What is Juvenile Idiopathic Arthritis (JIA)?

It is the most common type of arthritis affecting children. JIA is an autoimmune disease that lasts for more than six weeks and may cause any part of the body's joints to be affected.

It is an autoimmune disease in which the body's immune system damages itself by incorrectly targeting the synovium, the tissue inside the joint, and the synovial fluid within the joint, causing swelling, pain, and stiffness.

This can advance and destroy cartilage and bone in the adjacent tissues. The inflammation can also affect other parts of the body, particularly the eyes. If left untreated, JIA can hamper a child's normal growth and development.

What are the types of juvenile idiopathic arthritis?

Depending on the number of joints affected and the symptoms, there are many forms of JIA:

Oligoarthritis: This type of JIA involves fewer than five joints, commonly in the knee, ankle, or elbow. It can also lead to uveitis: an inflammation of the middle layer of the eye-the uvea. It cannot be observed in the eye without a particular exam. Of all the children in the United States diagnosed with JIA, around half are diagnosed as having oligoarthritis; it is more frequent in girls than boys. Most children will outgrow oligoarthritis, in that the oligoarthritis resolves by adulthood. In a small number of children, oligoarthritis will progress to involve more joints.
Polyarthritis: In this category of JIA, five or more joints are involved, although most commonly the same joints on both sides. Polyartritis can also affect the neck and jaw joints and smaller joints, including those in the hands and feet. It is more common among girls than boys, and accounts for 20 percent of the victims of JIA.
Psoriatic and psoriatic arthritis: This is a type of arthritis in children who have arthritis with the additional symptom of psoriasis, a rash which creates raised red patches or skin lesions covered by a silvery white buildup of dead skin cells. Other manifestations of psoriatic arthritis include nail changes that seem like pitting or dimpling.
Enthesitis-related arthritis: Also called spondyloarthropathy. Often the spine, hips, and entheses (where tendons and ligaments attach to a bone) are inflamed in this kind of arthritis, often in boys who are over seven years of age. This variety of arthritis involves your eyes frequently and may make them achy or red.
Systemic arthritis: Also called Still's disease, this variety occurs in about 10-20% of children who have JIA. A systemic illness is one which may affect the entire body or various body systems. Apart from arthritis, systemic JIA frequently causes persistent high fever and rash that most often manifest on the trunk, arms and legs at peak fever. Internal organs, the heart, liver, spleen, and the lymph nodes may be affected as well. Both boys and girls have this type of JIA wherein eyes are rarely involved.

What leads to juvenile idiopathic arthritis?

No cause of JIA has ever been established. Risk factors are present singly or in combination and include genetics (the disease can run in families) and infectious and other environmental factors that affect the immune system.

What are the symptoms of Juvenile Idiopathic Arthritis?

The symptoms of JIA depend on the particular type of JIA and may include:

Pain or tenderness in or around the affected joint. The joints also can be warm.
Morning stiffness in the joints.
Limpy gait (young children cannot perform motor tasks they have just learned)
Fever
Rash
Weight loss
Swollen lymph nodes on one or both sides of the neck
Feeling tired or cranky
Redness or pain in the eyes, blurring of vision

How is juvenile idiopathic arthritis diagnosed?

Since there is no test for JIA, the doctor will try to rule out other causes of arthritis and other diseases as a cause of the symptoms.

A doctor will take a total medical history that will include a description of the presenting symptoms and will perform a physical examination to make a diagnosis of JIA. In addition, the doctor will look for signs of arthritis in the joints.

The following are the tests the doctor may order:

Imaging by X-rays or MRI to present the condition of the joint;
Laboratory tests in blood, urine, and/or joint fluid can help identify what kind of arthritis is suspected. These include measuring the level of inflammation and checking for the existence of several substances, antinuclear antibodies, and rheumatoid factors. Furthermore, these tests can rule out other illnesses—such as an infection, bone disorder, or cancer—or injury as a cause of the symptoms.

How do physicians manage juvenile idiopathic arthritis?

