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How Common Is Juvenile Arthritis

Juvenile Arthritis Statistics: Nearly 300000 Children Affected

Juvenile Idiopathic Arthritis (JIA): Pathology & Clinical Presentation â Pediatrics | Lecturio

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Juvenile Arthritis is one of the most common yet least talked about chronic childhood disorders. Let us discuss some juvenile arthritis statistics to open your eyes to this silent pandemic in our children.

When we hear the word Arthritis, many of us usually think it is a joint-pain-related disease in older adults. But did you know that Arthritis can affect children below 16 years?

Arthritis in children is known as juvenile Arthritis. The most common form of childhood arthritis is Juvenile idiopathic Arthritis, which affects 294,000 children in the United States!

Juvenile Arthritis involves chronic joint inflammation in one or many joints in childrens bodies and may last for more than six weeks. Additionally, children can have symptoms like fever, rash, swelling, loss of appetite, fatigue, and difficulty doing daily activities like walking, playing, and dressing.

The exact cause of this disease is not known till now. But it is estimated that the disease impacts those children below 16 years of age whose immune system has not adequately developed.

This disease causes severe inflammation in their joints. It is diagnosed through X-rays and lab tests, but unfortunately, there is no cure for juvenile Arthritis. Any damage to the joint remains permanent and will impact the child for the rest of their life.

Contents

Juvenile Idiopathic Arthritis By Gender

  • Girls are more affected by Juvenile Idiopathic Arthritis compared to boys.5
  • Girls with oligoarticular juvenile Arthritis outnumber boys in the ratio of 3:1.3
  • The ratio of girls to boys with uveitis is in the ratio of 5-6.6:1.3
  • The ratio of girls to boys with polyarticular juvenile Arthritis is in the ratio 2.8:1.3
  • The systematic onset occurs in equal frequency in both boys and girls.3
  • Boys are affected more compared to girls with enthesitis-related Arthritis. 3

How Is Juvenile Arthritis Treated

Children with juvenile arthritis are usually treated by a multidisciplinary team of health professionals. This may include doctors , nurses, physiotherapists, occupational therapists, podiatrists and social workers.

Treatment can include:

  • painkillers and anti-inflammatories to help control pain and swelling
  • other medicines, such as steroids or disease-modifying anti-rheumatic drugs
  • exercises to help with joint mobility, muscle strength, and pain
  • splints to help with the support or use of a joint

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Juvenile Idiopathic Arthritis By Economic Burden

  • Between 2000 and 2009, the parents whose children had Juvenile Arthritis lost $4589.37 per year because of missed work. In contrast, the parents whose children did not have juvenile Arthritis lost only $2986.08 because of missed work on average.5
  • Parents with juvenile idiopathic Arthritis were 2.78 times more likely to report work time loss than parents whose children did not have juvenile idiopathic Arthritis.5
  • According to a 2015 study in Europe, there is a remarkable increase in health care costs of Juvenile arthritis patients due to extended hospital stay, wide use of biologics, and nonprofessional caregiver costs.5

What Causes Juvenile Idiopathic Arthritis

Juvenile Arthritis

Like adult rheumatoid arthritis, JIA is an autoimmune disease. This means the body’s immune system attacks its own healthy cells and tissues. JIA is caused by several things. These include genes and the environment. This means the disease can run in families, but can also be triggered by exposure to certain things. JIA is linked to part of a gene called HLA antigen DR4. A person with this antigen may be more likely to have the disease.

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What Are The Complications Of Juvenile Idiopathic Arthritis

Nearly half of all children with JIA recover fully. Others may have symptoms for years. Some will have rashes and fever. Others may have arthritis that gets worse. Problems may include slow growth and thinning bones . In rare cases, there may be problems with the kidneys, heart, or endocrine system.

Symptoms Of Juvenile Idiopathic Arthritis

Symptoms of JIA vary depending on the type, but all forms share persistent joint pain, swelling, warmth, and stiffness that are typically worse in the morning and after a nap or prolonged sitting. The pain may limit movement of the affected joint, although many children, especially younger ones, will not complain of pain. One of the earliest signs may be limping in the morning due to disease in one or both legs.

