Juvenile idiopathic arthritis (JIA), previously referred to as juvenile rheumatoid arthritis (JRA), is a term that includes many different types of chronic arthritis in children. Arthritis is defined as inflammation (swelling, limited range of motion or tenderness) in a joint. The clinical diagnosis of JIA is made when a child under the age of 16 presents with arthritis in at least one joint for 6 weeks’ duration without any clear identifiable cause such as infection or injury. People are often surprised that children can have arthritis. In fact, JIA is the most common rheumatic disease in children and the cause of a significant amount of short term and long term disability. About 1 to 20 per 100,000 children have JIA. This condition affects children of all ages, from toddlers to teenagers.
JIA is classified based on the number of joints involved or the location of the arthritis and some subtypes include oligoarticular JIA, polyarticular JIA, psoriatic arthritis and spondyloarthropathy. Systemic JIA is a different subset of JIA which presents with fever, rash and arthritis.
What are the symptoms of JIA?
Children who have JIA may experience symptoms such as joint pain, swelling, stiffness, limping and fatigue. Joint pain is one of the most common complaints in childhood, so it is important to have the pediatrician evaluate these symptoms for all possible causes, including infection, trauma or Lyme disease. If the parents or pediatrician suspect JIA, it is appropriate to refer to a pediatric rheumatologist for further evaluation.
It is important to know that children with JIA have an increased risk of inflammation in the eyes, which is known as uveitis. Once a child is diagnosed with JIA, they will be referred for regular monitoring with a pediatric ophthalmologist.
What is the cause of JIA?
The cause of JIA is not clear at this time but it seems to involve an interplay between genetics and the environment. There are multiple genes involved which are related to immunity and inflammation. JIA is more common in families who have autoimmune conditions such as inflammatory bowel disease, celiac disease, psoriasis and thyroid disorders.
How is JIA diagnosed?
When a child comes to see us in the Division of Pediatric Rheumatology at Hospital for Special Surgery, we will perform a detailed history and physical exam, and further work-up often includes blood work and imaging.
Is there a treatment for JIA?
Children have growing skeletons and are therefore particularly vulnerable to the consequences of uncontrolled inflammation in their joints. Fortunately, there are many excellent treatment options available for children who have JIA. Treating JIA early and appropriately allows patients to experience relief from their pain and stiffness in the short term and also prevents long term damage such as leg length discrepancy and bony erosions. The medications used would depend on the subtype of JIA and each child’s individual symptoms, physical exam findings and lab work. Families work closely with their pediatric rheumatologist to find the best treatment option for them.
Another important aspect of treatment also includes physical therapy and/or occupational therapy to help children with JIA regain full range of motion and joint mobility. We also pay close attention to promoting proper growth and development. Social and emotional support from family members, friends and teachers are also crucial.
Our team strives to educate patients and their families on how to manage the disease on a daily basis. We work together to minimize side effects of therapy.
With currently available medications and our multidisciplinary approach, our patients are able to achieve improvement, and often remission, of their symptoms and pursue the activities that they love.
Is it important to follow up with a rheumatologist?
JIA is a chronic condition and careful monitoring by a pediatric rheumatologist is recommended into adulthood. It was previously thought that children may “outgrow” arthritis. It is now recognized that most children have joint disease that persists. Prompt recognition and treatment of joint inflammation or limitation can help prevent pain and long-term damage.
Children with JIA also need continued ophthalmology monitoring for uveitis. The frequency of eye exams will depend on your child’s age and whether the ANA antibody is present.
Depending on your child’s symptoms, additional follow-up may be needed by other medical specialties.
The long-term prognosis for children with JIA has improved dramatically since the introduction of newer medications. Early recognition of disease, regular follow up and appropriate therapy will help to optimize functional outcomes.
Reviewed on July 9, 2020
Dr. Nancy Pan is a Pediatric Rheumatologist at Hospital for Special Surgery and specializes in the care and treatment of children with rheumatic diseases including juvenile idiopathic arthritis, juvenile dermatomyositis, childhood systemic lupus and vasculitides of childhood.