11 Ways JIA Affects the Whole Body
You may think of the stiff and swollen joints that come with arthritis as an older person's condition. But juvenile idiopathic arthritis (JIA) is an inflammatory autoimmune disorder that strikes kids before the age of 16. What’s more, JIA isn't simply a disease that affects the bones and cartilage: It's a condition that has a systemic impact. Here, experts breakdown all the ways JIA can affect the body.
JIA Starts With Your Immune System
“JIA is not the typical arthritis you think of,” says Beth Oller, M.D., a family physician in Stockton, KS, who works with a large pediatric population. “Most of us think of arthritis as osteoarthritis, the kind that happens from chronic overuse as we get older, with the bigger joints hurting as a result of that.” Since JIA is an autoimmune disorder, it isn’t something that happens from wear and tear. “The immune system that's supposed to be ready to hit and fight outside invaders gets confused and attacks your own body and tissue,” says Dr. Oller.
The Joints Are the Primary JIA Target (But Not the Only One)
JIA kicks off a faulty immune response that causes the release of inflammatory chemicals that attack the synovia, which is the tissue that lines the joints and produces lubricating fluid, says. Dr. Oller. “(This fluid) is the equivalent to grease or WD-40 that you put on hinges to make sure everything is moving smoothly and effectively.” But with JIA, the inflamed synovia can cause joints to painfully swell and become stiff.
Sometimes a Fever Is the Main JIA Symptom
Here’s where it gets murky with JIA: There are seven subtypes of the disease, and each comes with its own symptoms, says Philip J. Kahn, M.D., a pediatric rheumatologist at Hassenfeld Children’s Hospital in New York City. Many of these pertain to how many joints are affected during the first six months of diagnosis, but systemic-onset JIA comes with more vague side effects than the others. “With systemic-onset JIA, the child almost always presents with a prolonged fever,” says Dr. Kahn. “They may not have swollen joints to start, but a fever that isn’t infectious is the most florid symptom.”
JIA can abnormally increase white blood cell activity
Clinically, this is referred to as macrophage activation syndrome (MAS), and it’s a major inflammatory response that essentially takes over the entire body. According to the Arthritis Foundation, about 10% of children with systemic-onset JIA develop MAS, but some can have it more than once throughout the course of their disease. Symptoms of MAS range from fatigue, headaches, a transient rash that comes and goes with fever, along with more severe side effects like an enlarged liver and spleen, changes in blood pressure, and multi-organ dysfunction. Severity can vary hugely for some patients, it's some abnormal labs with or without fever. For others they need to be hospitalized and get a lot of immune-suppressing medications.
The Lungs and Heart May Be Affected
Research published in Rheumatology International has found that JIA can interfere with how well the heart pumps blood, particularly through the left ventricle. This can lead to high blood pressure and breathing problems. “Along with inflammation of the pericardium [the lining of the heart] patients may also have long-term changes of inflammation and irritation in the lungs and pleura [the lining of the lungs],” says Dr. Oller. “This over time can lead to lung disease.”
JIA Can Impact Liver Function
Patients who develop MAS are also more likely to experience severe liver inflammation, Dr. Kahn says. “This can make a patient extraordinarily ill thanks to a rare cytokine storm happening in the body,” he says. Cytokines are immune cells, but when too many are released too quickly the response can seriously harm healthy tissue. Research published in Annals of the Rheumatic Diseases found that early diagnosis of JIA may help halt autoimmune hepatitis as well as liver failure in these patients over time.
JIA Can Contribute to Anemia
“This is a good example of the ‘A’ not being initially present in a JIA case,” says Dr. Kahn. “A patient may be in the ICU for severe anemia, which is actually JIA.” Those who have anemia don’t have enough healthy red blood cells to carry oxygen around to different tissues. Not only can this cause fatigue but it can lead to iron deficiency and chronic inflammation throughout the body. On the opposite end of the spectrum, Dr. Oller adds that some JIA patients may store too much iron, which can lead to toxicity (stomach pain, nausea, and vomiting).
Growth Delays May Occur
Early diagnosis and treatment of JIA is important for many aspects, but because patients are children, detection is especially important when it comes to growth. “The longer [a child’s] body is dealing with an aberrant immune system the longer the period of having active inflammation in the joints will be, which may affect the growth of the child,” says Dr. Kahn. Past research from the Archives of Medical Science found that while those with JIA dealing with growth issues ranges from 10% to 40%, it’s more significant in those with systemic-onset JIA.
Puberty Can Also Be Delayed
Similar to height delays, puberty can also occur later depending on how severe the disease is. Females with JIA have been found to get their period approximately two years later than those without the disease, while male JIA patients may go through puberty later as a result of lower testosterone production. Additional research published in the Journal of Rheumatology found that additional reproductive issues for females may be caused later in life, too, such as ovarian cysts, gynecological disorders, and possibility of miscarriage.
Chewing May Be Difficult From Mouth Pain
Some patients with JIA may also have temporomandibular joint arthritis (TMJ) complications that comes with it if inflammation creeps up into the mouth and jaw. In addition to pain when trying to chew or eat (which can lead to weight loss or malnutrition over time if severe enough) those with JIA may experience facial asymmetry if only one area or side of the jaw is affected. In more mild cases, there may be issues with an over bite, teeth deformities, as well as other muscular imbalances and orofacial pain or structural issues over time.