The symptoms of JIA may go through cycles, flaring for a few weeks or months followed by periods when they go into remission. Some children have just one or two flares and never have symptoms again, while others have many flares or symptoms that never fully go away.

Besides joint problems, the inflammation associated with JIA can cause other symptoms, such as:

If left untreated, uveitis can lead to eye problems such as cataracts, glaucoma, and vision loss, so it is important for children with JIA to have frequent eye exams.

  • Skin changes. Depending on the type of JIA a child has, he or she may develop skin changes. Children with:
  • Systemic JIA who have fevers can get a light red or pink rash that comes and goes.
  • Psoriatic JIA can develop scaly red patches of skin. Psoriatic JIA can also cause pitted nails and dactylitis .
  • Polyarticular JIA with rheumatoid factor can get small bumps or nodules on parts of the body that receive pressure, such as from sitting.

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Myth: Arthritis Is Just For Older People

Fact: JIA is diagnosed in kids its even got juvenile in its name. But most children dont outgrow it, says Yukiko Kimura, MD, chief of the division of pediatric rheumatology at the Joseph M. Sanzari Childrens Hospital in Hackensack, New Jersey, and a professor of pediatrics at Hackensack Meridian School of Medicine in Nutley, New Jersey. According to the American Academy of Orthopaedic Surgeons, for a long time it was believed that many children would eventually outgrow juvenile arthritis. It is now known that the majority of the children diagnosed with juvenile arthritis will continue to have active arthritis 10 years after diagnosis, unless they receive aggressive treatment.

JIA is diagnosed in children up to age 16, and it affects about 1 in 1,000 children, according to the Cleveland Clinic. It may go into remission, according to the Arthritis Foundation, or last a lifetime, depending on different factors.

Systematic Juvenile Idiopathic Arthritis

Know about Juvenile Arthritis – Symptoms & Types | Dr. Mohit Kumar Arora

It affects nearly 10 percent of children with Arthritis. Systematic Arthritis begins with repeated fever, which can go above 103 degrees Fahrenheit . Salmon-colored rashes often come and go in patients with systematic Arthritis.

Arthritis persists in children after fever and other symptoms disappear. Individuals with systematic Arthritis have skin rash or enlargement of lymph nodes.

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Juvenile Idiopathic Arthritis By Incidence Of Uveitis

The incidence of Uveitis in Juvenile Idiopathic Arthritis varies all across the globe, and not much research has been done on this topic.

In a study done by considering Juvenile idiopathic arthritis patients cases from nordic countries including Denmark, Finland, Norway, and Sweden between January 1997 to June 2000, the following were some findings:

  • Uveitis developed in 89 out of 435 children.7
  • No uveitis was found in systemic and polyarticular RF categories.7
  • The highest incidence of uveitis was seen in Juvenile Psoriatic Arthritis and enthesitis-related Arthritis.7
  • The incidence of uveitis was higher in Finland than in other geographical areas. Finland had a high proportion of younger children suffering from Juvenile idiopathic Arthritis.7

Myth : Joint Pain Is The Only Symptom Children With Juvenile Arthritis Deal With

JA can have many different symptoms, not just joint pain. Children with arthritis may have physical limitations due to joint stiffness and swelling. Other symptoms vary depending on type of arthritis but may include fever, rash, fatigue, and swollen lymph nodes, to name a few.

In addition to dealing with the physical symptoms of JA, children can feel sad and anxious about their condition. Theres a lot of uncertainty around it, as a flare-up can get in the way of their daily activities and future plans. They may miss social activities, sports, or have trouble focusing in school.

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Myth : Juvenile Arthritis Doesnt Cause Serious Health Problems

Juvenile arthritis can sometimes go unnoticed, but that doesn’t mean it’s not a big deal. Kids with arthritis often look fine, but they may experience a tremendous amount of pain. Further, it can turn your childs life upside down.

Sometimes medications can make your child feel sick, causing headaches, nausea and fatigue. Theres also the potential for serious complications from the condition, such as inflammation of the eye, or uveitis, which can cause blindness.

