An Introduction to Juvenile Idiopathic Arthritis

Mark Borigini, M.D. Health Pro
  • Juvenile idiopathic arthritis (JIA), which used to be known as juvenile rheumatoid arthritis (JRA), recently underwent a name change to highlight the differences between childhood arthritis and adult rheumatoid arthritis.  But no matter what one might choose to call it, it is the most common type of arthritis in children under the age of 16 years, and can be very hard to live with, for the child and teen and their families.

    As with adult rheumatoid arthritis, the disease causes symptoms such as joint pain and swelling, accompanied by profound stiffness.  JIA can cause symptoms which only last a few months; however, in many cases it causes lifelong joint inflammation.  Under this umbrella of JIA, there lie several types of JIA, classified according to the following:

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       1. The type and number of joints involved.
       2. The signs and symptoms.
       3. The result of blood tests.

    In addition, certain types of JIA are more commonly associated with complications such as eye inflammation and difficulties with normal growth of the child.

    We tend to forget that children are not simply “little adults”, and many do not complain initially of what is often a subtle onset of pain:  In many cases, a parent or a babysitter may notice that a child is limping, especially after waking up in the morning, or a daytime nap.  It might also appear that a child affected with JIA is “clumsy”; whereas, the reality is that the joint stiffness makes it difficult to move as nimbly as a healthy child.

    There are three main types of JIA:

       1. Oligoarticulae JIA, where less than five joints during the first six months of the disease are affected.  Eye inflammation is more common in this type, and frequently associated with a positive ANA blood test.  Hip and knee joints are most commonly involved.
       2. Polyarticular JIA, where five or more joints are affected during the first six months of the disease.  This type is most similar to adult rheumatoid arthritis, as signs and symptoms are mostly limited to the joints; and the rheumatoid factor blood test is often positive.
       3. Systemic JIA, where evidence of disease is found in many places besides the joints.  Children so affected can experience swollen lymph nodes, rashes and fever, in addition to inflammation of the internal organs, particularly the liver.

    JIA is an autoimmune disorder, which means the body’s immune system attacks its own tissues.  It is a disease more common in girls, and more common in white children.  No one knows exactly what causes JIA, but theories include that it occurs more frequently in those who have had a viral infection beforehand, and who have deficiencies of certain protective antibodies.  However, no theory has been definitively proven.

    Treatment for JIA focuses on maintaining as much as possible the normal activity of childhood; to this end, a combination of pain relief, anti-inflammatories, physical therapy, and compassion must be used.  Medications used include ibuprofen and naproxen, methotrexate and sulfasalazine, Enbrel and Remicade, and corticosteroids such as prednisone.  Regular exercise is important in order to maintain muscle strength and joint flexibility - swimming is a good choice, as it places minimal stress on the joints.  Hot baths can help greatly with the stiffness of JIA.  A diet rich in calcium is important - chronic arthritis, medication used to treat the disease (for example, prednisone) and the decreased physical activity due to the debilitating nature of the disease.may all predispose to osteoporosis.


  • Family members are so important in assisting a child with JIA cope with all the ramifications of that illness, whether they be physical, psychological, or social.  It is imperative a child with JIA be treated, to the extent possible, the same as any other child; by e.g., encouraging them to participate in life to the fullest extent possible.  Parents should work with teachers to allow, for example, more time for the child with JIA to walk from classroom to classroom; an extra set of textbooks might be provided so the child does not have to carry a heavy load home every day.*

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    Treatment with the correct medications, coupled with a loving and supportive network of family and friends, can make it possible to live well with JIA.

    * Several laws protect children from discrimination in education and may support adaptations and accommodation ranging from physical access to longer time for tests (for more, see the Americans with Disabilities Act, section 504 of the Rehabilitation Act and the Individuals with Disabilities Education Act.

     

     

Published On: April 27, 2010