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How To Diagnose Juvenile Arthritis

Cause Of Juvenile Idiopathic Arthritis

Juvenile Idiopathic Arthritis (JIA): Diagnosis & Management â Pediatrics | Lecturio

In JIA, the bodys immune systemwhich normally helps to fight off infections and heal cuts and woundsmistakenly attacks some of its own healthy cells and tissues. The result is inflammation, marked by pain, swelling, warmth, and stiffness. Inflammation from JIA can damage the joints, eyes, or other affected organs.

Scientists do not know why the immune system attacks healthy tissues in children with JIA, but they believe that a complex mix of genes and environmental factors are involved.

While the origin of the immune systems overreaction in JIA is unknown, scientists have identified some of the molecules that contribute to inflammation in some forms of the disease. We now know that three moleculesTNF-alpha, IL-6, and IL-1are involved in creating inflammation in the joints of many children with JIA. This has led to new therapies that specifically target these molecules.

How Will Jia Affect Me

Many children who have JIA won’t have any symptoms when they’re adults, but its not possible to accurately predict this. In most cases, childhood arthritis has a good outcome. You should look forward to a future thats no different from those of your friends and classmates.

In at least 30% of cases, however, arthritis can remain active into adult life. Some young adults with JIA have joint damage that limits their daily activities to some extent and a few may need joint replacements. Other problems can sometimes occur. Some people are physically smaller than average or have osteoporosis as a result of their arthritis and/or treatment with steroids.

A successful outcome in JIA requires many things, including:

  • a positive approach
  • an experienced team working alongside your GP
  • a caring, helpful environment with support from family, friends and teachers.

You also need to know how to get help that you can understand, know who to approach and be confident enough to ask for support and advice.

You can read more about JIA and how it will affect you in our Young people section of the website.

Points To Remember About Juvenile Idiopathic Arthritis

  • JIA is a type of arthritis that affects children. It causes joint pain, swelling, warmth, stiffness, and loss of motion.
  • JIA begins when the immune system, which normally helps to fight off infections and heal cuts and wounds, becomes overactive and creates inflammation.
  • Treatment depends on the type of JIA and how bad the symptoms are, but usually includes a mix of medications, physical therapy, and regular doctor visits. Treatments can help children with the disease participate in activities.
  • There are many things you can do at home to help your child live with JIA, such as taking care of painful joints, balancing rest and exercise, working with their school, and coping with stress.

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Living With Juvenile Arthritis

There are many treatment options for juvenile arthritis. The primary goal of all treatment options is to bring about remission of the arthritis. Remission means the child should not have any swelling or inflammation detected by exam or imaging.

Treatment also focuses on preserving children’s quality of life by making it possible for them to participate in play, sports, school, and social activities.

In addition to treatment options, school administrators, social workers, and teachers can be important resources. They may be able to develop helpful lesson plans that teach classmates about juvenile arthritis.

With treatment, children should be expected to be able to attend school and have exellent long-term outcomes. Although pain sometimes limits sports and physical activity, children with juvenile arthritis can often fully participate when symptoms are under control.

What Are The Types Of Juvenile Arthritis

Juvenile Rheumatoid Arthritis Nursing Care Planning and Management

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

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Are There Support Groups For Individuals With Jia

The Arthritis Foundation is a leading non-profit organization that is dedicated to addressing the needs of adults and children living with arthritis in the United States. There are more than one hundred local offices throughout the U.S. Many local and national events are organized to educate and connect patients and families. To learn more visit

Some information specific to children can be found at

Last reviewed by a Cleveland Clinic medical professional on 02/01/2019.


Who Treats Juvenile Idiopathic Arthritis

Treating juvenile idiopathic arthritis typically requires a team approach that involves several different health care providers.

JIA is primarily treated by:

  • Pediatric rheumatologists, who specialize in treating arthritis and other diseases in children that involve the joints, bones, muscles, and immune system.

Other members of your childs health care team may include:

  • Mental health professionals, who can help children cope with difficulties in the home and at school that may result from their medical condition.
  • Occupational therapists, who teach ways to protect joints, minimize pain, perform activities of daily living, and conserve energy.
  • Ophthalmologists, who diagnose and treat diseases of the eyes.
  • Orthopaedists, who specialize in the treatment of and surgery for bone and joint diseases or injuries.
  • Pediatricians, who provide routine medical care for children.
  • Physical therapists, who help to improve joint function.
  • Rheumatology nurses, who may serve as the main point of contact with your doctors office about appointments, tests, medications, and instructions.
  • Social workers, who can help your child and your family deal with lifestyle changes caused by arthritis. A social worker can help you find resources and can serve as a liaison with your childs school, working with school-based staff to address any issues.