What Should I Look Out For

Types of Juvenile Arthritis and Best Course of Treatment

If you have any of these symptoms for more than a couple of weeks, you should see a doctor:

  • painful, swollen or stiff joint
  • joint that are warm to touch
  • increased tiredness
  • a fever that keeps returning
  • a limp but no injury.

If you think that you or someone you know may have JIA, book a GP appointment as soon as possible. Tell them your symptoms and concerns. They’ll consider referring you to a paediatric rheumatology consultant.

For more information on JIA please see our Young people section.

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How Is Juvenile Idiopathic Arthritis Diagnosed

Diagnosing JIA may be difficult. There is no single test to confirm the disease. Your childs healthcare provider will take your childs health history and do a physical exam. Your child’s provider will ask about your child’s symptoms, and any recent illness. JIA is based on symptoms of inflammation that have occurred for 6 weeks or more.

Tests may also be done. These include blood tests such as:

Your child may also have imaging tests. These can show how much damage the bones have. The tests may include:

  • X-rays. This test uses a small amount of radiation to make images of organs, bones, and other tissues.
  • CT scan. This uses a series of X-rays and a computer to make detailed images of bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays.
  • MRI. This test uses large magnets and a computer to make detailed pictures of organs and structures in the body.
  • Bone scan. This uses a small amount of radiation to highlight the bones in a scanner.

Other tests may include:

  • Urine tests. These look for blood or protein in the urine. This can mean the kidneys are not working normally.
  • Joint aspiration . A small sample of the synovial fluid is taken from a joint. It’s tested to see if crystals, bacteria, or viruses are present.
  • Full eye exam done by an ophthalmologist

Sexual Differences In Frequency

Girls with an oligoarticular onset outnumber boys by a ratio of 3:1. In children with uveitis, the ratio of girls to boys is 5-6.6:1, and in children with polyarticular onset, girls outnumber boys by 2.8:1. In striking contrast, systemic-onset occurs with equal frequency in boys and girls. Boys outnumber girls with enthesitis-related arthritis.

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Can A Person Have Both Ra And As

Its pretty rare for people to have both RA and AS at the same time. This is because these conditions have different mechanisms of development.

Still, its not impossible. A 2021 Chinese study observed 22 people with both RA and AS in a span of 6 years.

Heres a quick summary of the key similarities and differences between RA and AS.

Rheumatoid arthritis

What Is Juvenile Rheumatoid Arthritis

Juvenile Arthritis – Boys Town National Research Hospital

Juvenile rheumatoid arthritis , often referred to by doctors today as juvenile idiopathic arthritis , is a type of arthritis that causes joint inflammation and stiffness for more than six weeks in a child aged 16 or younger. It affects approximately 50,000 children in the United States. Inflammation causes redness, swelling, warmth, and soreness in the joints, although many children with JRA do not complain of joint pain. Any joint can be affected, and inflammation may limit the mobility of affected joints.

JRA is an autoimmune disorder, which means that the body mistakenly identifies some of its own cells and tissues as foreign. The immune system, which normally helps to fight off harmful, foreign substances such as bacteria or viruses, begins to attack healthy cells and tissues. The result is inflammation — marked by redness, heat, pain, and swelling.

Researchers still don’t know exactly why the immune system goes awry in children who develop JRA, although they suspect that it’s a two-step process. First, something in a child’s genetic makeup gives them a tendency to develop JRA. Then an environmental factor, such as a virus, triggers the development of JRA.

Doctors classify three kinds of JRA, based on the number of joints involved, the symptoms, and the presence of certain antibodies in the blood. These classifications help describe how the disease will progress.

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How Is Jia Treated

When JIA is diagnosed early and treated appropriately, it can usually be managed effectively. There’s no cure, but there’s a lot doctors can do to ease the symptoms of JIA and prevent or limit damage to joints.

For some people, taking medications like ibuprofen or naproxen can help reduce inflammation. Some patients need to take a weekly medication called methotrexate. Newer medications such as etanercept, adalimumab, abatacept, and tocilizumab can keep the immune system in check and control the disease far better than was possible a few years ago. For arthritis flare-ups, doctors may also use medicines called corticosteroids , but they try to limit these to avoid side effects.

