Juvenile rheumatoid arthritis: Everything you need to know

Symptoms

The symptoms of JIA vary depending on its subtype.

However, the most common symptoms include:

• Pain in the joints: Arthritis pain may get worse following an injury or persist even after an injury has healed. Many children report that the pain is worse in the morning. It tends to get worse with time and typically affects joints on both sides of the body.
• Eye health problems: Although pinkeye and other eye infections are common in children, children with JIA are more vulnerable to chronic and severe eye problems. They may develop pain or inflammation in their eyes that does not go away.
• Unexplained fatigue: Children with JIA may seem chronically exhausted or have little energy, even when they get enough sleep.
• Poor appetite: Some children with JIA eat very little or stop eating foods that they once enjoyed, which can result in weight loss.
• Fever or rash: Some children with JIA have an unexplained fever or rash. The fever may come and go, or it might persist even when a child does not seem sick.
• Stiff joints: The joints and lower back may feel less limber than normal, and some movements may hurt or be impossible. The stiffness is usually worse in the morning.
• Swelling or redness: Arthritis is inflammation in the joints, which can lead to swelling or redness around painful joints. Inflammation also occurs where tendons and ligaments insert into the bone (enthesitis).

Types

Doctors classify JIA into several subtypes depending on how many and which joints the disease affects, the severity of the symptoms, and which antibodies the immune system produces.

The types of JIA are:

• Oligoarticular JIA, which affects no more than four joints and usually involves larger joints, such as the ankles or knees. Children with this type of arthritis are more vulnerable to eye inflammation, especially if they test positive for the antinuclear antibody (ANA).
• Polyarticular JIA, which affects five or more joints. Symptoms often appear in the hands and feet, and they typically affect both sides of the body. It is more prevalent in females than in males.
• Systemic JIA, also called Still’s disease, is the most serious and least common type. It affects at least one joint and causes inflammation in organs such as the spleen and kidneys.
• Juvenile psoriatic arthritis is arthritis that links to the autoimmune condition psoriasis, which causes a painful, scaly rash. Some children develop psoriasis several years before arthritis symptoms, which typically affect the fingers, toes, wrists, knees, and ankles.
• Enthesitis-related JIA, which causes pain where bones meet connective tissue, such as ligaments or tendons. It typically affects the knees, feet, and hips. It is sometimes called spondylarthritis and is more common in boys, typically developing between the ages of 8 and 15 years.
• Undifferentiated JIA does not fit into any of the above categories or causes symptoms consistent with two or more subtypes of JIA.

Causes

Most research suggests that JIA is an autoimmune condition. Autoimmune disorders occur when the immune system initiates an attack on healthy tissue as if it were an infection. In JIA, the immune system attacks the tissue of the joints.

A combination of genetics and environmental factors may determine who develops JIA. Children with JIA may carry genes that predispose them to the condition, then develop symptoms following a triggering event, such as a virus or injury.

A 2016 analysis found that children with allergies are more likely to develop JIA. Allergies might somehow trigger the activation of genes for arthritis, or the genes that predispose children to arthritis might be similar to those that cause allergies.

Some types of JIA are more likely to affect children at certain ages. The primary difference between juvenile and adult arthritis is that juvenile arthritis sometimes disappears on its own or gets better in adulthood.

Juvenile arthritis is neither contagious nor currently preventable.

Diagnosis

Doctors cannot use any single test to diagnose JIA. Instead, they use a combination of symptoms and tests to confirm a diagnosis.

To help them make an accurate diagnosis, a doctor may:

• Take a complete medical history to assess whether chronic joint pain and inflammation are present.
• Perform blood work to check for signs of ANA, rheumatoid factor, and inflammation markers, which can suggest an autoimmune disease. A doctor may also perform other blood work to test for infections and other potential causes of joint pain.
• Order imaging scans to look at the muscles and bones.
• Perform arthrocentesis, in which they remove a small quantity of joint fluid using a needle.

Treatment

Many treatment strategies can help reduce the symptoms of JIA. These include:

• Lifestyle changes: Getting plenty of exercise and maintaining a healthy weight may help reduce flares. Some children also find that adopting particular diets or avoiding certain foods offers some relief.
• Pain medication: Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) can help with joint pain and inflammation, but they should not be the only treatment method.
• Corticosteroids: These prescription drugs, which include triamcinolone hexacetonide (Aristospan), can reduce inflammation and help with pain. However, doctors may not recommend using these steroids due to their side effects, which can include growth suppression, weight gain, osteopenia, and cataracts.
• Biologic drugs: These special medications reduce the body’s inflammatory response, helping lessen pain and inflammation. Doctors now prescribe these earlier in the disease and often pair them with a disease modifying antirheumatic drug (DMARD).
• Physical or occupational therapy: These therapies can reduce chronic pain, help children learn to move in ways that do not injure the joints, and prevent further joint damage.

Some people also try using alternative or complementary remedies, such as acupuncture. To get the best results, use these alternative therapies only with the approval of a doctor and never as a replacement for medical treatment.

It is crucial to tell a doctor about any side effects of treatment. Some children have to try several combinations of treatments before something works.

Prognosis

Doctors do not know how to cure juvenile arthritis. However, many children with this disease go into remission, which means that they stop having symptoms. It is possible for symptoms to return even after remission.

Remission estimates vary. A 2014 study that followed children with JIA for 30 years found that 59% were in remission without medication at the 30 year mark. A total of 7% were in remission with medication, while 34% still had active JIA.

There is no way to predict who will and who will not get better. With comprehensive and sensitive medical care, however, most children can find treatments that manage their symptoms and allow them to lead a full and comfortable life. Many will find that arthritis does not affect them when they reach adulthood.