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Help Yourself To Help Your Child

Living with JIA often means making lifestyle changes and adjustments. This can be frustrating and demanding for you, your child, and your family. Here are a few steps to help yourself:

  • Learn about the disease. Knowing more about it will help you and your child have less fear, make better decisions, and have better results.
  • Work as a team with your child’s doctors and other health professionals. The outlook is better when you and your child actively manage your child’s health.
  • Take good physical care of yourself so that you can help your child through the more difficult periods of illness. Consider becoming involved with a support group of families who live with JIA. Your local chapter of the Arthritis Society can provide classes and support-group information.
  • Remember that many children with JIA don’t have long-term disease and disability. They go on to lead healthy adult lives.

Medicines To Treat Jia

Juvenile Rheumatoid Arthritis for USMLE
  • Sulfasalazine.
  • Biologics such as adalimumab, etanercept, or tocilizumab.
  • Non-steroidal anti-inflammatory drugs . NSAIDs reduce inflammation and pain, especially before DMARDs can take effect. Naproxen is the most often used NSAID treatment for JIA because of its low incidence of side effects compared to its effectiveness. Ibuprofen may be used instead. But in general, less than one-third of children will have significant relief from NSAIDs.footnote 2 If you see no improvement after 6 weeks, your doctor may try a different NSAID.
  • Corticosteroids. Injections can be used for children who have just a few joints affected or who have enthesitis. Steroid medicines by mouth or through an IV are often used for widespread joint pain or systemic problems such as fever or pericarditis. Steroid medicines work faster than some other drugs, so they may also be used until other medicines start working.
  • Antimalarials, such as hydroxychloroquine.
  • Other therapies, such as cytotoxic drugs and intravenous human immunoglobulin.
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    What Is The Prognosis For Children Who Have Juvenile Idiopathic Arthritis

    JIA affects each child differently. For some, only one or two joints are affected and the disease is easy to control. For others, JIA may involve many joints and the symptoms may be more severe and may last longer.

    With early detection and treatment, including physical and occupational therapy, it is possible to achieve good control of the arthritis, prevent joint damage, and allow normal or near-normal function for most children who have JIA.

    Medical History And Physical Exam

    During the examination, the doctor usually:

    • Asks about your childs symptoms and when they began. They may also want to know about your childs family medical history because autoimmune diseases like JIA can run in families.
    • Checks your childs joints and skin.
    • Watches your childs movements for signs of trouble walking, climbing onto the examination table, moving the neck, or raising or closing the hands.
    • Shines a small light into your childs eyes to look for eye problems that stem from uveitis , such as glaucoma or cataracts.
    • Checks the lymph nodes and abdomen for signs of swelling or sensitivity.

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    Routine Monitoring And Ongoing Care

    Regular medical care is important because your doctor can:

    • Monitor how well treatment is working.
    • Adjust the treatment as needed. If a medication is not working well or if there are side effects, the doctor may try a different dosage, a different medicine, or a combination of medicines. If the treatment is working very well and the disease is well controlled, the doctor may discuss options for tapering or stopping medicines.

    What Happens When Someone Has Jia

    Juvenile Arthritis

    People with JIA may have pain and stiffness that can change from day to day or from morning to afternoon. These symptoms can come and go. When the condition becomes more active and the symptoms worsen, it’s known as a “flare” or a “flare-up.”

    JIA often causes only minor problems, but in some cases it can cause serious joint damage or limit growth. Although JIA mostly affects the joints and surrounding tissues, it can also affect other organs, like the eyes, liver, heart, and lungs.

    JIA is a condition, meaning it can last for months and years. Sometimes the symptoms just go away with treatment, which is known as remission. Remission may last for months, years, or a person’s lifetime. In fact, many teens with JIA eventually enter full remission with little or no permanent joint damage.

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    What Are The Symptoms Of Juvenile Arthritis

    The signs and symptoms can vary, depending on what type of juvenile arthritis your child has.

    Some of the most common symptoms of juvenile arthritis include swelling of a joint, along with stiffness and pain. Symptoms can involve the hands, feet, and knees, but any joint can be involved. Joint stiffness occurs primarily in the morning or after long periods of inactivity . Other signs include:

    • limping, especially in the morning
    • clumsiness

    What Are Some Tips For Children Living With Jia

    Children with JIA should live life as normal as possible. Attending school, playing sports, participating in extracurricular and family activities regularly is encouraged. Exercise does not make symptoms of arthritis worse. In fact, exercise can help prevent deconditioning, increase muscle strength and muscle endurance to support the joints.