The goals of therapy are to provide palliation from pain, reduce inflammation, improve range of motion, strengthen the joint, and limit joint damage and complications. The two pillars of therapy are medications and physical treatments.

Medications used for JIA are:

NSAIDs: These drugs decrease inflammation and pain but do not change the character of the disease course or long-term prognosis of JIA. Some are available over the counter; others require prescriptions. Examples of NSAIDs are ibuprofen (such as Motrin and Advil) and naproxen (such as Aleve). Any time someone must take these drugs, they are prone to nausea and upset stomachs and should be taken with food.
Steroids (corticosteroids): Steroids are commonly given by injection (shot) into one affected joint. They can also be given orally, by pill, especially for patients with more widespread disease. Oral steroids carry the severe side effects of weakening bones, with this occurring more often if the steroids are used over a long time. For this reason, doctors commonly avoid using long-term steroids on children because steroids can disrupt average growth in a child.
Disease-modifying antirheumatic drugs (DMARDs): Such drugs modify the actual disease process in arthritis. DMARD therapy aims to prevent the destruction of bone and joints by suppressing an immune system attack on the joints. Methotrexate is the most widely used DMARD in the management of JIA. Other Drugs include sulfasalazine and leflunomide.
Biological modifying agents: Biological agents are drugs that act directly on the molecules or proteins of the immune system that mediate the inflammation. They are administered through the subcutaneous injection or intravenous route. Biological agents are used in children suffering from more severe arthritis that has not responded well to other drugs. Biological agents must be used cautiously as they suppress children's immunity and make them vulnerable to infections. These drugs are etanercept, infliximab, adalimumab, abatacept, anakinra, rilonacept, and tocilizumab.
Exercise, along with physical and occupational therapy, may help reduce the child's pain, maintain muscle tone, enhance mobility or ability to move, and prevent permanent handicaps. Occasionally, splints or braces may be used to protect the joints as the child grows. Some special accommodations with schools might need to be made to accommodate children with limitations from their arthritis.

What are some complications of juvenile idiopathic arthritis?

If not treated, JIA can lead to:

Permanent joint damage
Destruction of a child's bones and growth
Chronic arthritis and disability or loss of function
Vision problems, including potentially blindness in one eye from uveitis-inflammation inside the eye
Pericarditis (inflammation in the sac surrounding the heart) or pleuritis (inflammation in the sac surrounding the lungs)-in systemic JIA

Can juvenile idiopathic arthritis be prevented?

As of yet, there is no known cause of JIA, hence there is no way to stop it from happening.

What is the juvenile idiopathic arthritis prognosis (outlook) for children?

Every child suffering with JIA experiences the disease differently. Some are affected by just one or two joints, easily controlled, while others involve many joints and the symptoms are so severe and could be long-lasting.

Early detection and treatment, along with physical and occupational therapy, allow adequate control of the arthritis, prevent damage to joint structures, and permit normal or near-normal functioning in most children who have JIA.

Living With

What should I teach my child living with JIA?

Children with JIA should lead lives as close to normal as possible. School attendance, sports, and regular involvement in extracurricular and family activities are encouraged. Exercise does not make arthritis symptoms worse. In fact, exercise can prevent deconditioning and increase muscle strength and endurance, thus helping to support the joints.

No evidence suggests special diets benefit children with arthritis, so any well-balanced diet is acceptable.

Why Choose Tender Palm Super-Speciality Hospital for Juvenile Idiopathic Arthritis (JIA) / Childhood Arthritis Treatment in Lucknow, India?

Tender Palm Super-Speciality Hospital offers advanced Juvenile Idiopathic Arthritis (JIA) / Childhood Arthritis treatment in Lucknow, India, at an affordable cost. We have a team of experienced pediatric rheumatologists and child care specialists who provide accurate diagnosis with advanced imaging and laboratory testing, personalized medical care, and both non-surgical and surgical treatment options. Our Pediatric Rheumatology and Child Care team has decades of experience in successfully treating Childhood Arthritis in Lucknow, India.