biologics can be used in combination with DMARD therapy.
Here are some examples of biologics that could be used to reduce inflammation and joint damage:
- abatacept (Orencia)
- rituximab (Rituxan)
- tocilizumab (Actemra)
TNF inhibitors (Humira).
In severe cases, steroid medication can be injected into the affected joints. This is not recommended if there are many joints involved. Surgery may be necessary to remove the entire joint in severe cases.
Lifestyle remedies
Children with JIA should exercise and eat a healthy diet. These lifestyle changes can help your child cope better with their symptoms and decrease the chance of complications.
Healthy eating
Children with JIA experience weight changes. Children with JIA may experience rapid weight gain or loss due to medication. A healthy diet with the right amount of calories can help your child maintain a healthy weight.
Talk to your healthcare provider about a food plan if your child is losing or gaining weight due to JIA.
Exercising regularly
Exercise at least three times per semaine can help strengthen muscles and increase joint flexibility. This will make it easier to manage JIA over the long-term. Swimming and walking are good options. It’s best to consult your child’s healthcare provider before you start any exercise program.
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Physical therapy
Your child’s physical therapist will be able to teach them the importance of following a workout program and can recommend exercises that are appropriate for their condition. The therapist might suggest exercises that will help strengthen and restore flexibility to stiff or sore joints.
They will collaborate with your primary care provider to prevent joint damage or abnormal bone/joint growth.
