Juvenile Idiopathic Arthritis

Juvenile Idiopathic Arthritis (JIA) is a chronic inflammatory disease usually found in children under 16 years old. It is one of the most common diseases in children, affecting up to 3 in 1000, and is the most common type of arthritis in kids and teens. Autoimmune diseases like JIA occur when the body’s immune system begins to release inflammatory chemicals that attack the healthy tissue surrounding the joint. As a result, the individual experiences discomfort around the joints and other symptoms that could affect everyday activities such as walking.

The most prominent symptom of JIA is persistent swelling and joint pain in the hands, knees, ankles, wrists, elbows, and other body parts such as the eyes. The joints can also turn red and feel warm to the touch, and patients may even lose their mobility depending on the severity of the arthritis. Due to the physical pain, those affected may have difficulty keeping up with normal activities like sports or schoolwork. Another common symptom is feeling fatigued and constantly drained of energy. It is also important to note that JIA symptoms can come and go depending on factors such as the time of day or weather, and while some children may experience symptoms for only a few months, others have symptoms for the rest of their lives. Certain symptoms are also specific to the type of arthritis a child has.

There are seven subtypes of JIA: oligoarthritis, polyarthritis, systemic onset arthritis, psoriatic arthritis, polyarticular arthritis, spondyloarthritis, and undifferentiated arthritis. The most common forms found in children are oligoarthritis, which affects four or fewer joints, and polyarthritis, which affects five or more joints. Proper diagnosis of the child is important because if the arthritis persists long enough, the joints can become damaged.

The first step in diagnosing JIA is to check the patient’s medical history and perform a full examination on the patient. Once a tentative diagnosis of JIA is suspected, the child is referred to a pediatric rheumatologist, who confirms the diagnosis and designs a treatment plan. Because symptoms of JIA can be similar to that of cancer, infections, and other inflammatory illnesses, doctors must be careful in excluding these possibilities before diagnosing the patient with JIA. Unlike these other conditions, no blood test can confirm a diagnosis of JIA, which is why “a child must have inflammation in one or more joints lasting at least six weeks, be under 16 years old and have all other conditions ruled out before being diagnosed with JIA,” according to the American College of Rheumatology.

As of now, there is no known cure for JIA, but treatments exist to slow down inflammation, control pain, and help kids live a normal life. Exercise is one form of non-drug therapy that is a critical component of a well-rounded treatment plan. Patients are typically referred to a physiotherapist and occupational therapist, who work on regaining range of motion in stiff joints. They may also work with the child on techniques for relieving pain, and will form an exercise plan once the disease is controlled. Exercise can help keep joints strong and flexible, so JIA patients are encouraged to engage in usual activities such as PE and sports. However, JIA can also be treated with medicine to reduce inflammation and pain. There are two lines of treatment: “first line” drug treatments are non-steroidal anti-inflammatory drugs (NSAIDs) and “second line” treatments consist of disease-modifying anti-rheumatic drugs (DMARDs). In some cases, DMARDs alone will not be enough to control the disease, so a medication called biologics is commonly used with DMARDs. Biologics are the newest and most powerful medication to treat inflammatory arthritis and may work more quickly than standard DMARDs.

Although researchers still have yet to figure out why JIA develops in kids, the outcome for children with JIA has improved over the years. With early aggressive treatment, remission is possible and the child’s quality of life can be drastically improved. Currently, newer biologic medication is being studied in children with JIA.

Sources:
https://www.arthritis.org/diseases/juvenile-idiopathic-arthritis

https://jointhealth.org/aboutarthritis-diseasespotlight.cfm?id=5&locale=en-CA

https://www.healthline.com/health/juvenile-idiopathic-arthritis-symptoms

Article by Kayla Lee

Image from brennerchildrens.org