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Juvenile Arthritis

A child with arthritis pain holding her hand.

Many people think that arthritis only affects adults, but children and teenagers can develop it as well. While arthritis in adults is frequently caused by “wear and tear” (meaning osteoarthritis), in children, arthritis is nearly always due to an inflammatory disorder. Some cases of arthritis in children are mild and self-resolve, while others are more severe and may persist into adulthood to cause long-term disability if not treated.

If you suspect your child has arthritis, it is important to bring them for an evaluation by a pediatric rheumatologist as soon as possible.

What is juvenile arthritis?

This is a blanket term that refers to various forms of arthritic conditions that affect children. The term “juvenile arthritis” generally includes all the subtypes of juvenile idiopathic arthritis (JIA) – including oligoarticular JIA, polyarticular JIA, enthesitis-related arthritis, psoriatic arthritis and systemic onset JIA (sJIA) – as well as reactive arthritis, arthritis associated with infectious diseases such as strep or Lyme, and arthritis associated with inflammatory bowel disease.

Can children or teenagers get osteoarthritis?

Osteoarthritis (OA) in children and teens is rare. When early onset osteoarthritis does affect a child, it is usually a symptom of an underlying condition or prior trauma that affects limb alignment, surrounding soft tissue structures, and/ or the joint surface. Osteoarthritis in a teenager is more common than in a younger child, due to longer wear and tear of the joints, but still occurs very infrequently.

Conditions that may lead to early onset OA in children may be genetic, congenital, or injury-related, and include:

Malalignment – in which the bones of certain joints do not meet at the correct angle – or other deformities, which can cause asymmetrical wear and tear on joint structures. These include bowlegs, knock knees, discoid meniscus, severe femoral anteversion or retroversion, hip dysplasia, osteochondrosis, and skeletal dysplasias, often associated with short stature (dwarfism).

Conditions that weaken or cause excessive stress on bones or other musculoskeletal tissues, such as juvenile osteoporosis, metabolic disorders, renal osteodystrophy, radiation, hypermobility syndrome, or osteogenesis imperfecta.

Prior traumatic injuries such as fractures, meniscal tears, ACL ruptures or osteochondritis dissecans that alter the mechanics of a joint, most commonly in the knee.

What is juvenile rheumatoid arthritis?

Childhood inflammatory arthritis used to be known as juvenile rheumatoid arthritis, but physicians now use the term “juvenile idiopathic arthritis,” or JIA. JIA has multiple different subtypes, which behave differently and have different prognoses. Children and teens with all types of JIA have inflammation in their joints, as manifested by swelling, warmth, pain, and limited range of motion.

What are the different types of juvenile arthritis?

There are five subtypes of juvenile idiopathic arthritis (JIA): oligoarticular, polyarticular, enthesitis related, psoriatic, and systemic-onset JIA. Other types of inflammatory arthritis which may occur in children (but are not considered JIA) include Lyme arthritis, arthritis related to strep infection, reactive arthritis, and arthritis associated with inflammatory bowel disease.

What are the symptoms of juvenile arthritis?

Symptoms of childhood arthritis vary, depending on the specific condition. Common characteristics include joint swelling, pain and stiffness. Some children have many joints affected, while others may have only one or two. Some types of juvenile arthritis affect the joints of the spine and pelvis, and children may complain of neck or back pain rather than pain in their limbs. Children with systemic onset JIA typically have other symptoms, including fevers and rashes.

Is juvenile arthritis hereditary?

Most forms of juvenile arthritis are autoimmune diseases, which means the immune system, designed to protect the body, mistakenly attacks healthy joint tissue. This can lead to joint pain, swelling, and stiffness. While autoimmune disease in general (and inflammatory arthritis specifically) may run in certain families, there is no single gene mutation that means that a child will or will not develop the disease. Certain genetic traits, such as the presence of the HLA-B27 gene, may make someone at higher risk for inflammatory arthritis (in particular, for spondyloarthropathies).

Does juvenile arthritis go away?

Some types of juvenile arthritis may resolve in childhood, while others persist into adulthood. Occasionally, a child may go into remission and no longer have joint symptoms, but then have a disease flare years later.

What is the therapy for juvenile arthritis?

Different types of juvenile arthritis are treated in different ways. Some children can be treated with nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen) and/or localized joint injections. Other children will require more advanced immunosuppressive therapy, with medications such as disease-modifying antirheumatic drugs (DMARDs) or biologics.

What is the prognosis for juvenile arthritis?

The prognosis for juvenile arthritis is variable, as there are many different diseases which fall into this category. The goal of treating all forms of juvenile arthritis is to ensure that the child can live as normal a life as possible and does not develop long-term disability. While some children will require only minimal treatment, others may require long-term therapy with multiple medications. Many children with juvenile arthritis who receive appropriate treatment live active, happy lives that are not limited in any way by their disease.

What is the life expectancy for a child with juvenile arthritis?

Children with most forms of juvenile arthritis have normal life expectancies. Children with systemic onset JIA are at greater risk of developing life threatening complications; however, most children with this disease do very well with available treatments.

Does juvenile arthritis become rheumatoid arthritis in adulthood?

Specifically, some cases of polyarticular-type JIA are considered to be early-onset rheumatoid arthritis and may evolve into this condition as a child ages. Other types of juvenile arthritis are not considered to be precursors to adult rheumatoid arthritis. However, children may grow into having other adult arthritic diseases, such as psoriatic arthritis or ankylosing spondylitis.

When should a teenager transition from a pediatric rheumatologist to one who treats adults?

Many pediatric rheumatologists will see new patients up to the age of 18. For a new patient consult for someone 18 or older, an adult rheumatologist may be more appropriate. Often, pediatric rheumatologists will see an established patient until they graduate from college or until age 22, but this may vary depending on the doctor.

Juvenile Arthritis Patient Stories

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Reviewed and edited by Sarah Faith Taber, MD and Shevaun Mackie Doyle, MD

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