    There is no evidence that shows special diets are effective for arthritis, so children can eat a standard, well-balanced diet.

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    Helping Your Child Live With Juvenile Idiopathic Arthritis

    Help your child manage his or her symptoms by sticking to the treatment plan. This includes getting enough sleep. Encourage exercise and physical therapy and find ways to make it fun. Work with your child’s school to make sure your child has help as needed. Work with other caregivers to help your child take part as much possible in school, social, and physical activities. Your child may also qualify for special help under Section 504 of the Rehabilitation Act of 1973. You can also help your child find a support group to be around with other children with JIA.

    Living With Juvenile Idiopathic Arthritis

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

    JIA affects the entire family all family members must cope with the special challenges of the disease. Having JIA can strain your childs participation in social and after-school activities and make schoolwork more difficult. Nevertheless, it is important to treat your child as normally as possible.

    Certain activities can help improve childrens ability to function on their own and maintain a positive outlook. These include:

    Talk to your childs health care provider before beginning an exercise program.

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    How Is It Treated

    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 may be used to prevent the arthritis from injuring bones and joints.
    • Non-steroidal anti-inflammatory drugs 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.
    • Surgery to correct joint problems is only done in rare cases.

    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.

    Comprehensive Juvenile Arthritis Care

    Early diagnosis of juvenile arthritis can preserve joint function — and possibly put the disease into remission. The first step is to identify the type of arthritis your child has. Juvenile idiopathic arthritis , previously called juvenile rheumatoid arthritis, includes six types of arthritis. Each subtype affects the body differently, causing varying symptoms and complications.

    Oligoarticular Juvenile ArthritisThe most common type of juvenile arthritis. It causes inflammation in four or fewer joints, usually affecting the knees, ankles, or elbows. Children with this subtype have the highest risk of developing a serious, chronic inflammatory eye condition called pediatric uveitis.

    Polyarticular Juvenile ArthritisAffects five or more joints. It is more likely to cause inflammation in smaller joints, including the hands, feet, or jaw, but it can also strike weight-bearing joints such as the knees, ankles, and hips.

    Systemic Juvenile ArthritisAffects far fewer children but can be much more serious. Along with joint swelling and inflammation, it can also cause inflammation of the heart, lungs, and other organs. Early symptoms may include an ongoing fever and skin rash.

    Juvenile Psoriatic Arthritis

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    What Do Doctors Do

    It’s not always easy for doctors to diagnose JIA right away. JIA itself can have lots of different symptoms, and some infections, like Lyme disease, have similar symptoms to JIA. So doctors will want to rule out any other possibilities before deciding something is JIA.

    If a doctor suspects a patient has JIA, he or she will ask about the person’s symptoms, find out if others in the family have had arthritis, and do a complete physical examination to look for joint swelling, eye problems, and rashes. A doctor may do blood tests and X-rays. In some cases, doctors may use a needle to take a sample of synovial fluid from a person’s joint.

    Sometimes, a doctor might need to see a patient for several months to determine the particular type of JIA the person has.

    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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    If Your Child Is On Aspirin Therapy

    Yearly influenza shots are recommended for children who are on long-term aspirin therapy. Children on long-term aspirin therapy who get chickenpox or the flu are at risk for getting Reye syndrome. Although there is a risk, Reye syndrome is very rare. Very few cases have been reported in children with chronic arthritis who were being treated with aspirin. If your child has been exposed to chickenpox or the flu, talk to the doctor about giving your child acetaminophen to control pain and relieve fever until the incubation period, or the illness itself, has passed.

    Common Signs Of Juvenile Arthritis

    The most common type of juvenile arthritis is juvenile idiopathic arthritis, formerly known as juvenile rheumatoid arthritis. Children as young as two may be affected. Other rheumatic diseases affecting children include juvenile dermatomyositis, juvenile psoriatic arthritis, systemic lupus erythematosus and systemic arthritis, or Stills disease. In these diseases, a childs immune system malfunctions for some reason, attacking her body instead, especially her joints. Here are the common symptoms of juvenile arthritis, and why they are different from symptoms caused by other illnesses or injury.

    Juvenile arthritis includes many different diseases, but one common thread between them is that they can have serious, even life-threatening impacts on a young child. Diagnosis by a physician can determine the cause of the symptoms, rule out injuries or other diseases, and suggest treatments that will ease symptoms and allow your child to return to school and resume playing with friends and enjoying childhood.

    Originally published by the Arthritis Foundation reprinted with permission. | Image credit: UCLA

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