Juvenile Idiopathic Arthritis

Condition Basics

What is juvenile idiopathic arthritis (JIA)?

Juvenile idiopathic arthritis (JIA) is a disease that happens to children. It causes inflamed, swollen joints. This makes joints stiff and painful. Your child may have some pain and may walk with a limp. Some children with JIA grow out of it after they get treatment. Others will need ongoing treatment as adults.

There are several types of JIA. Oligoarticular affects a few joints and is usually mild. Polyarticular affects more joints and is usually more severe. Systemic can be the most serious. This type can also affect organs. Enthesitis-related most often affects the areas where tendons and ligaments attach to bones (the enthesis).

What causes it?

The cause of JIA isn't well understood. Most experts believe it's caused by a combination of things, such as an immune system that's too active and attacks joint tissues. Viruses or other infections and certain genes that make the immune system more likely to attack joint tissues can also cause JIA.

What are the symptoms?

Children can have one or many symptoms, and although the symptoms come and go, they are long-lasting. They include joint pain, swelling, and stiffness. A child may also have trouble sleeping and problems walking. Systemic JIA can cause fever spikes and a rash.

How is it diagnosed?

JIA is often diagnosed after other possible causes have been ruled out and pain and stiffness have lasted for at least 6 weeks. Your doctor will ask questions about your child's symptoms and past health and do a physical exam. Your child may also have blood tests and a urine test.

How is JIA treated?

JIA is treated with disease-modifying antirheumatic drugs (DMARDS) and other types of medicine to prevent joint damage. NSAIDs can help reduce pain and inflammation. Other treatments, such as exercise and physiotherapy, can help keep your child's muscles flexible and strong. Work closely with your medical team to plan the best treatment.

Symptoms

Children can have one or many symptoms, and although the symptoms come and go, they are long lasting.

Symptoms include:

• Joint pain.
• Joint swelling.
• Joint stiffness.
• Trouble sleeping.
• Problems walking.

In some cases, these symptoms can be mild and hard for you to see. A young child may be more cranky than normal. Or a child may go back to crawling after he or she has started walking. Your child's joints may feel stiff in the morning. Or your child may have trouble walking.

Children with this disease can also get inflammatory eye disease. This can lead to permanent vision problems or blindness if it's not treated. Eye disease often has no symptoms before vision loss occurs.

Systemic JIA can cause fever spikes and a rash.

What Happens

The course of juvenile idiopathic arthritis (JIA) is unpredictable, especially during the first few years after a child is diagnosed. JIA can be mild, causing few problems. It can get worse or disappear without clear reason. Over time, the pattern of symptoms becomes more predictable. Most children have good and bad days.

Some children who have JIA will have long-term problems. These problems range from occasional stiffness and limits on physical activity to the need for surgery such as joint replacement. But for most adults who had JIA as children, any long-term problems tend to be mild and don't affect their overall quality of life.

A child's long-term outlook depends on the type of JIA and any complications he or she has. Treatment also affects the child's long-term outlook. Starting treatment early may help lower the chance of long-term problems.

When to Call a Doctor

Call your doctor now if:

• Your child has sudden, unexplained swelling, redness, and pain in any joint or joints.
• A baby or child is unusually cranky or reluctant to crawl or walk.
• Red eyes, eye pain, and blurring or loss of vision occur in a child who has been diagnosed with any form of juvenile arthritis.

Call your doctor if any of the following symptoms continue for more than 2 days:

• A child has unexplained daily fever spikes of 39.5°C (103°F) or higher that return to normal each day with or without a pink skin rash.
• A baby or child is reluctant to crawl or walk in the early morning but improves after 1 to 2 hours.
• A child taking aspirin or another non-steroidal anti-inflammatory drug (NSAID) develops stomach pain not clearly related to upset stomach, but possibly related to medicine use. (Symptoms may include heartburn, nausea, or refusal to eat.)
• Joint pain and skin rash develop following a sore throat.

