Overview

Juvenile Idiopathic Arthritis (JIA) affects children under 16 years in one or more joints for a period greater than six weeks.

Juvenile Idiopathic Arthritis (JIA)

Arthritis is inflammation of the joints, causing them to be swollen, painful and stiff. Juvenile idiopathic arthritis (JIA) affects children under 16 years in one or more joints for a period greater than six weeks.  It is a chronic condition that can persist for years.  JIA is classified depending on the number of joints involved, and some other features.

 

Types of Arthritis

This is the most common type of JIA and affects four or fewer joints. Symptoms are swollen, painful joints, particularly the knees and/or ankles. Eye inflammation is common and specialist eye checks are needed. Many children with oligoarthritis improve after some time, but if a few joints remain swollen, the disease is termed persistent oligoarthritis. If the disease worsens, and more joints become involved, it is called extended oligoarthritis. It tends to affect girls more commonly than boys.            

This is when 5 or more joints are affected in the first 6 months of the illness.  As well as pain and stiffness in joints other symptoms include tiredness and eye inflammation.

This is a rare type of arthritis in which joint pain is accompanied by general illness. It begins with symptoms such as fever, rashes, lethargy (tiredness) and swelling of the lymph glands in the neck, underarm and groin. Early signs are often mistaken for an infection. Rarely, the lining of the heart (pericarditis) or lungs (pleuritis) may become inflamed.

This occurs due to inflammation of tendons or ligaments where they attach to bone. The condition may also cause painful areas in the soles of the feet or other areas around the knees or hips. Stiffness and pain in the spine are uncommon in childhood, but can persist into adulthood (known as ankylosing spondylitis in adults-see entry).

Psoriatic arthritis describes a small group of children with JIA whose arthritis may occur in conjunction with psoriasis, which is a red, silvery, scaling rash most commonly occurring on the elbows and knees.

Causes

An alteration of the immune system causes it to target the lining of the joint, known as the synovium, resulting in inflammation. When the inflammation persists, joint damage may occur. It is not known what makes the immune system act in this way.

 

Treatment

Each child will have an individual care plan devised for them. In cases where other organs or systems are involved, such as the eyes, the appropriate specialist will need to be involved (eg ophthalmologist to assess eye inflammation).                                                                                             

 

Drug Treatment

  • Non-steroidal anti-inflammatory drugs (NSAIDs) - eg ibuprofen(Nurofen) or diclofenac (Voltarol). These can reduce fever, pain and inflammation.
  • Steroid injections - these can be given into joints and work by 'dampening' down the immune system and reducing the inflammation within the joint. Steroids can also be taken by mouth or injected into a muscle or vein.
  • Disease-modifying anti-rheumatic drugs (DMARDs) - such as methotrexate. This type of medication can be taken as a pill or as an injection and works by suppressing the disease process.
  • Biologic agents − a biologic agent copies the effects of substances naturally made by your body's immune system. They work by interfering with biologic substances that cause or worsen inflammation, thus reducing symptoms of JIA.

Non-Drug Treatment

Physiotherapy to improve mobility in painful joints as well as regular exercise will be an essential part of treatment for a child with arthritis. Occupational therapy may be needed to make sure the living environment and necessary aids and adaptations are in place for a child with reduced mobility, or for specialist hand therapy.

Inheritance Patterns

It is very rare to have more than one child with arthritis in a family, but there are some genetic factors passed on through the generations that may make it more likely that a child will develop arthritis.

 

Joint Protection

The Scottish Paediatric Rheumatology Clinical Network Group in February 2002 created an information sheet on joint protection which gives suggestions at reducing stress, inflammation and pain.

For more information