Juvenile Idiopathic Arthritis (JIA) is the most common type of arthritis found in teens and children typically causing pain in hands, knees, ankles, elbow and wrist. Previously called juvenile rheumatoid arthritis (JRA), the name changed as it is not a childhood version of the adult rheumatoid arthritis, and it can affect children from 6 months to 16 years old. This disease is where the child’s immune system mistakes the normal joints as foreign and thus attacks the area causing inflammation. There are several forms of JIA and the causes vary from idiopathic/unknown, to autoimmune and family history.
JIA is an autoimmune or autoinflammatory diseases. That means the immune system, which is supposed to fight invaders like germs and viruses, gets confused and attacks the body’s cells and tissues . This causes the body to release inflammatory chemicals that attack the synovium (tissue lining around a joint). The synovium produces fluid that cushions joints and helps them move smoothly. An inflamed synovium may make a joint feel painful or tender, look red or swollen or difficult to move.
The word “idiopathic” means unknown, and researchers aren’t sure why kids develop JIA. They believe kids with JIA have certain genes that are activated by a virus, bacteria or other external factors. But there is no evidence that foods, toxins, allergies or lack of vitamins cause the disease.
The most common symptoms of JIA include:
- Joint pain or stiffness; may be worse after waking or staying in one position too long.
- Red, swollen or warm joints.
- Feeling very tired or fatigued
- Blurry vision or dry, gritty eyes
- Appetite loss
- High fevers
There are six subtypes of JIA- oligoarthritic (affecting four or fewer joints), polyarthritis (affecting five or more joints), systemic (affecting the entire body and cause high fevers), psoriatic arthritis (joint symptoms and scaly rash’s), enthesis’s-related (also called spondyloarthritis affecting muscles, ligaments and tendons) and undifferentiated (where symptoms don’t match up with any of the subtypes however inflammation is present in a joint). Child may also find that symptoms come and go, and periods where there is worsened symptoms and inflammation are called flares which can last for days or months.
If JIA inflammation goes unchecked it can damage the cartilage around the bones, and the bones themselves resulting in may different health effect. In the lower limb it can result in foot pain and difficulty walking. It can also have debilitating symptoms such as pain and growth abnormalities, psychological and social impacts such as depression and anxiety, absences from school and difficulties participating in school such as sitting, writing, concentrating and participating in sport. It can also have challenging and complex treatment regimes with severe side effects and medical costs impacting financially.
A diagnosis of JIA is made in conjunction with your GP, pediatrician and rheumatologists through a thorough medical history, physical examination and laboratory blood tests and medical imaging.
Once diagnosis has been completed, whilst there is no cure for JIA, early treatment is key to getting the disease under control as quickly as possible with the following goals in mind:
- Slow down or stop inflammation
- Relieve symptoms, control pain and improve quality of life
- Prevent joint and organ damage
- Preserve joint function and mobility
- Reduce long-term negative health effects
- Achieve remission (little or no disease activity or symptoms)
Treatment for JIA varies depending on disease type and severity. A well-rounded plan includes medication, complementary therapies and healthy lifestyle habits. Good management of JIA includes a multidisciplinary team of:
- Orthopedic surgeons
- Pain management teams
- Occupational therapists
- And Orthotists
There are several medicines which can be used alone of in combination to assist with the symptoms of JIA including NSAIDS (non-steroidal anti-inflammatory), corticosteroids, DMARDS (Disease-modifying anti-rheumatic drugs) and short term analgesics. Commonly used DMARDSs are used to modify the abnormal immune response to slow or stop joint destruction.
Physical therapies from podiatrists, physios or OTs are used to control pain, prevent and correct joint contractors, preserve range of motion, maintain and improve strength. Podiatrists specifically also provide footwear advice and ortho-mechanical options to assist with mobility.
Children with JIA in general have lower activity levels so it is important to encourage participation in physical activities which are compatible with the child’s abilities and diseases restrictions.