It can be hard to know when an infant has joint pain. A young child may be unusually cranky or may revert to crawling after learning to walk. You may notice gait problems with a walking child or stiffness in the morning.

Examinations and Tests

To diagnose JIA, your doctor will ask questions about your child's symptoms and past health and will do a physical exam. This includes understanding the pattern and nature of joint symptoms.

Lab tests may be used to support the diagnosis and make sure symptoms aren't caused by another health problem. If your child has the disease, these tests can also help your doctor find out which type it is.

JIA is often diagnosed only after other possible causes of symptoms have been ruled out and the pain and stiffness have lasted for at least 6 weeks.

Routine exams and tests include:

• Complete blood count (CBC).
• Erythrocyte sedimentation rate (ESR, or sed rate).
• Urinalysis.
• Rapid strep test or throat culture (to test for strep throat).

Tests that are done if needed include:

• Rheumatoid factor (RF).
• Antinuclear antibody (ANA).
• X-ray of joints.
• An MRI scan, which may reveal early joint damage.
• HLA-B27 genetic test.

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Treatment Overview

Your child's treatment will be based on the type of JIA he or she has, and how serious it is.

• Disease-modifying antirheumatic drugs (DMARDS) may be used to prevent the arthritis from getting worse and injuring bones and joints.
• Non-steroidal anti-inflammatory drugs (NSAIDs) to help reduce pain and inflammation.
• Exercise and physiotherapy help keep your child's muscles flexible and strong.
• Occupational therapy helps your child live as independently as possible.

Even when JIA isn't severe, your child may still need long-term treatment. To make sure that treatment is right for your child, work closely with the medical team. Learn as much as you can about your child's disease and treatments. Stay on a schedule with your child's medicines and exercise.

Some children with JIA have no appetite, so malnutrition becomes a medical concern. If your child has little appetite for food, see a registered dietitian for help.

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Self-Care

You can do a lot at home to help your child relieve his or her symptoms and prevent JIA from causing problems.

• Do range-of-motion exercises.

  These help maintain your child's joint range and muscle strength. They also prevent contractures. You may need to help an infant or younger child do the exercises.

• Find a balance between rest and activity.

  Your child may need extra naps or quiet time to rest the joints and regain strength. But too much rest may lead to weakness in unused muscles.

• Follow a medicine schedule.
  • An older child may find it easier to remember to take medicine by using a pillbox or chart for a day's or week's worth of medicine.
  • Ask your doctor if the dose can be adjusted so your child can take it at times that are most convenient and won't make him or her feel "different" from others.
  • To avoid stomach upset, you can also give non-steroidal anti-inflammatory drugs (NSAIDs) with meals or a small snack.
• Use assistive devices.

  These can help your child hold on to, open, close, move, or do things more easily. Devices include Velcro fasteners and enlarged handles. Getting your child lightweight clothing and toys will also help.

• Make sure that your child sees the doctor regularly.

  Your child should also have eye exams with an ophthalmologist. Inflammatory eye disease can develop as a complication in children with JIA.

• Help manage your child's stiffness.
  • Apply heat to stiff and painful joints for 20 minutes, and repeat as needed. You can use hot water bottles. Or make hot packs from towels dipped in warm water or wet towels microwaved for 15 to 30 seconds. Always make sure that hot water bottles and hot packs aren't too hot for your child's skin. Keep a cloth between the hot water bottle and your child's skin. Don't use heat if your child's joints are red and warm.
  • Many children who have JIA have less stiffness in the morning if their joints are kept warm during the night. To help keep joints warm, try footed pyjamas, thermal underwear, a sleeping bag, a heated water bed, or an electric blanket.
  • Encourage your child to take a warm bath or shower first thing in the morning. It can help ease stiffness. Have your child stretch gently afterward.
  • Give morning medicines as early as you can, with a snack or breakfast, to prevent upsetting an empty stomach.

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