Physical therapy exercises that improve flexibility and the use of heat can help people with JIA control symptoms. It’s rare that joints get damaged in a person’s teens, but surgery can repair damaged joints if needed.

Juvenile Idiopathic Arthritis By Mortality

A study done by the British Society For Paediatric And Adolescent Rheumatology stated an increase in mortality rates in children compared to the general population. They surveyed 693 patients with Juvenile idiopathic Arthritis, where 99 children out of 693 patients had a systematic disease subtype. All the patients were 11 years old and had juvenile Arthritis for almost four years:

  • The standardized mortality ratio in Juvenile arthritis patients was 7.3. The SMR for severe systematic Juvenile arthritis patients was 21.7, while for nonsystematic juvenile arthritis patients was just 3.9.4
  • The mortality rate for females was higher than for males.4

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What Are The Types Of Juvenile Arthritis

Juvenile idiopathic arthritis is the umbrella term for several subtypes of arthritis seen in children and adolescents under the age of 16. JIA is arthritis with no known cause , to distinguish it from infectious forms of childhood arthritis. There are six main subtypes of JIA:

  • Oligoarticular JIA: arthritis that involves four joints or fewer
  • Polyarticular JIA: arthritis that involves five or more joints
  • Systemic arthritis: begins with fevers, rashes, and inflammation in other parts of the body as well as the joints
  • Psoriatic Arthritis: inflammation of the joints that occurs in some children with psoriasis
  • Enthesitis-Related Arthritis: arthritis associated with enthesitis, which is inflammation of the entheses, the places where tendons and ligaments attach to bones
  • Undifferentiated JIA: a type that doesnt fit into any one of the categories above

Other types of juvenile arthritis include:

  • : arthritis caused by an infection of the joint
  • lupus: a chronic autoimmune condition that can have arthritis as a feature
  • juvenile dermatomyositis: a chronic autoimmune condition that can occasionally have arthritis as a feature
  • enteropathic arthritis: a type of arthritis that can occur with inflammatory bowel disease

Myth: My Child Is Too Young To Be On Jia Medications

Juvenile Arthritis

Fact: Children are not too young for JIA medications, says Kimura. If they are not treated soon and properly, they can face a lifetime of health problems, which are a terrible reality. She adds that medications to treat JIA depend on the type of JIA, which is why proper diagnosis is so important.

The doctor will discuss which treatment is best for your childs particular diagnosis, and common medications include methotrexate and newer biologic medications such as several TNF inhibitors, abatacept , tocilizumab , and JAK inhibitors such as tofacitinib , says Kimura. Other newer medications to treat specific types of JIA include secukinumab and ustekinumab . Systemic JIA can be treated with IL-1 inhibitors such as anakinra and canakinumab as well as tocilizumab and other IL-6 inhibitors.

These newer medications have worked wonders to rapidly improve pain and other symptoms in JIA and have drastically improved outcomes in JIA in the past 10 to 20 years, says Kimura.

The side effects of these medications can vary and should be discussed with the treating rheumatologist, says Kimura.

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Swollen Lymph Nodes And Internal Organs

Systemic JIA can cause lymph nodes, which are small glands that act as your bodys filters, to swell up and become inflamed. Lymph nodes are found all over the body, including the corners of the jaw, in the armpits, and inside the thighs.

Sometimes swelling can spread to the internal organs, affecting the heart, liver, spleen, and the tissue that surrounds the organs . In rare cases, the lungs can become inflamed. A rare, but serious, complication called macrophage activation syndrome can occur when the immune system goes into extreme overdrive.

If juvenile idiopathic arthritis is left unchecked and untreated, it can cause severe symptoms, including:

  • difficulty chewing or brushing teeth
  • digestive issues

Joint Pain And Loss Of Mobility

The most common symptom of JIA is joint pain. Joints may swell and grow tender. They can turn red and feel warm to the touch or become stiff and lose their mobility. This can result in a loss of dexterity, especially in the hands.

If JIA is left untreated, children may find themselves becoming less physically active due to pain and loss of mobility. If JIA continues for a long time without treatment, joints may become permanently damaged.

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